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November 2018

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FEELING THE BURN?

Options for Acid Reflux

En español Send us your comments (link sends e-mail) (link sends email)


You’ve probably felt it. After a meal, a burning sensation rises through your
chest, or up to your throat. This feeling can come from reflux: when acid and
food rise up from the stomach into the esophagus, which is the tube that
connects your stomach to your throat.

Occasional reflux is normal. Most people may not even feel it. Sometimes it’s
mild, with occasional heartburn after large meals. Reflux can also cause
coughing, wheezing, or problems swallowing.

Anyone can experience reflux. But reflux two or more times a week for a few
weeks may be gastrointestinal reflux disease (GERD). GERD affects around 20% of
people in the U.S. at some point in their lives.

“Reflux becomes GERD when the symptoms start to negatively affect someone’s
daily quality of life,” says Dr. John Pandolfino, an expert on reflux at
Northwestern University.

GERD usually isn’t dangerous. But it can cause discomfort, pain, and fear of
eating, Pandolfino explains. Severe GERD can damage the lining of the esophagus,
which can raise the risk of esophageal cancer. Although that risk is low, people
should discuss reflux symptoms with their doctor.

Fortunately, there are many options for treating reflux and GERD. Some lifestyle
choices may simply prevent it. For example, certain foods can trigger reflux in
some people. See the Wise Choices box for tips to reduce reflux.

One of the most effective treatments for GERD is weight loss. In Pandolfino’s
clinic, people with GERD are automatically assigned a health coach who helps
them with diet and lifestyle changes.

“We help them lose about 10 to 15 pounds, and then see if we can get them off
their medication,” he says. “Our success rate has been very good. We can get
about a third of people off medication when they lose a little bit of weight.
And about 50% experience a dramatic improvement in their symptoms.”

But medications can still help many people with GERD. They work in different
ways, and you may need a combination to control your symptoms.

Doctors often first recommend antacids to relieve heartburn and other mild
symptoms. Drugs called H2 blockers may provide relief if an antacid alone isn’t
enough. These can stop your stomach from making acid in the short-term.

A type of drug called proton pump inhibitors (PPIs) may be recommended if other
drugs don’t help control your reflux. PPIs reduce the amount of acid the stomach
makes. They’re very effective. But people who take PPIs for a long time or in
high doses may be more likely to have side effects. Sometimes, the benefits of
these medications can outweigh the side effects. Talk with your doctor about the
long-term use of medications for GERD.

If GERD persists despite drugs and lifestyle changes, surgery to strengthen the
opening between the stomach and esophagus may be an option. This is especially
useful when reflux is caused by a physical problem, like a hernia. A hernia
happens when an organ squeezes through a weak muscle in your body.

Researchers are working on developing less-invasive procedures for people who
need surgery. Pandolfino and other researchers are also looking for better ways
to use existing tests to choose treatments.

“Reflux is such a mixed bag of symptoms and complications. We’d like to be able
to better tailor therapy based on these studies,” he says.


WISE CHOICES

WAYS TO REDUCE REFLUX

 * Maintain a healthy weight. Even a bit of weight loss can help reduce reflux.
 * Avoid your personal trigger foods. Some people have foods that make their
   reflux worse. These can include acidic foods, chocolate, or alcohol.
 * Don’t smoke. Smoking can cause more acid to enter the esophagus.
 * Manage stress. Stress and anxiety can make reflux feel worse.
 * Stay upright. Don’t lie down for 2 or 3 hours after a meal.
 * Raise the head of your bed. If you have reflux at night, raise the head of
   your bed by 6 to 8 inches.
 * Talk to your doctor, if you have reflux twice or more per week.


FIND MORE INFORMATION

 * Acid Reflux in Adults
 * Acid Reflux in Children & Teens
 * Acid Reflux in Infants
 * Digestive Diseases
 * Esophageal Cancer Screening


REFERENCES

The Reflux Improvement and Monitoring (TRIM) Program Is Associated With Symptom
Improvement and Weight Reduction for Patients With Obesity and Gastroesophageal
Reflux Disease. Yadlapati R, Pandolfino JE, Alexeeva O, Gregory DL, Craven MR,
Liebovitz D, Lichten A, Seger E, Workman M, St Peter N, Craft J, Doerfler B,
Keswani RN. Am J Gastroenterol. 2018 Jan;113(1):23-30. doi:
10.1038/ajg.2017.262. Epub 2017 Oct 10. PMID: 29016559.

Advances in the physiological assessment and diagnosis of GERD. Savarino E,
Bredenoord AJ, Fox M, Pandolfino JE, Roman S, Gyawali CP; International Working
Group for Disorders of Gastrointestinal Motility and Function. Nat Rev
Gastroenterol Hepatol. 2018 May;15(5):323. doi: 10.1038/nrgastro.2018.32. Epub
2018 Apr 6. PMID: 29622813.


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Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.
Illustrator: Alan Defibaugh

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