Acid reflux is a severe form of heartburn that causes chest pain, burning, and sometimes difficulty breathing.
More than 60 million American adults experience acid reflux a weekly basis. (Web MD, n.d.)
Most sufferers experience acid reflux at least once per month. Many sufferers experience worse symptoms at night, which disrupts their sleep patterns and leaves them feeling fatigued.
If you experience acid reflux regularly, you may have gastroesophageal reflux disease (GERD).
GERD is a chronic disorder caused when the esophageal sphincter – the valve that closes off the esophagus from the stomach — does not function correctly and allows partially digested food and stomach acid to reflux back into the esophagus.
It may also be caused when the esophagus does not contract rapidly or forcefully enough to force food into the stomach.
Symptoms of acid reflux include:
- A burning sensation in the throat
- Chest pain
- Stomach bloating
- Upper abdominal pain
Additional symptoms of GERD may include:
- Dry cough
- Sore throat
- Asthma symptoms
- Difficulty swallowing
Signs of Heartburn That Could Be Mistaken for a Heart Attack
- Pain that extends from the chest to the neck and arms. This does not happen often with heartburn but it can
- A sharp pain or burning sensation just below the breastbone.
- A cold sweat (this is rare)
If you think you are having a heart attack, you should seek medical help immediately.
- Eating spicy food
- Eating high-fat and rich foods including tomato-based sauces
- Citrus foods
- Foods with mint
- Fermentable carbohydrates (FODMAPs) - onions are a common trigger
- Eating a heavy meal before bed
- Sleeping on your back
- Smoking tobacco
- Caffeinated beverages
- Carbonated drinks
Around 50% of pregnant women experience acid reflux during pregnancy. It is thought to be caused by a change in hormones and an increase in pressure against the stomach from the growing fetus. It usually resolves after the baby is born. (American Pregnancy Asso., 2015)
Typically, people who have recurrent bouts of acid reflux, experience symptoms at nighttime.
Diagnosing Acid Reflux
One or more of the following procedures may be used to help your physician diagnose acid reflux disease or GERD.
The use of an upper gastrointestinal endoscopy (EGD) is a common procedure to help diagnose GERD. This procedure involves the insertion of a narrow tube containing a miniaturized camera into the mouth and down the gastrointestinal tract.
As the tube is guided down through the esophagus, stomach, and duodenum, the lining of the digestive system can be viewed on a monitor and assessed. If the esophageal lining is inflamed or ulcerated, a diagnosis of GERD can be made.
If you are undergoing an esophagram, you will first swallow a barium solution. This is a contrasting agent that allows a radiologist to see the stomach clearly in an X-ray.
This type of test can help to determine if there is a narrowing of the esophagus or if there is also a hiatal hernia.
Throat and Larynx Examination
GERD can affect the throat and larynx and cause sore throat, a dry cough and hoarseness. Your doctor may, in this case, recommend a visit to an ear, nose and throat specialist who will assess any signs of inflammation in the throat or larynx.
Though these symptoms may be caused by a throat infection, GERD is often the cause if other symptoms are present.
Esophageal Manometry Test
This is a type of esophageal test to determine how well the esophageal muscles are working. A narrow tube is passed through the nose and down into the esophagus.
There are sensors on the internal end of the tube that detect pressure each time the esophagus contracts. The other end of the tube is a device that records the pressure. The pressure is measured while the patient is resting and relaxing and again while swallowing.
Medications for Acid Reflux
Antacids are often used to neutralize stomach acid and relieve symptoms of heartburn and bloating that may accompany GERD.
There are a number of well-known brands such as Rolaids, Alka-Seltzer, Gaviscon, Maalox, Pepto-Bismol, and Tums. These over-the-counter antacids come in tablets, gel caps and liquid forms. This type of medication may be beneficial for people who are in the early stages of GERD who have no damage to the esophagus.
Histamine-2 is a chemical in the human body that triggers acid production in the parietal cells in the stomach lining. H-2 blockers oppose its action and suppress acid reduction.
This type of medication can be useful in the treatment of GERD when too much acid is being produced in the stomach and is an alternative for people who do not respond to antacids. The four most commonly prescribed histamine-2 blockers are Axid (nizaidine), Pepcid (famotidine), Pepcid (famotidine) and Tagamet (cimetidine).
They are available in tablet, capsule, and oral liquid forms.
Proton Pump Inhibitors
Proton pump inhibitors reduce the production of acid in the stomach and are more potent than histamine-2 blockers.
Examples of commonly prescribed proton pump inhibitors include lansoprazole (Prevacid), rabeprazole (Aciphex) and omeprazole (Prilosec). Esomeprazole (Nexium) is a newer form of omeprazole and acts faster to provide sustained relief from heartburn.
Proton pump inhibitors are usually taken as an oral dose, once daily. They were designed for short term use.
Long term use significantly increases the risk of SIBO and severe nutrient deficiencies.
Motility agents or pro-motility drugs such as Metoclopramide (Clopra, Maxolon, Reglan) work by increasing the muscle tone and action of the lower esophageal sphincter.
This means that they enable the easy emptying of food from the stomach to the intestines. They should be taken 30 minutes before each meal and at bedtime.
Treating Acid Reflux Without Medications
If you suffer from acid reflux or even GERD, you can help alleviate symptoms by making some lifestyle changes. These include:
Eating meals moderately and slowly
Try to avoid eating large meals. When your stomach is too full, it can increase the chance of reflux into the esophagus. Eating 4-5 smaller meals throughout the day may be tolerated better than three large meals.
Avoid trigger foods and beverages
Certain foods and drinks are more likely to trigger acid reflux than others. These include:
- Fatty foods
- Spicy foods
- Tomatoes and tomato-based sauces
- Onions and garlic
- Fermentable carbohydrates (FODMAPs)
- Caffeinated beverages
- Carbonated beverages
Eliminate these together for three weeks and then reintroduce one at a time to determine which ones are your triggers.
Don’t eat before bedtime
If you want to avoid acid reflux you should finish eating at least four hours before you go to bed. When you lie down, gravity is no longer able to help acids stay in your stomach as it does when you sit or stand.
Avoid exercise after eating
If you start exercising soon after you have eaten a meal, this can trigger acid reflux. Moving too quickly and bending after eating are also triggers. If you want to exercise after a meal, wait for a couple of hours, or take a steady walk.
Sleep with your head raised
Sleeping with your head raised 6-8 inches higher than your feet can help you avoid acid reflux. You can elevate the head of your bed or place a foam wedge beneath your upper body.
Maintain a healthy weight
If you are overweight, this puts pressure on the muscles that support the lower esophageal sphincter. When this happens, the pressure that holds the sphincter closed is decreased, which can cause frequent bouts of acid reflux.
If you are overweight, weight loss can significantly reduce acid reflux symptoms.
In some cases, alternative treatments may be effective in alleviating the symptoms of acid reflux. These include:
This form of traditional Chinese medicine has been in use for over 4,000 years. It involves the use of very fine needles inserted in various places on the body.
This painless procedure is believed to remove blockages that impede the flow of energy throughout the body and stimulate healing. Acupuncture has been shown to alleviate the symptoms of GERD even in cases where drugs have been unsuccessful. (Health CMi, 2016)
Hypnotherapy involves the use of guided relaxation to help individuals reach a deep state of relaxation. It may improve digestive health by reducing symptoms such as abdominal pain, bloating, irregular bowel movements, and anxiety.
In a 2015 clinical review published in the American Journal of Hypnotherapy, it was suggested that hypnotherapy may be useful in the treatment of digestive disorders such as acid reflux and GERD. The study samples were small, and more research is needed. (Riehl et al., 2015)
Melatonin is a hormone produced in the pineal gland and intestinal tract. It helps to regulate sleep. Melatonin supplements are well known for their ability to aid sleep, but they may also help reduce the symptoms of acid reflux.
In a 2010 study published in BMC Gastroenterology, 38 subjects were given either melatonin, omeprazole (a proton-pump inhibitor), or a combination of the two for 4-8 weeks. The individuals who took melatonin alone or a combination of melatonin and omeprazole showed a reduction in GERD symptoms. (Kandil et al., 2010)
There are a number of natural remedies shown to be useful for treating acid reflux. These include:
Aloe vera has been used in medicine for thousands of years, dating back to ancient Egyptian times. These days aloe vera is also recognized for its ability to help treat digestive disorders such as irritable bowel syndrome and can help with heartburn relief. Aloe vera, in liquid form or gel caps, can help digestive complaints such as acid reflux.
Aloe vera coats the esophagus and the stomach with a soothing layer that reduces inflammation and can prevent the stomach from refluxing. (Brusie, 2016)
Drinking aloe vera juice is the best way to make the most of this natural remedy.
Baking soda, or sodium bicarbonate, neutralizes stomach acid and may be a good remedy for quick and temporary relief of acid reflux. Sodium bicarbonate is available in capsule and tablet form as well as powder.
You can take ½ tsp in 4 ounces of water two hours away from meals. You can repeat this dose after two hours if symptoms still persist. You should not take more than 3 ½ teaspoons of sodium bicarbonate in one day. (Cherney, 2018)
Probiotic food and supplements contain live beneficial bacteria such as the ones that naturally inhabit the gastrointestinal tract.
Taking a probiotic supplement may benefit people who suffer from acid reflux because they help to restore the natural balance of the digestive system. (Brown, 2016)
Probiotics can be found naturally in foods such as yogurt, kefir, sauerkraut, miso, and kombucha. The recommended daily dose for a probiotic supplement ranges from 1 billion to 10 billion colony-forming units (CFU), which is typically 1-2 capsules per day. (Harvard Health Publishing, 2005)
It’s best to start with a lower dose and increase gradually to avoid gas and bloating.
Ginger is a well-known digestive aid. You can add raw or dried ginger to your meals, or you can make ginger tea. You can also take a ginger supplement in the form of capsules if you don’t care for the flavor.
In small amounts, ginger has an anti-inflammatory effect, which may be beneficial for people with acid reflux, because inflammation of the esophagus is common to this disorder. (Marcin, 2016)
The recommended dosage for a ginger supplement is 510g per day divided into two or three individual doses. (Michigan Medicine UOM, n.d.)
Drinking chamomile tea may help to alleviate symptoms of acid reflux, thanks to its benefits for the digestive system.
Not only is it helpful for reducing gas and bloating — it also relaxes the intestinal muscles. (Srivastava et al, 2010)
It also has anti-inflammatory and antianxiety effects, which may help alleviate symptoms of GERD. (McDermott, 2016)
Apple Cider Vinegar
Although raw apple cider vinegar (ACV) is often touted as a treatment for acid reflux, because it is alkaline, there is no scientific research to support this claim.
Taking one tablespoon of ACV in water twice a day is enough to see if it helps over a week or two. For some people, the ACV will make reflux worse. Drink through a straw to avoid erosion of tooth enamel.
If you suffer from occasional acid reflux or GERD, you have several options for treatment, including over-the-counter and prescription medications. You can also try making some lifestyle changes or using herbal remedies or probiotics.