Reflux Disease


While occasional heartburn is no cause for concern, frequent heartburn could be a sign of reflux disease – and a sign that you should see your doctor.

Causes

When you eat, food passes through the esophagus from the throat to the stomach, where a ring of muscle fibers, the sphincter, prevents food from moving back into the esophagus. If this sphincter muscle doesn’t close well, food, liquid and stomach acid can leak back into the esophagus.

Risk Factors

  • Hiatal hernia
  • Pregnancy
  • Scleroderma
  • Obesity
  • Smoking
  • Drinking alcohol
  • Use of certain medications

Symptoms

  • Heartburn or burning pain in chest that is relieved by antacids
  • Sensation that food is trapped behind the breastbone
  • Nausea after eating
  • Pain that is more likely/worse at night or when lying down

Diagnostic Tests

If your symptoms are severe or return after treatment, one or more tests may help diagnose reflux or any complications:
  • Esophagogastroduodenoscopy (EGD) to examine the esophagus for damage
  • Barium swallow
  • Continuous esophageal pH monitoring
  • Esophageal manometry
  • A positive stool occult blood test to check for bleeding

Treatment

Implementing the following lifestyle changes may help alleviate symptoms:
  • Avoid foods and beverages that may trigger symptoms, such as alcohol, caffeine, acidic fruits/vegetables, spicy or fatty foods, full-fat dairy products, etc
  • Avoid bending over or exercising just after eating
  • Avoid garments or belts that fit tightly around your waist
  • Do not lie down with a full stomach
  • Do not smoke
  • Eat smaller meals
  • Lose weight if you are overweight
  • Reduce stress
  • Sleep with your head raised about 6 inches. Do this by tilting your entire bed, or by using a wedge under your body, not just with normal pillows
  • Take over-the-counter antacids after meals and at bedtime
Over-the-counter and prescription medication can also be used to treat reflux. They work slower but provide longer-lasting relief than antacids.
  • Proton pump inhibitors (PPIs) such as omeprazole (Prilosec) and esomeprazole (Nexium)
  • H2 antagonists such as amotidine (Pepsid) and ranitidine (Zantac)
  • Promotility agents such as metoclopramide (Reglan)
  • Anti-reflux operations such as Nissen fundoplication

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