Acid indigestion/heartburn is a chronic digestive problem. According to the Mayo Clinic, these symptoms occur when stomach acid or bile backs out of the stomach into the esophagus. This acid irritates the lining of the esophagus. If a patient experiences these symptoms more than twice a week or if these symptoms interfere with daily life, they are termed gastroesophageal reflux disease (GERD).
Causes
According to the National Institutes of Health (NIH), GERD occurs because the lower esophageal sphincter, or the separation between the esophagus and stomach, relaxes inappropriately. A hiatal hernia, which occurs when the stomach and esophageal sphincter move above the muscle that typically separates the stomach from the chest, can allow acid reflux to occur more easily. GERD also occurs more frequently in patients who are obese, smoke or are pregnant.
Diagnosis
Typically, a doctor diagnoses GERD on the basis of symptoms alone. If symptoms persist despite treatment, further testing can be done. According to the NIH, an upper endoscopy can be performed to take a direct look at the lining of the esophagus to determine whether stomach acid has damaged the cells. In this test, a patient is sedated with medication, and a thin tube with a light and a camera at the end is put down the throat. Small pieces of tissue can be removed for a closer look under the microscope. Another test that can be performed is pH monitoring, in which a small device is inserted into the esophagus to monitor the amount of acid that enters the esophagus while the patient goes about his normal activities.
Lifestyle Treatments for GERD
In some cases, a patient may find that modifying her diet improves symptoms. Foods that worsen the symptoms of acid indigestion and heartburn include citrus fruits, chocolate, caffeinated beverages, alcohol, fatty foods, spicy foods and tomato-based foods. Avoiding these foods, eating small meals more frequently and avoiding lying down for several hours after a meal may help to relieve symptoms. Losing weight, quitting smoking and raising the head of the bed with wooden blocks also help with symptoms in some situations.
Treatment for GERD
The first medications recommended are typically antacids, which are combinations of magnesium, calcium and aluminum designed to neutralize stomach acid. Another class of medication, H2 blockers, reduce the amount of acid the stomach produces. These are available in both prescription strength and over the counter. Proton pump inhibitors also reduce the amount of acid produced, but are stronger than H2 blockers and help to heal the lining of the esophagus. While these medications are effective and sometimes used in combination to relieve symptoms, it is advised that patients discuss all medications with their doctor as they do have side effects that should be monitored. If medications do not improve symptoms of acid indigestion and heartburn, surgery is sometimes needed.
Complications
If symptoms of acid indigestion go untreated, complications can result. Persistent acid in the esophagus can cause damage to the lining and result in ulcerations or bleeding. Tissue damage from acid can also cause scars to form that result in difficulty swallowing. If damage from acid cause the cells that line the esophagus to change in size, this can lead to esophageal cancer over time. Patients with these cellular changes should be closely monitored by a digestive specialist.
