Acid reflux can occur by itself or with a variety of other symptoms. Complaints of heartburn, coughing, bloating or nausea are possible in people who experience acid reflux. While any severe or frequent reflux-associated symptoms should be brought to your doctor’s attention, this is especially true for stomach pain. Acid reflux with stomach pain can indicate the presence of a more significant digestive system problem that, if left untreated, could result in serious health risks.
The Stomach, Esophagus and Acid Reflux
Reflux occurs when stomach contents escape upward into the esophagus, the tube connecting the mouth to the stomach. This takes place when the muscular opening to the stomach -- called the lower esophageal sphincter -- fails to open and close properly. Stomach contents can irritate the lining of the esophagus, commonly leading to heartburn. Acid reflux is a common problem. A June 2014 article published in the journal "Gut" reported that an estimated 18 to 28 percent of U.S. adults experience symptoms of acid reflux at least once per week. Pain that may be experienced with acid reflux typically consists of a dull burning sensation in the middle of the chest that can radiate toward the back of the throat.
Causes of Reflux With Stomach Pain
The most common causes of acid reflux with stomach pain are functional dyspepsia, gastritis and peptic ulcer disease. Functional dyspepsia refers to symptoms such as bloating, nausea, fullness and upper stomach pain that occurs without an identifiable medical cause. Gastritis refers to stomach lining inflammation. It can result from various causes, including:
-- Irritation caused by nonsteroidal antiinflammatory drugs, such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve).
-- Infection with Helicobacter pylori bacteria (H. pylori).
-- Cocaine or alcohol abuse.
Peptic ulcer disease describes deep, craterlike erosions in the lining of the upper digestive tract, most commonly in the stomach or duodenum, the first portion of the small intestine. The same issues that can precipitate gastritis can also lead to peptic ulcer disease. In rare instances, these ulcers can result from certain chronic illnesses, like Crohn disease.
Making the Diagnosis
Medical evaluation is needed to determine the cause of acid reflux with stomach pain. In some situations, questions about your symptoms and a detailed physical exam may be all that is needed. For moderate, severe or persistent symptoms, additional workup may be recommended. H. pylori testing is commonly performed if peptic ulcer disease or gastritis is suspected. Blood tests may be recommended to check for anemia, which can develop if bleeding ulcers or severe gastritis are present. If the diagnosis is unclear, an endoscopy is often conducted. This involves inserting a small tube down the throat into the digestive tract to directly view the lining of the esophagus, stomach and duodenum.
The recommended treatment depends on the cause of your symptoms. According to American College of Gastroenterology guidelines, treatment for dyspepsia and acid reflux may include:
-- Acid-reducing medications, such as omeprazole (Prilosec), lansoprazole (Prevacid) or ranitidine (Zantac).
-- Antibiotics, if H. pylori infection is present.
-- Weight loss for overweight individuals.
-- Not eating 2 to 3 hours before bed.
-- Avoiding smoking and foods that trigger symptoms.
-- Eating smaller, more frequent meals.
These treatment options may also be used to help treat gastritis and simple peptic ulcers -- in addition to discontinuing any medications or abused substances that contributed to the illness.
Warnings and Precautions
Acid reflux with stomach pain can signal a serious illness and should not be ignored. Ulcers that are actively bleeding or have eroded completely through the lining of stomach or intestine are extremely dangerous and may require emergency surgical repair. Seek immediate medical attention if you experience any of the following symptoms:
-- Severe abdominal pain.
-- Chest pain or shortness of breath.
-- Fever over 101 degrees Fahrenheit.
-- Inability to tolerate food or fluids, or persistent vomiting.
-- Black, tarry or bloody stools.
-- Persistent, worsening or increasingly frequent symptoms.
-- Vomiting blood or material the resembles coffee grounds.
-- Dizziness or fainting.
- National Institute for Health and Care Excellence: Gastro-oesophageal Reflux Disease and Dyspepsia in Adults: Investigation and Management
- New England Journal of Medicine: Gastroesophogeal Reflux Disease
- American Family Physician: Heartburn
- American Family Physician: Update on the Evaluation and Management of Dyspepsia
- Gut: Update on the Epidemiology of Gastro-oesophageal Reflux Disease: A Systematic Review
- National Institute of Diabetes and Digestive and Kidney Diseases: Gastritis
- American Family Physician: Diagnosis and Treatment of Peptic Ulcer Disease and H. Pylori Infection
- American College of Gastroenterology: Management of Dyspepsia
- American College of Gastroenterology: Management of Helicobacter Pylori Infection
- American College of Gastroenterology: Management of Gastroesophageal Reflux Disease