Dr. Scott Becker Austin Gastroenterology South

Q: What are the symptoms of acid reflux?
A: The most common symptoms of acid reflux include heartburn or “pyrosis,” regurgitation and dysphagia (difficulty swallowing). Heartburn is generally described as a burning sensation behind the sternum that radiates to the neck. Regurgitation is the effortless return of stomach contents into the mouth or pharynx without nausea or retching. Dysphagia is the sensation of food sticking in the esophagus after swallowing. This can be a painful sensation that occurs behind the sternum or in the neck. In addition, a variety of “extra-esophageal” symptoms can occur including asthma, laryngitis and chronic coughing.

Q:What causes the disease?
A: Acid reflux is caused by exposure of the esophageal lining to acid coming from the stomach. The irritation tends to correlate with increased exposure of the esophagus to stomach acid. A variety of factors contribute to this process, including a weak lower esophageal sphincter (the muscular valve at the lower end of the esophagus that prevents stomach acid from coming into the esophagus), a hiatal hernia (where a portion of the stomach herniates from the abdomen into the chest) and a decreased ability of the esophagus to clear refluxed acid by the normal muscular propulsive action.

Q:How can I prevent acid reflux?
A: A variety of lifestyle changes can be useful in preventing acid reflux. These include dietary maneuvers such as avoiding spicy and acidic foods, foods that decrease the pressure of the lower esophageal sphincter such as peppermint, chocolate and caffeine, and avoiding alcohol and tobacco. Avoiding late night eating and elevating the head of the bed can also be helpful.

Q: If I’m already suffering, what can I do to relieve the pain?
A: In many cases lifestyle changes are simply not sufficient to control symptoms and the irritation of the esophagus. Medical therapy involves using agents called “proton pump inhibitors,” in order to decrease stomach acid production. Other medications that enhance the esophagus and stomach muscular propulsive activity also can be useful. Finally, a surgical anti-reflux procedure called a “Nissen fundoplication” can now be done laparascopically. However, this procedure tends to be reserved for patients with acid reflux that is refractory to medical therapy or for patients with extra-esophageal manifestations such as laryngitis or asthma. Long term studies of patients who have had anti-reflux surgery indicate that more than half eventually require medical therapy again.