The Symptoms, Causes, and Diagnosis of Acid Reflux

In today's article, we'll tell you what you need to know about the symptoms, causes, and diagnosis of acid reflux, a common health problem that many people experience, although usually on a one-off basis.

Written and verified by el nutricionista Saúl Sánchez.

Last update: 30 January, 2024

Acid reflux is a symptom experienced by some people with stomach and esophageal problems and is caused by irritation of the epithelium due to stomach acid or bile. It’s a very bothersome condition that can affect well-being, in addition to causing other diseases in the medium term. Therefore, the proper diagnosis of acid reflux is very important.

Acid reflux is usually experienced after a meal. The fact a meal is copious when a person has a tendency to suffer from the problem increases the risk of heartburn. However, those who suffer from a hiatal hernia can develop discomfort even after consuming light foods. There are also those who wake up in the middle of the night feeling reflux.

The function of the esophagus

The esophagus is a muscular tube that connects the mouth to the stomach. Food is lowered through it when swallowed, generating a series of contractions to facilitate its descent. It has a final valve located in the space before the stomach connection. This prevents the bolus from returning.

However, these sphincters don’t always work correctly. Sometimes, inefficiencies in its role can be experienced, causing a certain amount of stomach acid to access the esophagus and causing irritation and affections in the smooth muscle that makes up the tube.

It should be noted that, to be specific, there are two different sphincters. The first one is in the upper part of the tube, called the upper esophageal sphincter. This is opened during swallowing to allow food to flow down the inside of the tube.

There’s an internal esophageal sphincter, which is that which connects the esophagus with the stomach. It can’t be controlled voluntarily, as is the case with the previous one.

At the same time, it can weaken over time, either due to an inadequate diet or other pathological causes. When this happens, acid reflux develops. This is evidenced by a study published in the journal Missouri Medicine .

Symptoms of acid reflux

The symptoms of acid reflux, according to research published in the journal Primary Care, are as follows:

• Abdominal distension
• Bad breath
• Cough
• Gas
• Heartburn and a burning sensation in the chest
• The sensation of having something stuck in the throat
• Hiccups
• Nausea
• Regurgitation
• Throat pain
• Vomiting

In addition, when acid reflux occurs frequently, there’s a change in the cells that make up the esophageal epithelium (the most superficial cells of the tissue). This condition is known as Barret’s esophagus, according to a review published in Disease-a-Month .

For many years, this problem was linked to an increased risk of tumor formation. However, there’s currently considerable disagreement on this matter.

It’s important to take into account that esophageal carcinoma is one of the most dangerous, as the survival rate after five years is less than 20%. This is evidenced by a study published in the World Journal of Gastroenterology. However, this disease seems to be influenced to a greater extent by habits such as smoking and other conditions such as obesity than by the reflux itself.

As in most tumors, increased inflammation and oxidation tend to cause a worse prognosis. For prevention, it’s key to guarantee antioxidants in the diet and good lifestyle habits.

The causes of acid reflux

There are several factors that can condition the weakness of the esophageal sphincters, which could cause the sensation of acid reflux. One of the main risks is the existence of a hiatal hernia.

When this occurs, there’s an inability to close the sphincter fully, which makes it more likely that the stomach contents move back into the esophagus.

Other risk factors such as being overweight, obesity, pregnancy, the continued use of drugs (such as sedatives or antidepressants), and smoking can be identified. It should be taken into account that both being overweight and smoking also increase the incidence of tumors related to the digestive tract.

When body composition status is improved, there’s usually a significant improvement in symptoms. For this reason, reflux associated with pregnancy is transitory.

The diagnosis of acid reflux

The diagnosis of acid reflux is usually straightforward. In fact, many people are able to identify this condition without visiting a specialist.

Furthermore, normally, no clinical test is performed to confirm the existence of the problem, as the patient’s medical history and a detailed description of the symptoms are sufficient. In some cases, a physical exam may be done.

Not all people have esophageal reflux to the same degree. In many cases, it’s an occasional condition that’s linked to excesses at the dietary level. However, this problem can become chronic. In this case, it’s important to use a series of diagnostic tests to assess sphincter competence and whether there are associated problems.

Usually, the following is done in the diagnosis of acid reflux:

• An endoscopy to assess tissue damage.
• Esophageal manometry, which measures muscle contractions.
• Monitoring of esophageal pH and impedance.
• X-rays of the esophagus after the ingestion of a liquid with contrast.

Treatment for esophageal reflux

The treatment of esophageal reflux is based on changing lifestyle habits, although there are also drugs that can be used to relieve symptoms. Either way, the abuse of some of them is controversial at the health level.

Changes in lifestyle

Normally, a healthy diet approach can alleviate the symptoms of esophageal reflux. It’s important to consume foods and products that are easily digestible, avoiding those that are ultra-processed or inflammatory and copious or very fatty meals. The preferred cooking methods will always be a skillet, the oven, steaming, or boiling.

Also, it’s important to avoid the following foods:

• Carbonated drinks
• Alcoholic drinks
• Processed foods that are high in trans fat (pastries and fast food)
• Irritating substances such as coffee (although it depends on individual tolerance)

Regular exercise is often beneficial, as it helps control body weight and generate well-being. It’s essential to avoid tobacco and spaces with smoke. At bedtime, it’s best to sit up slightly in order to hinder the rise in acid in the case that acid reflux produces problems related to rest.

Regarding meal planning, it’s best to eat small meals throughout the day. It’ll also be necessary to test the tolerance to certain foods that are irritating, such as tomatoes, spices, mint, etc…

Pharmacology

For the treatment of esophageal reflux, there are a series of over-the-counter medications aimed at symptom control. In any case, their consumption is recommended only when experiencing a crisis, as their abuse is counterproductive. Also, it’s important to consult your doctor first. The most common are the following:

• Antacids: They work by blocking stomach acids. A similar effect can be generated by drinking a glass of milk. However, some studies mention that in the medium term, this solution could be counterproductive.
• Bismuth subsalicylate: This drug reduces the flow of fluids and acids into the intestine.
• H2 receptor blockers: These drugs reduce the amount of acid in the stomach. They work quickly and have long-lasting effects.
• Proton pump inhibitors: These are most used thanks to their ability to help control symptoms and reduce stomach acid production. However, there’s research that links the regular use of this class of compounds with an increased risk of developing some types of cancer.

When to visit a doctor?

When heartburn goes from being a one-time problem to a frequent condition, it’s advisable to visit a doctor. He or she will carry out tests to know the origin of the disease, as well as to know if there’s an alteration of the esophageal epithelium.

In addition, you can schedule pharmacological treatment if necessary to improve well-being or to efficiently control symptoms.

At the same time, if acid reflux is usually accompanied by vomiting, seeking professional help will be crucial. The same is true if you experience difficulty swallowing or breathing. In these cases, there may be another underlying disease that conditions the appearance of reflux, and treatment will be necessary to prevent its progression.

Acid reflux: An increasingly frequent problem

The increase in the rates of excess weight and obesity has caused acid reflux to be more and more frequent among the population. Normally, when weight is reduced, and body composition status is improved, there’s an improvement in symptoms. However, it’s possible that there’s an underlying disease that’s causing heartburn, such as a hiatal hernia.

In any case, if you experience acid reflux on a frequent basis, it’s advisable to visit a doctor who will perform a sphincter competence assessment. Likewise, it’s beneficial to improve lifestyle habits by investing in a healthy diet and practicing physical exercise.

Although there are pharmacological treatments to control symptoms, you should only resort to medications when strictly necessary. These products tend to have side effects on the body, so they shouldn’t be abused.