Acid reflux is a disease that is caused by stomach acid abnormally moving up into the esophagus and possibly higher into the mouth or airway structures. Many different factors can contribute to the development and presence of acid reflux.
Normally, your body’s natural protective factors limit reflux. We produce 1 pint to 1 quart of saliva per day that is swallowed. Saliva has many jobs. Saliva neutralizes acid, which means it buffers any acid that refluxes into the esophagus. It also helps to digest food, protect the teeth, and lubricate the esophagus so we can swallow. We swallow hundreds of times a day. The purpose of a swallow is to move material from the mouth to the esophagus and ultimately to the stomach. Frequently, swallowing occurs spontaneously without our intentional control. This spontaneous swallowing is protective against reflux because it clears material from the esophagus, including refluxed acid that may be present. Decreased saliva production either as a consequence of aging or because you are taking medications can be a contributing factor to new-onset acid reflux. Also, if your esophageal muscle is weak, it may decrease clearance of refluxed acid from the esophagus.
Gravity passively protects the esophagus from material moving up from the stomach, but there are local factors. Normally, there is an anatomic barrier to reflux. This barrier is made up of several structures that are at the junction of the stomach and esophagus. But first, a short anatomy lesson. The diaphragm is a muscle that separates the chest from the abdomen and enables us to breathe. The esophagus passes from the chest into the abdomen through a hole, or hiatus. Fibrous tissues in the abdomen called ligaments hold the stomach and esophagus in place. At the bottom of the esophagus within its wall is a circular band of muscle called the lower esophageal sphincter (LES). This muscle is usually contracted or closed between swallows to prevent movement of material down to the stomach or up from the stomach, as in reflux.When you swallow, this muscle relaxes and allows food material to pass from the esophagus to the stomach. The LES blocks reflux by staying closed.
This normal anatomy is required to maintain normal esophageal function because the diaphragm, ligaments, and circular muscle all contribute to the amount of pressure the LES can generate to block reflux. Normal anatomy can be lost as part of the aging process. The ligaments can stretch and the hole, or hiatus, in the diaphragm can enlarge. If this happens, part of the stomach can move up into the chest instead of normally staying in the abdomen. This condition is called a hiatus or hiatal hernia. Because the normal relationships between the structures that contribute to the strength of the lower esophageal sphincter are lost, the LES loses its ability to remain contracted with its normal strength, and the result is reflux.
Weight gain and obesity increase the risk of developing acid reflux disease. Extra body weight within the wall of the abdomen leaves less room within the abdominal cavity and increases pressure on the stomach. Increased pressure within the abdomen counteracts the benefits of gravity as a protective factor against reflux. Similarly, a pregnant woman’s enlarged uterus, which takes up space in the abdomen, can also push the stomach and its contents up into the esophagus, causing reflux. These factors contribute even more to reflux at night when the enlarged abdominal wall or pregnant uterus press on the stomach.
In addition to weight, dietary issues, alcohol consumption, and anatomic factors, other medical conditions or medications for other problems can also lead to acid reflux symptoms. As they age, people tend to take more medications, and many medications can affect stomach acid production, the speed at which the stomach empties, and the ability of the LES to maintain its strength. High blood pressure medications called calcium channel blockers, such as nifedipine, can relax the LES. Drugs used for depression such as tricyclic antidepressants and drugs for psychosis impair stomach emptying. We have tried to touch on a few of the reasons that people may develop new-onset acid reflux. However, people can experience reflux for a variety of reasons. It is important that you read through the remainder of this book and find the specific areas that may interest you to help explain your acid reflux.
How can I improve my symptoms of acid reflux? The best way to minimize and possibly avoid acid reflux is to eliminate or reduce the factors that are within your control. Simple changes to make to start include lifestyle choices.
Immediately after you eat something, your body produces the greatest amount of acid for digestion of that food. Anytime you lie flat stomach acids can reflux into the esophagus. To reduce acid reflux symptoms, avoid eating late at night or wait at least 2 hours after you eat before you lie down. By coordinating your sleep habits and eating habits, you can allow ample time for the acid and food to pass through the stomach and can minimize reflux.
A simple maneuver to improve nighttime acid reflux is to elevate the head of your bed. You can do this simply by placing small wooden blocks or bricks under the head of your bed. You can elevate your head by using special pillows called “Wedgies,” which are available at surgical supply stores. This type of pillow allows your head and chest to be elevated at an incline, which helps keep your stomach below the level of your esophagus. Another nighttime tactic to try is to sleep on your left side. This position moves the stomach below the level of the esophagus and helps bring gravity back into the equation.
Certain foods and the way you eat your meals can also exacerbate acid reflux. Spicy, acidic, citrus, tomato-based, fatty, and fried foods can aggravate acid reflux symptoms. Some of these foods promote the production of more stomach acid, whereas others delay the stomach from emptying because they require more time for digestion to complete. By avoiding these types of foods, you can decrease the likelihood of acid reflux.
Other types of foods, such as alcohol, chocolate, or peppermint, can also cause reflux by relaxing the LES, which lowers its pressure. Normally, the LES acts as a one-way valve that relaxes to open during a swallow but stays contracted between swallows as a barrier to reflux. Avoiding foods that relax the LES can reduce the occurrence of reflux.
Caffeinated and carbonated beverages are also known to cause problems with reflux. The carbonation and gas in them can increase the pressure in the stomach and lead to heartburn. Also, carbonated drinks are acidic and can be irritating to an inflamed esophagus. Limiting these types of beverages can improve reflux.
Being overweight and eating large meals are closely related to acid reflux. Both of these factors can cause increased pressure in the stomach that can lead to reflux. Extra body weight in the abdomen increases pressure on the stomach and can force acid back into the esophagus. When you eat large meals, you overfill your stomach, which not only increases pressure in the stomach but slows stomach emptying and promotes acid reflux. Eating smaller meals will not only help people control their weight, but also helps reduce reflux symptoms.
Other lifestyle changes that may also be beneficial include stopping smoking, losing weight, and wearing loose clothing. Smoking hinders the protective factors against reflux, for example, decreasing saliva production. Wearing loose clothing and losing weight reduce the pressure on the stomach that can cause acidic fluid to be forced back into the esophagus.
These are only a few suggestions to help you improve your symptoms of acid reflux. As you read through the book, you’ll notice many other lifestyle changes you can make to help reduce reflux symptoms.
By Mortin - Copyright 2009
Last modification 31/12/2009
What Causes Acid Reflux to Develop? References