Causes and Treatment for Acid Reflux

Acid reflux is a common digestive condition in which stomach contents flow back into the oesophagus, a tube approximately 1 inch wide and 10 inches long that connects the mouth to the stomach.

Located at the bottom of the oesophagus, the lower oesophageal sphincter (LES), a circular ring of muscles connects the oesophagus to the stomach. When you swallow, the LES relaxes and opens to allow food to enter the stomach, where it mixes with stomach acid to aid in digestion. Afterwards, the LES closes to prevent stomach acid and food from flowing back into the oesophagus.

Occasional reflux is quite common after a large meal and most of the time the condition is brief. Despite not usually causing significant issues or complications, it could still damage the oesophagus and induce a number of bothersome symptoms.

Symptoms of acid reflux

Common acid reflux symptoms include:

Heartburn (a burning sensation in the chest)
Regurgitation (the feeling of stomach contents being forced back up your oesophagus)
Difficulty swallowing or pain when swallowing
Sour taste in the mouth
Nausea or vomiting
Bad breath
Voice hoarseness
Chest pain

There is a much more severe form of acid reflux known as GERD (Gastroesophageal Reflux Disease). It is defined as a chronic digestive condition and is characterised by persistent symptoms that can significantly impact one’s quality of life.

Causes of Acid Reflux

Why Does Acid Reflux Happen?

Acid reflux happens when the lower oesophageal sphincter (LES), a ring of muscle between the stomach and oesophagus, becomes weak or relaxes when it should remain closed. This allows stomach acid to travel upward into the oesophagus, causing symptoms such as heartburn, regurgitation, and a sour taste in the mouth.

What Are the Common Triggers of Acid Reflux?

Several factors can increase the risk of acid reflux:

Dietary triggers: Spicy foods, fatty meals, caffeine, and alcohol
Eating habits: Large meals or lying down soon after eating
Lifestyle factors: Smoking and poor sleep habits
Obesity: Increased abdominal pressure pushing acid upward
Pregnancy: Hormonal changes and pressure on the stomach
Medical conditions: Hiatal hernia affecting stomach positioning

Why Is Acid Reflux Often Worse at Night?

Acid reflux symptoms can become more noticeable at night because lying flat makes it easier for stomach contents to flow back into the oesophagus. Eating large meals late in the evening may further increase the risk of reflux symptoms while sleeping.

Can Stress Cause Acid Reflux?

Stress may not directly cause acid reflux, but it can worsen symptoms in some individuals. Stress can influence eating habits, sleep quality, and digestive function, all of which may contribute to more frequent reflux episodes.

Diagnosis of acid reflux

Based on your reported symptoms, your doctor may perform an upper gastrointestinal (GI) endoscopy. This involves using an endoscope, a thin, flexible tube with a camera to inspect the oesophagus and lining of the stomach. During the procedure, biopsy samples may be taken to check for damage or signs of infection.

Prolonged oesophageal pH test can also be done to determine how severe the acid reflux is. This involves the insertion of a small tube with a sensor through the nose into the oesophagus or placing a wireless sensor during an upper endoscopy. The sensor remains in place for 24 hours.

How is acid reflux treated?

Treatment for acid reflux depends on the severity of symptoms and may include lifestyle changes, medications, or medical procedures.

Lifestyle changes for mild acid reflux

Several lifestyle changes to help alleviate mild acid reflux include:

Avoid trigger foods such as spicy or fatty meals
Do not lie down immediately after eating
Maintain a healthy weight
Reduce caffeine and alcohol intake

Medications for acid reflux

Medications for acid reflux include:

Antacids for short-term relief due to its ability to neutralise stomach acid
H2 blockers (e.g. famotidine) to reduce stomach acid production
Proton pump inhibitors (PPIs) (e.g. omeprazole and pantoprazole) for more severe symptoms

When is further treatment needed?

More advanced treatment may be required if:

Symptoms persist despite medication
Acid reflux occurs frequently
Complications such as oesophageal damage develop

Potential complications

Complications that come with acid reflux are usually not serious with most people, especially if they are receiving treatment. However, some individuals with severe acid reflux may sometimes experience potentially serious complications.

Dental problems	Repeated occurrences of acid reflux can gradually erode teeth enamel.
Lung and throat problems	When stomach acid flows back into the throat, it can cause vocal cords inflammation, throat pain, or hoarse voice. The acid can also potentially be inhaled into the lungs causing symptoms of pneumonia or asthma, as well as irreversible damage to the lungs if the condition persists.
Erosive oesophagitis	This is a condition where stomach acid erodes the lining of the oesophagus and results in potential bleeding that is caused by erosions or sores. Stool tests can help detect bleeding from an ulcer, even if the bleeding is not visibly apparent.
Oesophageal stricture	Damage from stomach acid can lead to scarring and narrowing of the oesophagus. Repeated ulceration of the oesophagus followed by the healing process forms scar tissues which creates a partial obstruction (stricture) that may cause food or pills to become stuck.
Barrett’s oesophagus	This happens when a different cell type known as intestinal cells replaces the squamous cells that usually line the lower oesophagus. This change is typically the result of repeated injury to the oesophageal lining due to chronic acid reflux. Over time, there is a small risk that these intestinal cells may develop into cancer cells. Individuals with Barrett’s oesophagus are advised to undergo regular upper endoscopies to check for early signs of cancer.

How Can You Prevent Acid Reflux?

Lifestyle and dietary modifications are recommended to lower the frequency and severity of acid reflux occurrences.

What Foods Should You Avoid If You Have Acid Reflux?

Common trigger foods include:

Spicy foods
Fried and fatty foods
Chocolate
Tomatoes and tomato-based products
Citrus fruits
Carbonated drinks
Caffeine
Alcohol

Triggers vary between individuals, so keeping a food diary may help identify foods that worsen symptoms.

For many people, eating spicy food can be a common cause of acid reflux as spicy foods contain a compound called capsaicin. It relaxes the lower oesophageal sphincter and makes it easier for the stomach acid to flow into the oesophagus. You should avoid eating too many spicy foods if you are prone to acid reflux.

What Is the Best Sleeping Position for Acid Reflux?

Sleeping on the left side may help reduce acid reflux symptoms. This position helps keep stomach contents lower than the oesophagus, making it less likely for stomach acid to flow backwards during sleep.

Can Acid Reflux Be Prevented Naturally?

Many people can reduce acid reflux symptoms through lifestyle changes such as maintaining a healthy weight, avoiding large meals before bedtime, limiting trigger foods, stopping smoking, and reducing alcohol consumption.

To prevent overeating, remember to eat smaller sized meals throughout the day. To minimise the symptoms of acid reflux, avoid eating late at night and give yourself at least three hours between your last meal and bedtime.

Schedule an appointment at Gleneagles Hospitals

For any questions or concerns regarding acid reflux, contact us to schedule an appointment today for a consultation, or visit our team of Gastroenterologists at your nearest Gleneagles Hospital.

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