What causes acid reflux hiccups. How are hiccups and heartburn related to cancer treatment. What are effective management strategies for persistent hiccups. How can heartburn be alleviated through lifestyle changes. What role do caregivers play in managing these symptoms.

The Connection Between Acid Reflux, Hiccups, and Cancer Treatment

Acid reflux, hiccups, and heartburn are interconnected symptoms that can significantly impact a person’s quality of life, especially for those undergoing cancer treatment. These conditions, while sometimes benign, can also be indicators of more serious underlying issues. Understanding the relationship between these symptoms and their potential causes is crucial for effective management and treatment.

Cancer and its various treatment modalities can sometimes trigger hiccups or exacerbate heartburn. However, it’s important to note that these symptoms can also arise from non-cancer-related factors or medications. This complex interplay of causes necessitates a comprehensive approach to diagnosis and treatment.

How do cancer treatments contribute to acid reflux and hiccups?

Cancer treatments, particularly certain chemotherapy drugs and radiation therapy to the chest or upper abdominal area, can irritate the digestive system and the nerves controlling the diaphragm. This irritation may lead to increased acid production in the stomach or cause spasms in the diaphragm, resulting in acid reflux and hiccups respectively.

Hiccups: More Than Just a Nuisance

Hiccups, while often considered a minor annoyance, can become a significant problem when persistent or intractable. They occur when the diaphragm, the muscle separating the chest cavity from the abdomen, experiences sudden, involuntary contractions.

What are the primary causes of hiccups in cancer patients?

• Certain chemotherapy drugs
• Steroids and anti-nausea medications
• Nerve or brain injuries
• Fluid accumulation in the lungs or near the heart
• Bloating and gas in the stomach area
• Electrolyte imbalances
• High blood sugar levels
• Esophageal issues
• Tumors or blockages in various organs

While most hiccup episodes are short-lived, lasting only a few minutes to hours, persistent hiccups (lasting more than 48 hours) or intractable hiccups (lasting more than a month) can be indicative of a more serious underlying condition and warrant medical attention.

Are there effective home remedies for managing hiccups?

While medical intervention may be necessary for persistent hiccups, several home remedies have been found to be helpful in managing short-term hiccup episodes:

1. Breathing slowly and deeply into a paper bag for 10 breaths
2. Sipping water slowly
3. Performing the Valsalva maneuver (bearing down gently as if having a bowel movement)
4. Holding a teaspoon of sugar in the mouth before swallowing
5. Avoiding forced eating

These techniques aim to disrupt the hiccup cycle by affecting the nerves involved in the diaphragm’s spasms. However, it’s important to note that the effectiveness of these methods can vary from person to person.

Heartburn: A Burning Issue in Cancer Care

Heartburn, characterized by a burning sensation in the throat, chest, or upper abdominal area, is a common problem associated with excessive stomach acid. In cancer patients, this condition can be particularly troublesome, often exacerbated by treatments and medications.

How does cancer treatment contribute to heartburn?

Cancer treatments, especially chemotherapy and radiation therapy to the chest or upper abdomen, can irritate the lining of the esophagus and stomach. This irritation can lead to increased acid production or weaken the lower esophageal sphincter, allowing stomach contents to flow back into the esophagus more easily.

Additionally, certain medications commonly used in cancer care, such as pain relievers and steroids, can increase the risk of heartburn. The stress and anxiety associated with cancer diagnosis and treatment can also contribute to digestive issues, including heartburn.

What are the long-term risks of untreated heartburn?

Chronic heartburn, often diagnosed as gastroesophageal reflux disease (GERD), can lead to more serious complications if left untreated. Prolonged exposure of the esophagus to stomach acid can result in:

• Esophageal ulcers
• Strictures or narrowing of the esophagus
• Barrett’s esophagus, a condition associated with an increased risk of esophageal cancer

Given these potential complications, it’s crucial for cancer patients experiencing frequent heartburn to discuss their symptoms with their healthcare team. Early intervention can prevent the development of more serious conditions and improve overall quality of life during cancer treatment.

Lifestyle Modifications for Managing Heartburn

While medication may be necessary to manage severe or persistent heartburn, several lifestyle modifications can significantly reduce the frequency and intensity of symptoms. These changes can be particularly beneficial for cancer patients looking to minimize discomfort during treatment.

Which dietary changes can help alleviate heartburn symptoms?

Adopting a heartburn-friendly diet can make a substantial difference in symptom management. Consider the following dietary adjustments:

• Avoid trigger foods: Common culprits include spicy, fatty, or acidic foods
• Eat smaller, more frequent meals: This helps prevent overloading the stomach
• Limit alcohol and caffeine consumption: Both can relax the lower esophageal sphincter, allowing acid reflux
• Avoid eating close to bedtime: Give your body at least 2-3 hours to digest before lying down
• Stay hydrated: Drink water throughout the day to help dilute stomach acid

It’s important to note that individual triggers can vary, so keeping a food diary to identify personal trigger foods can be helpful in developing a tailored diet plan.

How can sleep positioning help reduce nighttime heartburn?

Nighttime heartburn can be particularly distressing, disrupting sleep and impacting overall well-being. Adjusting sleep position can help minimize symptoms:

1. Elevate the head of the bed: Raise the head of the bed by 6-8 inches using bed risers or a wedge pillow
2. Sleep on your left side: This position can help reduce acid reflux
3. Use a body pillow: This can help maintain a beneficial sleeping position throughout the night

These adjustments help utilize gravity to keep stomach contents where they belong, reducing the likelihood of acid reflux during sleep.

The Role of Medications in Managing Acid Reflux and Hiccups

While lifestyle modifications are often the first line of defense against acid reflux and hiccups, medications can play a crucial role in managing more severe or persistent symptoms. It’s essential for cancer patients to work closely with their healthcare team to find the most appropriate medication regimen, as some treatments may interact with cancer therapies.

What types of medications are commonly prescribed for acid reflux?

Several classes of medications can be used to manage acid reflux and heartburn:

• Antacids: Provide quick relief by neutralizing stomach acid
• H2 blockers: Reduce acid production in the stomach
• Proton pump inhibitors (PPIs): Offer long-lasting reduction of stomach acid
• Prokinetics: Improve the movement of food through the digestive system

The choice of medication depends on the severity of symptoms, frequency of occurrence, and individual patient factors. It’s important to use these medications as directed and to inform the healthcare team of any side effects or changes in symptoms.

Are there specific medications for managing persistent hiccups?

While most hiccup episodes resolve on their own, persistent or intractable hiccups may require medication. Some options include:

• Baclofen: A muscle relaxant that can help reduce diaphragm spasms
• Chlorpromazine: An antipsychotic medication that can be effective for hiccups
• Metoclopramide: Primarily used for nausea but can also help with hiccups

These medications should only be used under the guidance of a healthcare provider, as they can have side effects and may interact with other medications. The dosage and duration of treatment will be tailored to the individual patient’s needs and overall health status.

The Impact of Stress and Anxiety on Digestive Symptoms

The psychological toll of a cancer diagnosis and treatment can significantly impact digestive health. Stress and anxiety can exacerbate symptoms of acid reflux and contribute to the occurrence of hiccups. Understanding this connection is crucial for comprehensive symptom management.

How does stress affect acid reflux and hiccups?

Stress can influence digestive symptoms in several ways:

• Increased stomach acid production
• Heightened sensitivity to normal digestive processes
• Changes in eating habits (e.g., eating too quickly or skipping meals)
• Muscle tension, including in the diaphragm

These stress-induced changes can create an environment more conducive to acid reflux and hiccups. Additionally, the physical discomfort of these symptoms can, in turn, increase stress levels, creating a challenging cycle.

What stress management techniques can help alleviate digestive symptoms?

Incorporating stress-reduction techniques into daily life can help manage both the psychological and physical aspects of cancer treatment:

1. Mindfulness meditation: Helps reduce overall stress and can improve body awareness
2. Deep breathing exercises: Can help relax the diaphragm and reduce muscle tension
3. Progressive muscle relaxation: Promotes overall body relaxation
4. Gentle yoga or stretching: Improves flexibility and reduces muscle tension
5. Counseling or support groups: Provides emotional support and coping strategies

These techniques not only help manage stress but can also contribute to overall well-being during cancer treatment. It’s important to find methods that work best for each individual and to practice them regularly for maximum benefit.

The Caregiver’s Role in Managing Acid Reflux and Hiccups

Caregivers play a vital role in supporting cancer patients dealing with acid reflux and hiccups. Their attentiveness and assistance can significantly improve the patient’s comfort and quality of life during treatment.

How can caregivers help monitor and manage symptoms?

Caregivers can take several steps to support patients experiencing acid reflux and hiccups:

• Monitor fluid intake: Ensure the patient stays adequately hydrated
• Assist with meal planning: Help prepare and serve smaller, more frequent meals
• Track symptoms: Keep a log of when symptoms occur and potential triggers
• Medication management: Help administer medications as prescribed and monitor for side effects
• Environmental adjustments: Assist in elevating the head of the bed or providing supportive pillows

By taking an active role in symptom management, caregivers can help patients focus on their treatment and recovery.

What signs should caregivers watch for that may indicate a need for medical intervention?

While many cases of acid reflux and hiccups can be managed at home, caregivers should be aware of signs that may warrant medical attention:

1. Persistent hiccups lasting more than 48 hours
2. Difficulty swallowing or pain when swallowing
3. Unexplained weight loss
4. Vomiting, especially if it contains blood
5. Severe chest pain or pressure
6. Shortness of breath or wheezing

If any of these symptoms occur, caregivers should promptly contact the patient’s healthcare team. Early intervention can prevent complications and ensure the patient receives appropriate care.

Hiccups and Heartburn | Cancer-related Side Effects

• Hiccups
• Heartburn
• What caregivers can do for hiccups and heartburn

Cancer and its treatment can sometimes cause hiccups or heartburn. It’s important to know that other non-cancer problems and medicines can also cause them or increase the risk for them.

Hiccups

Hiccups (or hiccoughs) are spasms that affect a muscle between your lungs and stomach that is used when you breathe, called the diaphragm. A hiccup happens when the diaphragm is irritated and suddenly contracts between normal breaths.

Hiccups can be caused by irritation of the nerve that controls the diaphragm which can happen for different reasons, such as:

• Certain chemotherapy drugs used to treat cancer
• Other drugs that may or may not be taken for cancer-related problems, including steroids, anti-nausea medicines, and antibiotics
• Nerve or brain injuries
• Fluid in the lungs or near the heart
• Bloating and gas in the stomach area
• Low levels of certain electrolytes (blood chemistries) such as sodium, calcium, and potassium
• High blood sugar level
• Problems in the esophagus (the swallowing tube that goes from the throat to the stomach)
• Tumors or blockages in the esophagus, lungs, liver, pancreas, kidney, or colon
• Changes in temperature
• Stress and excitement
• Drinking certain types of liquids or eating certain foods.

In people with cancer, certain chemotherapy drugs can have hiccups as a side effect,

Hiccups are usually temporary and stop within minutes to hours. If hiccups last more than 2 days, they can be considered persistent; they are considered intractable if they last more than a month. Hiccups that last a long time can be a sign of a serious problem.

Managing hiccups

There is a medication that can be prescribed to help manage hiccups if needed. But usually they are very temporary and stop without any kind of treatment. There’s not a lot of research about ways to manage hiccups other than using medication your doctor prescribes, but here are some things people have found useful.

• Breathe slowly and deeply into a paper bag for 10 breaths at a time.
• Drink water slowly.
• Bear down gently as if having a bowel movement (called the Valsalva maneuver).
• Hold a teaspoon of sugar in your mouth and then swallow.
• Avoid forcing yourself to eat.

Heartburn

Heartburn is a burning sensation in the throat, chest, or upper abdominal (belly) area that often worsens after eating or when you lay down. Some people might notice it more in the evening or after going to bed at night. It’s sometimes called indigestion or acid reflux. It’s a common problem from having too much acid in the stomach that forces contents of the stomach up into the esophagus.

If heartburn happens frequently it is often called or diagnosed as gastroesophageal reflux disease (GERD). Sometimes, several years of heartburn can lead to ulcers or Barrett’s esophagus which is linked to an increased risk of cancer of the esophagus.

Causes of heartburn include:

• Increased production of stomach acid
• Drinking too much alcohol, caffeine, acidic juices, or carbonated beverages
• Treatments for cancer, such as certain chemotherapy drugs and radiation to the chest or upper abdomen
• Taking certain medications, such as aspirin and anti-inflammatories (Advil, Motrin, Aleve, ibuprofen)
• Eating high-fat foods
• Smoking
• Being obese
• Blockages or changes in structure of the esophagus due to narrowing or tumor growth

Managing heartburn

Your health care team may prescribe an over-the-counter antacid to help with heartburn. There are other medications that might be prescribed short-term. Talk with your health care team if you have heartburn, and if any recommended or prescribed medications are not working.

• Avoid tobacco
• Limit caffeine and alcohol
• If you are overweight, losing weight may help relieve symptoms
• Eat small rather than big meals
• Avoid eating less than 2 to 3 hours before bedtime

What caregivers can do for hiccups and heartburn

• Watch the patient to be sure that they’re able to drink enough liquid.
• Elevate the head of the bed for comfort.
• If medicine is given, watch for dizziness. The patient may need help getting up or walking.

Call the health care team if the patient

• Has nausea that isn’t managed even after taking medication
• Has trouble breathing, eating, or swallowing
• Has heartburn and develops a puffy or bloated stomach or constipation

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Lohr L. Treatment of hiccups in patients with cancer. Oncology Times. 2018;40(7):10,48-49.

Kang JH, Bruera E. Hiccups during chemotherapy: What should we do? J Pall Med. 2015;18:572.

Kroch DA, Madanick RD. Medical treatment of gastroesophageal reflux disease. World J Surg. 2017;41(7):1678-1684.

National Comprehensive Cancer Network. Palliative Care. Version 2.2019. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on September  19, 2019.

Steger M, Schneemann M, Fox M. Systemic review: The pathogenesis and pharmacological treatment of hiccups. Alimentary Pharmacology & Therapeutics. 2015;2(9):1037-50. Accessed at https://onlinelibrary.wiley.com/doi/full/10.1111/apt.13374 on January 2, 2020.

Zaterka S, Marion SB, Roveda F, Perrotti MA, Chinzon D. Historical perspective of gastroesophageal reflux disease clinical treatment. Arq Gastroenterol. 2019;56(2):202-208.

 

 

 

Last Revised: February 1, 2020

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

Hiccups and gastroesophageal reflux: cause and effect?

Case Reports

. 1989 Aug;34(8):1277-80.

doi: 10.1007/BF01537278.

M J Fisher 
¹
, R K Mittal

Affiliations

Affiliation


• ¹ Department of Internal Medicine, University of Virginia, Charlottesville 22908.

• PMID:

  2752874

• DOI:

  10.1007/BF01537278

Case Reports

M J Fisher et al.

Dig Dis Sci.

1989 Aug.

. 1989 Aug;34(8):1277-80.

doi: 10.1007/BF01537278.

Authors


M J Fisher 
¹
, R K Mittal

Affiliation


• ¹ Department of Internal Medicine, University of Virginia, Charlottesville 22908.

• PMID:

  2752874

• DOI:

  10.1007/BF01537278

Abstract

Chronic hiccups may be a problem of great significance to the affected patient. A 62-year-old man with severe heartburn and persistent hiccups despite numerous diagnostic tests and therapeutic drug trials presented to our clinic. Esophageal motility and intraluminal pH studies demonstrated decreases in intraesophageal pressure during hiccups and acid exposure during 68% of the measured time. The patient underwent Nissen fundoplication, which improved his heartburn but not his hiccups. The association between gastroesophageal reflux and hiccups is discussed. Our experience suggests that the presence of hiccups and gastroesophageal reflux in the same patient may be coincidental rather than having a cause-and-effect relationship.

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Publication types


MeSH terms


Acid reflux: unexpected symptoms and consequences

What is acid reflux?

Involuntary leakage of stomach contents into the esophagus is called acid reflux.

Reasons may be:

1. You may have a weakened lower esophageal sphincter that is unable to prevent acid from the stomach from entering the esophagus. The sphincter is a muscular ring located between the esophagus and stomach. Its function is to pass food down into the stomach, and then close it tightly, which contributes to the further implementation of digestion.
2. Excessive amount of acid in the stomach as a result of eating unhealthy food or in case of overeating.
3. Fullness of the stomach as a result of unhealthy eating habits.
4. During pregnancy, the fetus can put pressure on the mother’s stomach, which can also cause acid reflux in a woman.

Combinations of the above reasons are also possible.

Most common symptoms of reflux

The most common symptoms of stomach acid entering the esophagus are burning and chest pain, better known as heartburn. This is because when acid from the stomach enters the esophagus, the lining of the esophagus is damaged. The duration and intensity of pain will depend on the amount of acid that has fallen on the esophageal mucosa, and on the duration of such contact.

Unexpected symptoms of acid reflux

You may have heard or read about gastroesophageal reflux disease (GERD) or reflux esophagitis in connection with acid reflux. This is the name of diseases with various symptoms that affect the upper parts of the human digestive tract.

Therefore, the already mentioned symptoms of acid reflux can be attributed to some other signs:

• a strong feeling of tightness in the chest;
• unpleasant sour taste in the mouth and nausea;
• sour or bitter eructations in throat or mouth;
• difficulty swallowing and feeling as if food were stuck in the throat;
• pain when swallowing.

Other symptoms associated with reflux may also include:

• feeling full;
• belching;
• continuous hiccups;
• weight loss for unknown reasons;
• hoarseness, dry cough, chronic sore throat.

A number of possible symptoms may not always be characterized by the presence of pain in a patient, even if there are signs of heartburn.

How to avoid acid reflux

You can avoid acid reflux if you pay attention to the following signs in time:

• When you belch.
• After eating what food or drink you felt heartburn.
• What you have already done or are doing at the moment when the first signs appear.

Heartburn can start at night with a late meal or a too spicy or fatty dinner. Perhaps you just overate. Spicy or fatty foods are a known factor in causing acid reflux. Try to reduce your consumption of these foods or avoid them altogether if that works for you. Try to finish dinner no later than two hours before bedtime. If you go to bed with a full stomach that has just begun to digest food, the chances of stomach acid entering the esophagus are greatly increased due to the horizontal position.

Try to eat small, frequent meals. An adequate volume of food in the stomach promotes proper circulation of stomach acid.

Another serious factor in the occurrence of heartburn is the abuse of alcoholic and caffeinated drinks.

Strenuous exercise immediately after a meal or improper exercise can also cause heartburn. If you decide to exercise, do not start immediately after eating. Let the food digest first. Twisting exercises, bending over, or activities that cause a sudden change in body position can also contribute to the development of acid reflux. Take this into account when choosing the type of load.

How to Treat Acid Reflux

If you suffer from heartburn, Gaviscon ^® Dual Action is here to help. The drug will help quickly (within 3.6 minutes) ¹ and long-term (works up to 4 hours) ^2.3 to alleviate the development of further symptoms of acid reflux.

Gaviscon ^® Dual Action neutralizes acid and forms a protective barrier over the contents of your stomach, so the drug acts on your stomach to keep excess acid from entering your esophagus. “Gaviscon ^® “Dual Action” has a longer effect in the treatment of acid reflux than simple antacids. ^4.5

So, we figured out that, in fact, there may be more symptoms of acid reflux than we previously thought. Prolonged exposure of the vulnerable esophageal mucosa to gastric acid can have serious consequences in the future if not controlled and treated. So if you think you’re experiencing similar symptoms too, but aren’t sure if they indicate you have acid reflux, it’s always best to get professional advice first.

Dosage and administration Gaviscon

^® Dual Action

Suspension: Adults and children over 12 years: 10-20 ml after meals and at bedtime up to 4 times a day

Maximum su the exact dose 80 ml

Tablets: Adults and children over 12 years: 2-4 tablets after meals and at bedtime up to 4 times a day

Maximum daily dose – 16 tablets All information provided not intended for diagnosis or prescription of medications. Detailed information about Gaviscon 9 preparations0081 ® see instructions for use. In case of complications or prolonged course of the disease, it is necessary to consult a doctor.

---

¹ Bordin D.S., Masharova A.A., Firsova L.D., Kozhurina T.S., Safonova O.V. patients with GERD // Experiment. and wedge. gastroenterol. – 2009. – No. 4. – S. 83-91.

² Instructions for medical use of the drug Gaviscon Double action

³ Kwiatek MA, Roman S, Fareeduddin A, Pandolfino JE, Kahrilas PJ., An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial ‘acid pocket’ in symptomatic GERD patients, Aliment Pharmacol Ther . 2011 Jul;34(1):59-66. doi: 10.1111/j.1365-2036.2011.04678.x. Epub 2011 May 3.

⁴ Rohof W.O., Bennink R.J., Smout A.J., Thomas E., Boeckxstaens G.E. An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease // Clin. Gastroenterol. Hepatol. – 2013. – V. 11 (12). – P. 1585-1591.

⁵ Bordin D.S., Masharova A.A., Firsova L.D., Kozhurina T.S., Safonova O.V. Evaluation of the effectiveness of the alginate-raft barrier in the treatment of gastroesophageal reflux disease // Consilium Medicum Gastroenterology – 2009. – No. 1. – P. 3.

Acid reflux

CloudHospital

Last updated: 06-Feb-2023

Medical review

Medical examination 90 005

Dr. Lavrinenko Oleg

Medical examination

Dr. Hakkou Karima

Originally written in English

Acid Reflux

Acid reflux, more commonly referred to as heartburn, is a burning sensation in the chest caused by stomach acid moving up towards the throat through the esophagus. If this condition recurs and becomes chronic, then it is called gastroesophageal reflux disease (GERD). Researchers estimate that about 20% of people in the US have GERD.

Symptoms of acid reflux

The main symptoms of heartburn are:

• Burning in the middle of the chest;
• Bad taste in mouth caused by stomach acid;
• Hiccups;
• Hoarse voice;
• Bad breath;
• Nausea and vomiting;
• Erosion of teeth;
• Difficulty or pain in swallowing;
• Wheezing;
• Dry, persistent cough;
• Bloating and nausea.

These symptoms may be worse after eating, especially when you lie down or bend over.

Acid reflux in infants and children

Regurgitation is normal in children under 1 year of age, so GER and regurgitation are common in infants. About 70 to 85 percent of babies have daily regurgitation by age 2 months, and most of them will no longer have symptoms of GER (gastroesophageal reflux) by the time they are 12 to 14 months old. Any infant can have GERD, but it is more common in premature babies or infants with certain conditions that affect the nervous system, lungs, or esophagus. If you suspect your child has GERD, you should talk to your pediatrician.

Typically, specialists analyze gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by looking at side effects and the child’s medical history. If the indications suggest GERD, specialists may suggest treatment with lifestyle changes or medication. Specialists may suggest clinical trials if indications indicate that the child may have a condition other than GERD or a complication of GERD. Specialists may also suggest testing if symptoms do not improve after lifestyle changes and medications. The child may be referred to a gastroenterologist for diagnosis and treatment of GERD.

Tests that help diagnose GERD in children are very similar to those used for adults and mainly include:

• Upper gastrointestinal endoscopy;
• Esophageal pH monitoring;
• Fluoroscopy of the upper gastrointestinal tract.

Specialists may prescribe a medical procedure to treat GERD in children if medications and lifestyle changes do not improve symptoms or if there are genuine complications of GERD. In children, complications after surgery occur much more often than in adults.

Fundoplication is the most widely recognized medical procedure for GERD. This generally results in long-term improvement in GERD symptoms. Specialists routinely perform fundoplication laparoscopically, whereby small incisions are made in the abdominal cavity and surgical instruments are inserted to perform the operation. Laparoscopic fundoplication leaves a few small scars at the site of insertion of instruments into the abdominal cavity. During this technique, specialists stitch the highest point of the stomach, also known as the gastric fundus, around the end of the esophagus, which increases pressure on the lower esophageal sphincter and reduces reflux.

Pregnancy acid reflux

In the United States alone, 30 to 50 percent of women experience heartburn during pregnancy, even if they do not have a history of acid reflux. During pregnancy, lifestyle changes are recommended, such as not eating too late at night and eating small meals. If you’re pregnant and experiencing acid reflux, talk to your doctor about treatment options. Drink plenty of water as it thins out the acid in the stomach, making symptoms easier, and avoid overeating. It’s also important to take care of yourself at night, as sleeping position can affect the severity of heartburn symptoms; try sleeping with your head slightly elevated, as gravity alone can deal with nighttime heartburn. If you are pregnant, quit smoking and drinking for both your baby’s health and yours, as cigarettes and alcohol put you at risk for acid reflux. If you need help quitting smoking, ask your doctor or midwife. Although many women experience heartburn symptoms, it is important to note that you should not suffer alone, always seek advice and possible treatments from your doctor.

What causes acid reflux?

Acid reflux is quite common and is not always a sign of an underlying disease. In infants under 6 months of age, this is fairly common and is not usually a cause for concern.

Heartburn is a condition in which a portion of stomach acid gets into the throat, down the throat, which causes a burning sensation in the chest.

The stomach contains hydrochloric acid, a strong acid that helps break down food and protects against harmful microorganisms. The lining of the stomach is protected from acid damage, but the lining of the esophagus is not.

The muscular ring, the gastroesophageal sphincter, is the valve through which food enters the stomach but not back into the throat. Sometimes, when the stomach is full, its acidic contents are thrown back into the esophagus through this valve, which is felt as heartburn.

Acid reflux can be a symptom:

• Hiatal hernia is a disease in which the upper part of the stomach rises into the chest through a hole in the diaphragm. This leads to increased pressure in the lower esophagus and increases the risk of GERD. Some of the most common hiatal hernia symptoms are:
1. Chest pain;
2. Bloating;
3. Belching;
4. Difficulty swallowing;
5. Bad taste in the mouth;
6. Upset stomach, nausea;
7. Reverse flow of fluid from stomach to mouth;
8. Shortness of breath.

If you have any of the following symptoms, you need urgent medical attention:

• Severe chest or stomach pain;
• Indigestion;
• Vomiting;
• Inability to defecate or pass gas.

This may be a sign of a strangulated hernia or intestinal obstruction, which is considered a medical emergency.

What makes acid reflux worse and foods to avoid

Sometimes acid reflux is caused or worsened by:

• Certain foods and drinks, such as coffee, tomatoes, or any other citrus or acidic foods chocolate, onion , peppermint, carbonated drinks, alcohol, mint, fatty or very spicy foods;
• Overweight;
• Smoking;
• Bending over or lying down, immediately after eating;
• Stress and anxiety;
• Pregnancy;
• Certain medicines such as anti-inflammatory pain relievers such as ibuprofen;
• Hiatus hernia, when part of the stomach passes into the chest.

Foods that reduce acid reflux

• High fiber foods. High-fiber foods make you feel full, so you’re less likely to overeat, which can contribute to heartburn. Fiber-rich foods include whole grains (oatmeal, couscous, brown rice), root vegetables such as carrots, beets, sweet potatoes, and green vegetables such as asparagus, broccoli, and green beans;
• Alkaline products. Alkaline foods help neutralize strong stomach acid. Low pH foods are more likely to cause acid reflux. Alkaline foods are bananas, melons, nuts, fennel, cauliflower.
• Liquid food. Eating liquid foods can help reduce stomach acid, which reduces the risk of heartburn. Some examples of high water foods include celery, cucumber, watermelon, herbal tea, broth-based soups, lettuce.
• Lean proteins. Eggs and lean meats are rich in protein. High-fat meals and other foods tend to decrease lower esophageal sphincter pressure and delay gastric emptying, which greatly increases the risk of reflux. Choose lean meats that are grilled, poached, baked, or boiled.
• Healthier fats. As a general rule, you should avoid or reduce your intake of saturated fats (found in meat and dairy products) and trans fats (found in processed foods such as margarine and shortenings). Try replacing them with unsaturated fats from fish or plants, such as monosaturated fats (found in olive oil, sesame oil, sunflower oil, avocado, peanuts, peanut butter, seeds, and many nuts) and polyunsaturated fats (found in oils such as safflower, soybeans, etc. corn, flaxseeds and walnuts, soybeans, tofu, oily fish such as salmon and trout)

Home remedies for acid reflux

Here are some home remedies for acid reflux:

• Eat less, but more often;
• Elevate your head and chest above waist level when sleeping or lying down to keep stomach acid out of your throat;
• Lose weight if acid reflux is caused by being overweight;
• Try to find a way to relax;
• Avoid foods and drinks that cause symptoms;
• Quit smoking as nicotine can relax the lower esophageal sphincter;
• Do not drink much alcohol;
• Do not wear too tight clothes around the waist;
• Do not eat 3-4 hours before bedtime;
• Avoid coffee;

Some people find that drinking milk relieves heartburn symptoms, but it’s important to note that milk comes in many varieties. Full-fat milk can aggravate acid reflux, while skim milk can act as a temporary buffer between the stomach lining and acidic stomach contents and can provide immediate symptom relief.

Diagnosis of GERD

Your doctor may order at least one of the accompanying tests to help diagnose GERD if:

• Your symptoms suggest you may have a GERD complication;
• Your symptoms point to other health problems similar to those of GERD;
• Your symptoms do not improve with treatment and lifestyle changes.

Some ways to diagnose GERD include:

• Esophageal manometry is a test that measures the contraction of the muscles of the esophagus during swallowing and measures esophageal stricture.
• Endoscopy of the upper gastrointestinal tract. An upper gastrointestinal endoscopy is a technique in which a specialist uses the tract, including the throat, stomach, and duodenum. During an upper gastrointestinal endoscopy, a specialist may take a biopsy by passing an instrument through the endoscope to remove small pieces of tissue from the lining of the throat. The pathologist will examine the tissue under a microscope. Specialists may arrange an upper GI endoscopy to check for complications of GERD or problems other than GERD that may be causing your symptoms.
• Esophageal pH monitoring. Monitoring the pH of the esophagus is the most accurate method for determining the corrosive effect of the stomach in the throat. Two types of esophageal pH monitoring:
1. Catheter monitoring, in which the physician inserts one end of a catheter—a thin cylinder—through the nose and into the throat to quantify acid and non-acid reflux;
2. Capsule monitoring, in which a clinician uses an endoscope to place a small, removed capsule on the lining of the esophagus to measure acid reflux;

While monitoring esophageal pH, you will wear a screen that receives data from a catheter or capsule and tracks your diet, sleep, and symptoms. Your doctor will use this information to determine how your diet, sleep, and symptoms are related to heartburn. Specialists may order this test to confirm a diagnosis of GERD or to see if GERD medications are working.

• Barium X-ray. This testing involves visualizing the esophagus, stomach, and upper duodenum after swallowing a chalk-like liquid that helps improve image contrast.

GP treatment for acid reflux

You may be prescribed a proton pump inhibitor (PPI) that reduces stomach acid production, such as omeprazole and lansoprazole. You will usually need to take this medication for 4 to 8 weeks, depending on the severity of your acid reflux.

Always talk to your doctor if symptoms return even after you stop taking the medicine, as you may need long-term treatment.

You can buy many GERD medicines without a prescription. However, if you have symptoms that won’t go away with over-the-counter medications, you should talk to your healthcare provider. Your doctor may recommend at least one medication to treat GERD.

• Antacids. Specialists may prescribe acid neutralizers to reduce mild indigestion and other mild symptoms of GERD. Antacids are available without a prescription. Acid neutralizers can help relieve mild symptoms. Be that as it may, you should not use these medicines continuously or for severe symptoms, except after careful discussion with your healthcare provider. These drugs may have side effects such as diarrhea and constipation.
• Sucralfate inhibitors.
• Potassium competitive acid blockers.
• GABA receptor antagonists (B).
• Selective serotonin reuptake inhibitors (SSRIs).
• Theophylline, a serotonin and norepinephrine reuptake inhibitor.
• Prokinetics. These drugs help to empty the stomach faster. Side effects of these medications include diarrhea, anxiety, and nausea.
• Erythromycin. It is an antibiotic that helps to empty the stomach faster.
• H2 blockers. H3 blockers reduce the production of acid in the stomach. H3 blockers may help repair the lining of the esophagus, but not in the same way as proton pump inhibitors (PPIs). You can buy h3 blockers without a prescription, or your doctor may recommend them.
• Proton pump inhibitors (PPIs). PPIs reduce the level of corrosiveness in your stomach. PPIs are better at managing the side effects of GERD than h3 blockers, and they can repair the lining of the esophagus in the vast majority of people with GERD. You can get a PPI without a prescription, or your healthcare provider may recommend it. Specialists may recommend PPIs for the long-term treatment of GERD.

Side effects are noticeable and may include migraine, diarrhea, and upset stomach. Studies also show that taking PPIs may increase the risk of Clostridioides difficile (C. diff) infection. Experts are still speculating about the consequences of taking PPIs for a long time or in high doses. Talk to your healthcare provider about the dangers and benefits of taking PPIs.

If PPIs do not relieve your symptoms, your doctor may refer you to a specialist for:

• Tests to find out the cause of your symptoms, which may include gastroscopy;
• Stomach surgery that stops acid reflux is called laparoscopic fundoplication.

Surgery is usually the last resort for GERD and is recommended by a gastroenterologist. Surgical treatments include:

• Fundoplication. A fundoplication is a surgery in which the surgeon stitches the upper abdomen around the esophagus to increase pressure on the lower abdomen and esophagus, thereby reducing reflux.
• Endoscopic procedures. This is a series of procedures that includes endoscopic stapling, which uses sutures to compress the esophageal sphincter muscle, and radiofrequency, which uses heat to create small burns that compress the sphincter.

GERD complications

Untreated GERD can sometimes lead to serious complications such as esophagitis, esophageal stricture and Barrett’s esophagus, as well as complications outside the esophagus.

• Esophagitis is an inflammation of the esophagus that can cause ulcers and bleeding in the lining of the esophagus. Chronic esophagitis increases your chances of developing esophageal stricture and Barrett’s esophagus.
• Esophageal stricture occurs when a narrowing develops in the esophagus, which can lead to difficulty swallowing.
• Barrett’s esophagus is a condition in which tissue similar to the lining of the intestine replaces the tissue that lines the esophagus. A small number of people diagnosed with Barrett’s esophagus develop a specific type of cancer called esophageal adenocarcinoma.

Complications outside the esophagus include:

• Asthma;
• Chronic cough;
• Hoarseness;
• Laryngitis;
• Destruction of tooth enamel due to gastric juice.

Esophagitis

This complication, most commonly caused by GERD, affects 2 to 5 percent of people aged 55 and older, with a generally good prognosis. There are different treatment options depending on the cause of esophagitis. Common symptoms of esophagitis include:

• Abdominal pain;
• Pain and difficulty in swallowing;
• Disturbance of the passage of food in the esophagus;
• loss of appetite;
• Nausea and even vomiting;
• Cough;
• Pain in chest when eating;
• Difficulty gaining adequate weight;
• Mouth ulcers.