Acid reflux occurs when the sphincter between the esophagus and the stomach fails to close properly after food has entered the stomach, and the stomach contents come back up into the lower portion of the esophagus. The hydrochloric acid from the stomach then irritates the esophagus, creating the burning sensation. The lining of the stomach is designed for normal amounts of hydrochloric acid without being damaged– the esophagus is not.
Symptoms of reflux can include difficulty swallowing, burning, regurgitation, chronic cough or hoarseness, sore throat, bad breath, non-allergic asthma, or may feel like a heart attack.
So what prevents the sphincter from closing completely? In some cases, the pressure of the stomach contents is too great, as in the cases of overeating. Gravity also plays a role, and laying down immediately after eating can push the sphincter open. There are also certain foods that some people find cause reflux, and these foods may be irritating to the esophagus or stomach. The action of the sphincter is also dependent on the amount of acid it encounters. Receptors at the sphincter sense how much acid there is and tell the sphincter to close or stay open. Under conditions of high acid (low pH), the sphincter closes tightly to protect the esophagus. If the stomach made NO acid at all (neutral pH), the sphincter would stay open, but there wouldn’t be an issue because there would be no acid to irritate the esophagus.
But what about situations where there’s not enough acid to stimulate the sphincter to close, but just enough to still irritate the esophagus? That’s exactly what’s happening in a person who experiences reflux– there’s enough acid to irritate and burn, but nor enough to close the sphincter.
Many of the current treatments for reflux use medications that block acid production or neutralize acid (antacids). These treatments assume that the problem is one of too much acid, rather than too little. True overproduction of hydrochloric acid can occur but is associated with a fairly rare cancer that overstimulates the acid-producing cells in the stomach. Many people also think of ulcers being due to high acid levels, but the common causes of ulcers (stress, Helicobacter pylori infection, and nonsteroidal anti-inflammatories) damage the protective lining in the stomach rather than increase the acid levels.
Acid production often decreases naturally with age, but also with stress, eating easily digestable or highly processed foods, or irregular eating patterns. All of these factors will increase the risk of reflux, as well as decrease the nutrition obtained from your food. Proteins and several key vitamins and minerals can only be digested or absorbed in a highly acidic environment, and people who take acid blockers over long periods of time or produce low levels of acid can put themselves at risk for malnutrition, regardless of what they area actually eating. If your stomach can’t break it down, it won’t get absorbed!
Reflux also has some serious complications, including esophagitis (inflammation of the esophagus), and esophageal ulcer, or stricture, which can cause significant pain, bleeding, and difficulty swallowing. Esophagitis can also lead to Barret’s metaplasia, a type of esphogeal cancer.
Treatments for mild reflux include apple cider vinegar before meals, a simple diet avoiding food sensitivities, avoiding tight clothing, drinking enough water between meals, weight loss, avoiding alcohol, tobacco, and high fat meals, eating at least 3 hours before bed, and seeing what may be “eating you up”.
© Kimberly Hindman, 2006