After each meal the food in the stomach stimulates the production of hydrochloric acid that is quite strong (pH 2 or less) that promotes the digestion and prepares the nutrients for optimal absorption in the small intestine.  Once food has passed from the mouth through the esophagus and into the stomach the lower esophageal sphincter (LES), a muscular ring, closes the opening of the esophagus into the stomach.  Overeating or over distention of the stomach may cause this to incompletely close and certain foods cause the LES to relax or close less strongly, which may allow acid to reflux up into the lower part of the esophagus.  Most episodes of acid reflux are asymptomatic but some evidence indicates that about one-third of otherwise healthy Americans experience heartburn at least once a month.  When the lower esophagus is irritated by strong hydrochloric acid this may in turn stimulate a contraction of the muscle in the esophagus normally responsible for pushing the food from the lower esophagus into the stomach and this contraction returns approximately 90 percent of the acid and food back to the stomach.  Once the contraction ends, the LES closes again and the remaining acid in the lower esophagus is neutralized by the successive swallows of saliva, which is alkaline.

  “Heartburn” is the burning sensation or discomfort behind the breastbone or sternum and it is the most common symptom of acid reflux, which is sometimes referred to as gastroesophageal reflux disease (GERD).  If this occurs on a chronic basis there may be complications including erosion of the esophagus resulting in an esophageal ulcer.  Multiple eroded and scarred areas may result in a stricture or significant narrowing of the esophagus, which may result in difficulty swallowing.  There are also pulmonary manifestations such as asthma, coughing or intermittent wheezing and vocal cord inflammation with hoarseness as sometimes the gastric acid ascends to the level of the throat resulting in irritation of these tissues.

    Many episodes of GERD occur during the day, usually after eating but some people experience this reflux during sleep and those who experience a nocturnal reflux have a higher risk of esophagitis and some of the above-described consequences.  GERD can be due to a variety of gastrointestinal problems such as delayed stomach emptying, ineffective esophageal clearance and diminished saliva as well as a weak LES.  Some medications, foods or other products may worsen the symptoms of GERD in some patients.  It is relatively well known that tobacco, caffeine, chocolate, fatty foods and overeating as well as tight clothing and the presence of a hiatal hernia may worsen the symptoms of GERD. 

  The treatment of GERD depends upon the cause of the condition. Sometimes this simply requires some lifestyle modifications as in reducing the volume of meals, losing weight or avoiding consumption of food within several hours of bedtime.  In other cases it requires the avoidance of certain types of food that may adversely affect the LES.  Some patients are treated with antacids and alginic acids and others are treated with prokinetic medications that help to promote the timely emptying of the stomach into the small intestine.  Others require medications that block the production of acid and for those who have significant hiatal hernia or otherwise are unresponsive to medical measures, surgery is sometimes necessary.

  In most cases your family doctor can effectively diagnose and treat GERD.  If you have experienced these symptoms you should discuss this and the risk factors with your physician to determine the appropriate course of treatment.