Story Content

Acid reflux is the condition, which happens when some of the stomach acidic contents goes back into your esophagus. This is also called gastroesophageal reflux disease (GERD), if the symptoms of acid reflux occurs more than twice a week. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), GERD affects about 20 percent of people in the United States. It is required to give an immediate treatment as if left untreated, it can sometimes become worsen. 

Heartburn, acid reflux, and GERD

Acid reflux is a common medical condition and can range from mild to serious in severity. Gastroesophageal reflux disease (GERD) is the chronic, more severe form of acid reflux. Heartburn is a symptom of GERD and acid reflux.

Symptoms

Many symptom have been observed, which includes:

• Burning Sensation: Sometimes there is a burning sensation in the chest causing heartburn. Burning sensation also occurs in throat and stomach.
• Difficulty in swallowing:  which leads to breathing problems, like a chronic cough or asthma.
• Chest pain
• Nausea

Causes

At the entrance of the stomach and end of the esophagus, there is a muscle present known as lower esophageal sphincter (LES), which is a circular band of disease muscle, relaxes and open when we eat food and closes and tightens, as soon as the foods passes away into the stomach. If Acid reflux happens, it does not close and tighten properly, resulting the acid produced and the other contents in the stomach can move up into the esophagus, causing many symptoms like burning sensation etc. 

Acid reflux occurs due to a weakening of the esophageal sphincter. The sphincter is a muscle that acts as a valve and allowed the swallowed food to enter the stomach and by closing, prevent the food to reverse. If the sphincter is weak, it may not function properly.

The other common cause is stomach abnormality known as hiatal hernia, which makes the digestive acid to move up into esophagus. 

The other causes includes:

• Overweight
• Hiatal hernia
• Eating certain foods, such as tomato, citrus, garlic, chocolate, onions, spicy and fatty foods
• Drinking alcohol, carbonated drinks, coffee, tea or smoking is another major cause of Acid reflux.

These are also the main causes which weakens esophageal sphincter weaker, according to National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Risk factors

Certain conditions and lifestyle behaviors can also increase the chances of developing Acid reflux or GERD, including:

• Smoking
• Eating large meals
• Lying down or sleeping just after eating
• Eating certain types of foods, such as deep fried or spicy foods
• Drinking certain types of beverages, such as soda, coffee, or alcohol
• Using non-steroidal anti-inflammatory drugs (NSAIDS), such as aspirin or ibuprofen

Treatment options

In most cases, little change in lifestyle like eating habits etc. and recommended medications by physician are enough to prevent and relieve symptoms. But if not relived, surgery is needed. Over-the-counter medications are also recommended like 

• Antacids- Antacids neutralize the acid in the stomach such as Tums ®, Rolaids ® and Maalox
• H2 receptor blockers- such as Ranitidine (Zantac®) and Famotidine
• Proton pump inhibitors (PPIs) - one of the older study showed the effects of the proton pump inhibitor (PPI)-esomeprazole, pantoprazole etc. found that, it reduced the bedtime heartburn and sleep disturbances also.

Prevention

According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), some lifestyle can prevent symptoms of GERD and Acid reflux, which include: 

• Reducing alcohol intake 
• Quitting smoking
• Maintaining a moderate body weight
• Dietary changes
• Foods which trigger Acid reflux and needs to avoid in the diet

In some people, certain types of foods and beverages trigger symptoms, which includes: 

• High-fat foods
• Spicy foods
• Coffee, Tea
• Alcohol, Soda
• Chocolate
• Citrus fruit, Tomato, Pineapple
• Onion, Garlic, Mint

Foods which needs to include in the diet : As stated by IFFGD, these foods, if included in the diet, may help prevent or reduce acid reflux:

• Fruits, vegetables
• Whole grains
• Eggs, lean meat
• Healthy fats, such as olives, avocado, and oily fish

Why do acid reflux is more at night?

Research suggest that those with acid reflux after bedtime may have more acute symptoms than those experiencing it at day time. Published data showed that acid reflux gets worsen at the night time, mainly for the 3 reasons i.e. 

• Acid concentration in the stomach is higher at night that daytime. The reason is eating food while sitting or standing, the force of gravity helps keep acid and food inside the stomach during digestion, making symptoms less likely to occur. 
• Lying position makes it easier for acid to reflux and to remain in the esophagus, Gravity does not take the acid back down into the stomach.
• While sleeping, we don't swallow, which is important as it carries the acid that has refluxed into the esophagus back into the stomach. 

Study in The International Foundation for Gastrointestinal Disorders (IFFGD), showed that 79% of people with GERD experience symptoms after bedtime and 75% showed symptoms that influenced their sleep and 40% claimed the loss of sleep affects their ability to function when they get up.

Management

According to the American Academy of Allergy, Asthma, and Immunology (AAAAI), a person can ease acid reflux they experience when trying to sleep by elevating the head of the bed 6–8 inches, which can also help to prevent food from backing up from the stomach into the esophagus.

• Avoid lying down 2–3 hours after a meal
• Eating smaller meals more frequently and not eating heavy meals before bedtime
• People who experience acid reflux at night can be prevented by changing their diet and lifestyle.

Research suggests that some medications or the hormone “melatonin” may reduce symptoms of Acid reflux. Melatonin is the hormone produced in the body during bedtime and help to ease symptoms of GERD, produced at night. It also help in sleep improvement, reducing stomach acid secretion and helps LES to stay closed.

Summary

People with Acid reflux shows more symptoms at bedtime than at daytime. People with acid reflux are at greater risk of developing complications such as inflammation of the esophagus. Diet modification and some changes in lifestyle may help to manage the symptoms. However, if these adjustments do not work, it would be advisable to visit a doctor.