At RefluxMD we hear this question several times a week; what is acid reflux? Acid reflux, also known as GERD, is a serious and potentially progressive disease, but it’s also misunderstood. This article debunks the most common reflux myths and fills you in on what you really need to know.
We’ve all experienced heartburn, that burning sensation in the chest and the feeling of fullness that often results when we eat too much. Heartburn is the most common symptom of a potentially serious condition – gastroesophageal reflux, or GERD. Some patients with GERD also experience regurgitation, difficulty swallowing, persistent cough, and hoarseness. Millions of people suffer from reflux. In fact, it’s estimated that 1 in 3 Americans suffer from the pain and discomfort of reflux disease on a regular basis. Reflux disease has an enormous impact on the overall quality of life of the people who suffer from it. The symptoms can make it difficult to eat, sleep, work, and simply go about the day. Many medical experts view reflux disease as an epidemic yet little is being done to improve our ability to manage it.
What is acid reflux and is it a progressive disease?
Reflux disease is caused by a weak lower esophageal sphincter, or LES. The LES is a ring of muscle in the lower end of the esophagus just above the stomach. It acts as a gatekeeper, opening to allow food to pass into the stomach and then closing to prevent the contents of the stomach from backflowing, or refluxing, into the esophagus. Reflux can happen for a variety of reasons – overeating can cause a buildup of pressure in the stomach or chemicals in certain foods can cause the LES to relax inappropriately. Over time, the more you reflux, the more you damage the esophagus and the weaker the LES becomes. This vicious cycle results in a gradual decrease of LES function. Because the lining of the esophagus is easily irritated by the contents of the stomach, reflux disease can lead to complications such as inflammation and erosions of the lining of the esophagus, narrowing of the esophagus, Barrett’s Esophagus (a pre-cancerous condition), and cancer.
Acid reflux disease is linked to cancer
Esophageal adenocarcinoma, a type of cancer of the esophagus, is directly linked to reflux disease. In fact, reflux disease is the only cause for this type of cancer. The number of esophageal cancer cases has grown over 600% since 1975 making this deadly disease the fastest growing type of cancer in the United States. When charted against the incidence of all other cancers, esophageal cancer is in a league of its own. Sadly, esophageal adenocarcinoma is also one of the most lethal types of cancer. The overall likelihood of surviving five years is only 10-15%. This year alone approximately 20,000 deaths will result from reflux-induced esophageal cancer. Despite this, reflux-induced cancer receives little attention.
Acid reflux disease treatment is misunderstood
The question that follows “what is acid reflux?” is always “how can I treat acid reflux?” Many times when a patient complains of the symptoms of reflux, a proton pump inhibitor, or PPI, such as Prilosec, Prevacid, or Nexium is prescribed. These drugs relieve the symptoms of reflux by reducing the amount of acid produced by the stomach, which helps minimize heartburn and allows some complications like inflammation of the esophageal lining to heal. If the patient’s symptoms are relieved, no additional testing or monitoring is done. But symptom control doesn’t mean that the reflux is cured. While on PPIs, patients continue to reflux – they just can’t feel it – and their disease will continue to progress. Treatment with PPIs does not prevent complications like Barrett’s esophagus and cancer.
So why don’t doctors do more? Because treating reflux disease is complicated. Patients respond differently to different treatment options, so there is no one solution that will work for everyone. Physicians tend to be unfamiliar with diagnostic testing and monitoring, which results in the underutilization of those tools. Furthermore, treatment often requires coordination between a variety of specialties that have differing opinions about how to best treat reflux. In addition, many physicians simply underestimate the seriousness of the disease.
The truth about PPIs
PPIs are among the most prescribed drugs in the world. Consumers spend more than $24 billion each year on PPIs, looking for relief from their reflux symptoms. While they have helped millions of people, there are risks that users must understand. Reflux disease is a chronic, progressive disease, so once PPIs are started, they are often continued indefinitely. Studies have shown that long-term use of these drugs is correlated to an increase in the incidence of bone fractures, clostridium difficile colitis, a potentially deadly infection of the intestines, pneumonia, and low magnesium levels. In fact, the FDA recently placed over-the-counter PPIs on their watch list because of the danger of C. difficile colitis. PPIs are also known to interact with other drugs; the most important of these is Plavix, a blood thinner used for prevention of heart attacks and strokes. What’s most concerning is that several studies have demonstrated that 30% of PPI users don’t even have reflux. That means that millions of people are taking a potentially dangerous drug that they don’t even need.
PPIs must be used carefully as a long-term maintenance medication and only under the care of a well-informed physician. Never take over-the-counter PPIs for more than 14 days without talking to a doctor. And remember, even when they are used appropriately to treat reflux disease, PPIs simply control the symptoms of the disease. The reflux is not stopped or cured, and PPIs don’t reverse the damage to the LES or stop the disease from progressing.
You are in control
The good news is that reflux is controllable. By creating an action plan and following it, you can find relief for your symptoms and stop the progression of GERD. As a patient, it is your job to understand reflux and where you are in the progression of the disease, to monitor your symptoms, and to work with a knowledgeable physician to create a personalized treatment plan. A comprehensive approach to this disease includes the following:
- Manage your body mass index (BMI) to 24 or less
- Adopt a GERD-friendly diet
- Make all the necessary lifestyle changes
- Use the least powerful drugs only as necessary that result in satisfactory symptom control
- Experiment with natural home remedies to determine if any work for you.
- Consider antireflux surgery if the above changes do not provide adequate symptom relief
RefluxMD is here to assist you to find your path to relief. We have 100s of articles on all topics related to GERD. We can provide you a GERD-friendly diet plan and we offer a “hands on” weight loss and GERD advisory service that has helped others to find optimal health and freedom from their symptoms.
Since you’re here, chances are you or someone you love has been suffering fro acid reflux for some time. Perhaps you too have wondered what is acid reflux. Maybe you’ve seen your doctor about it and maybe you’ve even tried medications, but your current treatment just isn’t working. Don’t be discouraged. The reality is that you are in control. And you don’t have to suffer.
Are you ready to take control of your reflux? Start today by taking our assessment to learn where you are in the progression of acid reflux disease.
Reviewed by: Dr. Dengler, RefluxMD Medical Director