Where Do You Hurt with Acid Reflux?

Acid reflux happens when the lower esophageal sphincter becomes weak or relaxes, causing stomach contents to back up into the esophagus. 

Causes of lower esophageal sphincter weakness or relaxation include:

• Being overweight or obese, which puts increased pressure on the abdomen 
• Pregnancy, which also puts increased pressure on the abdomen
• Hiatal hernia 
• Smoking or inhaling secondhand smoke
• Certain medications
  • Anticholinergics 
  • Antidepressants 
  • Antihistamines
  • Asthma medications 
  • Calcium channel blockers
  • Dopamine-active drugs 
  • Painkillers
  • Progestin 
  • Sedatives
• Alcohol use 
• Laying down after eating
• Scleroderma

Acid reflux and gastroesophageal reflux disease (GERD) are diagnosed with a patient history and physical examination.

In addition, tests used to diagnose acid reflux include: 

• Upper gastrointestinal (GI) endoscopy and biopsy
• Upper GI series
• Esophageal pH and impedance monitoring
• Esophageal manometry 
• Stool occult blood test

Acid reflux can often be managed with lifestyle changes or with non-prescription medicines. 

Home remedies to relieve acid reflux include:

• Lose weight if you are overweight or obese
• Don’t overeat
• Don’t eat 2 to 3 hours before bed
  • Lying down with a full stomach can make reflux worse
• Raise the head of the bed 6 to 8 inches using blocks of wood or rubber under 2 legs of the bed or a foam wedge under the mattress
• Avoid medications such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn) that can aggravate reflux
• Avoid foods that worsen symptoms 
  • Coffee
  • Chocolate
  • Alcohol
  • Peppermint
  • Fatty or greasy foods
  • Spicy foods
• Take medications with plenty of water
• Don’t smoke
• Wear loose clothing around the stomach area

If lifestyle changes do not relieve symptoms of acid reflux, medications to treat the condition include: 

• Antacids
  • Aluminum hydroxide and magnesium hydroxide (Maalox), calcium carbonate and magnesium hydroxide (Rolaids), sucrose and calcium carbonate (Tums), and simethicone (Mylanta)
• Histamine blockers
  • Cimetidine (Tagamet HB), famotidine (Pepcid AC), and nizatidine (Axid AR)
• Proton pump inhibitors (PPIs)
  • Esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), and rabeprazole (AcipHex) 
• Prokinetics
  • Bethanechol (Urecholine) and metoclopramide (Reglan) 
• Antibiotics
  • Erythromycin has fewer side effects than prokinetics

In severe cases of gastroesophageal reflux disease (GERD), surgery may be indicated when symptoms do not improve with lifestyle changes or medications. 

Surgery used to treat gastroesophageal reflux disease (GERD) includes: 

• Fundoplication
  • A laparoscopic procedure in which a thin tube with a tiny video camera is inserted into the abdomen and the top part of the stomach is sewn around the esophagus to reduce reflux
• Endoscopic techniques
  • Endoscopic sewing uses small stitches to tighten the sphincter muscle
  • Radiofrequency creates heat lesions, or sores, to help tighten the sphincter muscle
  • Results for endoscopic techniques are not as good as those for fundoplication