Gastric Acid Reflux

Gastroesophageal reflux or Gastric Acid Reflux, as it may be called, is caused by the lower esophageal sphincter (LES) not closing properly and stomach contents being regurgitated up into the esophagus. When the amount of gastric juices refluxed into the esophagus goes beyond the normal limit, it can result in an injury of the esophageal mucosa, which is the typical symptom of the condition. About half of all people who have acid reflux develop esophagitis.

 

Acid reflux is as common among males as it is among females. It happens in all age groups, but the prevalence increases among people over forty years old. Abnormal gastric acid reflux is a result of irregularities in one or more of the following protective mechanisms: (1) relaxation of the LES, (2) pressure of the LES, (3) intra-abdominal or intra-gastric pressure.

 

The most common causes of gastric acid reflux are functional LES problems (frequent transient LES relaxation) and mechanical LES problems associated with a hypotensive LES. Esophageal clearance is meant to neutralize acid refluxed through the LES. Mechanical clearance occurs via esophageal peristalsis, while chemical clearance occurs because of saliva.

 

Some foods and beverages, like coffee and alcohol, can decrease LES pressure. Medications like calcium channel blockers, beta-blockers, and nitrates as well as hormones like progesterone can also have the same effect.

 

Obesity is a contributing factor to gastric acid reflux, possibly because it leads to increased intra-abdominal pressure. Studies indicate that a high body mass index or BMI is a risk factor for this condition, but the mechanism by which high BMI increases exposure to esophageal acid is not fully understood. One of the things that people with gastric acid reflux should be aware of is that gastric reflux liquid does not only have acid but also duodenal contents such as pancreatic secretions and bile.

 

Non-esophageal symptoms of acid reflux include coughing or wheezing because of gastric contents aspirated into the trachea and bronchi or because of the vagal reflex arc producing constriction of the bronchial air passages. Another non-esophageal symptom is hoarseness from irritation of the vocal cords (often experienced by acid reflux sufferers in the morning).

 

Reflux is actually the most common source of noncardiac chest pain, and about half of these cases can be attributed to reflux. Once the health care providers have excluded cardiac causes of chest pain, they generally try to rule out acid reflux by using esophageal manometry and 24-hour pH testing. Take note, though, these tests are also said to be seldom useful in establishing a diagnosis of gastric acid reflux conclusively.