Acid reflux happens when stomach contents flow back up into the esophagus, the tube that carries food from your mouth to your stomach. Most people feel it as heartburn: a burning feeling behind the breastbone, often after a big meal or when lying down. For many people it is an occasional nuisance. For others it becomes a daily problem that affects sleep, eating and quality of life. Dr. Pimienta treats acid reflux and GERD for adults across Los Angeles County, and most people feel much better with the right plan.
What is the difference between heartburn and GERD?
A ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, normally acts like a one-way valve. It opens to let food into the stomach and then closes. When it relaxes at the wrong time or is weak, acid and other stomach contents can splash back up. That is acid reflux, and heartburn is its most common symptom.
GERD (gastroesophageal reflux disease) is reflux that happens often, for example two or more times a week, or that causes problems such as irritation of the esophagus, trouble swallowing or poor sleep. GERD is a long-term condition, but it is very treatable.
Reflux that reaches the throat and voice box is called laryngopharyngeal reflux (LPR), or "silent reflux," because heartburn may be mild or missing. It can cause hoarseness, throat clearing or a long-lasting cough. Many other things cause these symptoms too, so they deserve a careful look.
What are the symptoms of acid reflux?
- Heartburn: burning in the chest, often after meals or at night
- Regurgitation: sour or bitter liquid or food coming back into the mouth or throat
- Chest discomfort that is not from the heart
- Nausea, or a feeling of fullness high in the belly
- A long-lasting cough, hoarseness or sore throat
- Trouble swallowing, or the feeling that food sticks (see swallowing difficulties)
Chest pain can be a heart problem. If you have new chest pain or pressure, especially with shortness of breath, sweating, or pain spreading to the arm, jaw or back, call 911. Also call 911 or go to the nearest emergency room if you vomit blood or material that looks like coffee grounds, have black or bloody stools with dizziness, or have food stuck and cannot swallow your own saliva.
What causes reflux?
Common causes and triggers include:
- A hiatal hernia: part of the stomach slides up through the opening in the diaphragm, which weakens the barrier against reflux.
- Extra weight around the belly, which presses on the stomach. Pregnancy does the same.
- Large or late meals, and lying down soon after eating.
- Smoking and alcohol, which relax the valve at the bottom of the esophagus.
- Certain foods and drinks for some people: fatty or fried foods, spicy food, chocolate, peppermint, coffee, carbonated drinks, citrus and tomato. Triggers differ from person to person.
- Some medicines, which can relax the valve or irritate the esophagus. Never stop a prescribed medicine on your own; ask your doctor first.
When should I see a GI doctor for heartburn?
See a gastroenterologist if you have heartburn two or more times a week, if over-the-counter medicine does not help or you need it most days, or if symptoms come back every time you stop. Make an appointment soon if you have any of these warning signs, sometimes called alarm features:
- Trouble swallowing, or food that feels stuck
- Pain when swallowing
- Weight loss you cannot explain
- Vomiting that keeps coming back
- Black or tarry stools, or vomiting blood
- Anemia (a low blood count) or low iron on a blood test
- New reflux symptoms that start after age 60
Our article Heartburn: when to see a GI doctor goes through these signs in more detail.
How does Dr. Pimienta evaluate reflux?
Your visit starts with your story: what you feel, when it happens, what and when you eat, and every medicine and supplement you take. Dr. Pimienta also examines you and reviews past tests. For many people without warning signs, the diagnosis is clear from the history alone, and treatment can start right away.
Tests are added only when they will change your care:
- Blood tests, for example to check for anemia.
- Upper endoscopy (EGD): a thin, flexible camera looks at the esophagus, stomach and first part of the small intestine while you are sedated. Small tissue samples (biopsies) can be taken during the exam. It is usually recommended when there are warning signs, when symptoms do not improve with treatment, or when long-standing reflux raises the question of Barrett's esophagus.
- Other tests that may be arranged, such as pH monitoring, which measures how often acid reaches the esophagus over a day or more. This can help when the diagnosis is unclear or before surgery is considered.
How is acid reflux treated?
Treatment works in steps, starting with the simplest changes. You and Dr. Pimienta decide together what fits your symptoms and your life.
Lifestyle changes
Eating smaller meals, finishing dinner two to three hours before bed, raising the head of your bed, quitting smoking and limiting alcohol help many people. If you carry extra weight, losing even a modest amount often eases reflux. Medical weight management can help when weight has been hard to change on your own.
Medicines
- Antacids neutralize acid for quick, short relief.
- H2 blockers (such as famotidine) lower acid production for several hours. They are useful for mild or occasional symptoms, or at bedtime.
- Proton pump inhibitors (PPIs) (such as omeprazole, esomeprazole or pantoprazole) are the strongest acid reducers. They work best taken 30 to 60 minutes before a meal, usually breakfast. Many people take them for a set course; some need them long term.
When a PPI is needed long term, the goal is the lowest dose that controls your symptoms, reviewed at follow-up visits. If you want to come off a PPI, do it with a plan. Stopping suddenly can cause a short burst of extra acid (rebound) that feels like the reflux is back, so the dose is usually lowered slowly instead.
When medicines are not enough
If symptoms continue despite treatment, the next step is to confirm that reflux is really the cause. For proven GERD that medicines do not control, surgery or other procedures done by other specialists may help; Dr. Pimienta will talk with you about whether one fits.
What is Barrett's esophagus?
In some people with reflux for many years, the lining at the bottom of the esophagus changes to a different type of tissue. This is called Barrett's esophagus. It causes no symptoms of its own, but it slightly raises the risk of esophageal cancer, so it is checked with an upper endoscopy and biopsies. When it is found, regular endoscopy can catch changes early. Dr. Pimienta may suggest a one-time endoscopy if you have had reflux for years along with other risk factors, such as being male, older than 50, a current or past smoker, carrying extra weight around the belly, or having a close relative with Barrett's esophagus or esophageal cancer.
Living with reflux: practical tips
- Raise the head of your bed 6 to 8 inches with blocks or a wedge. Extra pillows alone usually do not help.
- Try sleeping on your left side, which many people find eases night symptoms.
- Keep a short food and symptom log for two weeks to find your own triggers, rather than cutting out every food on a list.
Questions patients ask
Is it safe to take a PPI for a long time?
For people who need them, PPIs are generally considered safe, and for some conditions, such as Barrett's esophagus or severe inflammation of the esophagus, they are important to keep taking. When there is a clear reason to take one, the benefits usually outweigh the risks. Dr. Pimienta reviews whether you still need it and at what dose.
Can I stop my reflux medicine?
Many people can lower their dose or stop, especially after lifestyle changes. Stopping a PPI suddenly can cause rebound acid for a few weeks, so it is best done slowly with a plan. Talk with Dr. Pimienta before stopping.
Do I need an upper endoscopy for heartburn?
Not always. Many people with typical heartburn and no warning signs can start treatment without one. An endoscopy is usually recommended for warning signs such as trouble swallowing, bleeding, anemia or weight loss, for symptoms that do not respond to treatment, or to check for Barrett's esophagus in people at higher risk.
Can reflux cause a cough or a hoarse voice?
Yes, reflux can irritate the throat and airways. But allergies, asthma and postnasal drip are common causes too, so Dr. Pimienta looks at the whole picture, sometimes together with an ear, nose and throat doctor.
Will losing weight help my reflux?
Often, yes. Extra weight around the belly puts pressure on the stomach, and losing even a modest amount can reduce symptoms for many people. Dr. Pimienta is board-certified in obesity medicine and can help with a plan that fits you.
References
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Acid Reflux (GER & GERD) in Adults.
- American College of Gastroenterology. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. American Journal of Gastroenterology, 2022.
- American College of Gastroenterology. Acid Reflux (patient information).