What Causes Chronic Reflux?

Chronic reflux, or gastroesophageal reflux disease (GERD), refers to the backward flow of stomach acid or bile into the esophagus, otherwise called the food pipe. The act of swallowing involves the relaxation of a band of muscle at the bottom of the esophagus. It relaxes long enough to permit food or liquid to enter the stomach, then resumes a closed position. When this muscle becomes weak or relaxes abnormally, stomach acid can back up into the esophagus, producing heartburn and other symptoms. Some factors that may bring on or exacerbate this disorder include obesity, pregnancy, and scleroderma.

The backward movement of stomach acid into the esophagus can irritate its lining and lead to symptoms of GERD. A primary sign of chronic reflux is heartburn, which is a burning feeling in the chest, sometimes reaching the throat. Chest pain, difficulty swallowing, and regurgitation of food are also experienced. Symptoms of a heart attack can sometimes be mistaken for GERD. Anyone with chest pain, particularly if it comes with shortness of breath or jaw or arm pain, should get immediate medical attention, as it could be a heart attack.

Chronic reflux and the associated esophageal inflammation may lead to complications. Scar tissue can form in the lower esophagus, which makes the opening smaller, thus causing swallowing to become difficult. Stomach acid can cause the formation of an ulcer, or open sore, in the esophagus, which can bleed or be painful. Sometimes the appearance of tissue lining the lower esophagus can change, resulting in an increased risk of cancer.

Treatment for chronic reflux usually begins with over-the-counter acid-neutralizing medicines, such as simethicone or calcium carbonate. Medication groups called H2-receptor blockers, which reduce acid formation, and proton pump inhibitors, which block acid formation, are available in prescription strength as well as over-the-counter strength. Prokinetic agents, drugs which strengthen the muscle in the lower esophagus, may be prescribed. When medications don't solve the problem, surgical procedures to prevent the backward flow of stomach acid may be needed. In addition to surgery, a technique that uses electrode energy to form scar tissue in the esophagus is sometimes used.

Healthy lifestyle practices, such as maintaining a healthy weight and abstaining from smoking and alcohol, are helpful. Items that cause heartburn, such as caffeine, chocolate, and fatty foods, should be avoided. Anyone with gastroesophageal reflux disease shouldn't lie down or bend over after eating. The head of the bed can also be elevated to allow gravity to assist in keeping acid from flowing back from the stomach.