If you’ve lived with acid reflux for a while now, you probably already consider yourself an expert on the condition. You’ve scoured the internet to learn the causes, diagnosis and treatment plans for acid reflux. But here are 10 surprising facts about acid reflux that you probably didn’t know!
- Acid Reflux Has Become More Prevalent
- There Are Different Types Of Reflux Diseases
- If Ignored, Acid Reflux Can Lead To Serious Issues
- Acid Reflux Is Not Caused By Excess Stomach Acid But A Lack Of It
- Proton Pump Inhibitors (PPIs) Are Overused In The Treatment Of Acid Reflux
- It Is Not Always Triggered By Spicy Food
- Food Triggers Are Not The Only Reason Behind Your Reflux
- The Way You Sleep Can Lead To Heartburn
- Several Medicines Can Cause Heartburn
- Acid Suppressing Drugs Come With Serious Side Effects
Acid Reflux Has Become More Prevalent
According to Statistical Brief On Gastroesophageal Reflux Disease (GERD) Hospitalizations in 1998 and 2005 conducted by Healthcare Cost and Utilization Project, the total number of inpatient hospital discharges with a primary GERD diagnosis increased 4.8 percent from 1998 to 2005. However, when even secondary GERD diagnosis was taken into account, the increase was a whooping 216%!
Across all age groups, the elderly accounted for roughly 30% of hospitalizations with a primary GERD diagnoses but the largest increase in discharges with any primary or secondary GERD diagnosis between 1998 and 2005 was for patients age 18–34, increasing at a rate of 273%. As you can see from this, acid reflux has become more prevalent in young adults and is no longer a chronic disease only associated with the elderly. In fact, a primary GERD diagnosis rose by 84% between 1998 and 2005 in children aged between 2 to 17 years as well.
Surprisingly, more women are hospitalized due to acid reflux symptoms as compared to men. In 2005, women accounted for 62% as compared to 38% for men of all GERD discharges. A study conducted at Houston Department of Veterans Affairs Medical Center found white and black people in the United States have a similarly high prevalence of GERD symptoms. However, black people have a lower prevalence of esophagitis for the same frequency of GERD symptoms.
There Are Different Types Of Reflux Diseases
Most people think that acid reflux is synonymous with heartburn wherein the symptoms are a burning sensation in the chest which occurs when stomach acid backs up into the esophagus. Otherwise known as GERD or Gastro-Esophageal Reflux Disorder, this is not the only type of reflux disease.
“Throatburn Reflux” or Laryngopharyngeal Reflux (LPR) occurs when gastric contents back up into the esophagus, and creep up into the larynx, bronchi, lungs, or sinuses. The symptoms of this condition are chronic cough, hoarseness, and a lump-like sensation in your throat. LPR can also cause acid erosion of teeth, sleep apnea, recurrent pneumonia, bronchitis and asthma.
There is a third kind of reflux disease known as Non-erosive Reflux Disease (NERD) which is a subcategory of GERD with similar symptoms but no esophageal erosions are seen via conventional endoscopy. NERD sufferers are usually unresponsive to PPI therapy.
GERD or Gastro-Esophageal Reflux Disorder is itself of two types – supine acid reflux and upright acid reflux, with the latter being more common. Supine (or night-time) acid reflux is diagnosed when symptoms are most prevalent at night when a person is lying down, while a patient is diagnosed with upright acid reflux when symptoms are most prevalent throughout the day when a person is sitting up.
If Ignored, Acid Reflux Can Lead To Serious Issues
If you think that you don’t need to really need to change your diet and lifestyle to minimize reflux because antacids and PPIs always seem to treat your acid reflux symptoms, think again. When left untreated, acid reflux can manifest into more serious diseases like Barrett’s esophagus, esophageal cancer and IBS.
Studies have investigated the association of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) suggesting that these can co-exist in patients with functional abnormalities of the GI tract. Chronic, untreated acid reflux leads to Barrett’s esophagus, a common precursor lesion to adenocarcinoma (cancer) of the esophagus. What’s more, esophageal cancer is considered the fastest growing cancer in America and Europe since the mid 1970s.
Acid Reflux Is Not Caused By Excess Stomach Acid But A Lack Of It
Most people assume that acid reflux is caused by too much stomach acid. After all, that’s why the doctor prescribes acid-suppressing drugs, right? Wrong! On the contrary, acid reflux is caused by too little gastric acid.
Studies have found that over 30% of elderly patients (>60 years) suffer from a condition marked by little to no acid secretion, called as atrophic gastritis. So why are a majority of GERD patients also over 60 years of age?!
Jonathan Wright, MD of the Tahoma Clinic in Washington State and author of the book “Why Stomach Acid Is Good For You” explains: “When we carefully test people over age forty who’re having heartburn, indigestion and gas, over 90 percent of the time we find inadequate acid production by the stomach. In 24 years of nutritionally oriented practice, I’ve worked with thousands of individuals who’ve found the cause of their heartburn and indigestion to be low stomach acidity. In nearly all these folks, symptoms have been relieved and digestion improved when they’ve taken supplemental hydrochloric acid and pepsin capsules”.
In simpler words: While heartburn and GERD are caused when stomach acid splashes back into the esophagus, it doesn’t necessarily mean that there’s TOO MUCH acid, or that suppressing stomach acid with drugs will relieve those symptoms. By suppressing gastric acid production, you make digestion harder because our stomach needs acid to break down food and absorb nutrients.
Proton Pump Inhibitors (PPIs) Are Overused In The Treatment Of Acid Reflux
If you have been diagnosed with acid reflux in the recent past, chances are that you were prescribed PPIs. These acid-suppressing medications do more harm than good, especially when used for an indefinite period. Think of them as a band-aid – they mask the symptoms of acid reflux rather than curing it. And by suppressing gastric acid production, they disrupt the delicate gut microbiome to encourage growth of infection causing bacteria. Once the medication cures the pain of acid reflux, the patient will rarely change their lifestyle and continued damage to the LES ensues. An effective long-term GERD treatment plan MUST be built upon positive diet and lifestyle changes to prevent further damage and reverse the condition for long-term relief from reflux disease.
In fact, studies have shown that lifestyle modification for 2 months significantly improved chronic laryngo-pharyngitis symptoms in patients. When compared to control, treatment with a PPI failed to demonstrate significantly greater improvement in reflux symptoms, health status, or laryngeal appearance.
It Is Not Always Triggered By Spicy Food
Read any heartburn guide and it’ll tell you that avoiding spicy food is the key to keeping reflux symptoms at bay. Turns out, that’s not necessarily true. In fact, a report submitted by Stanford University School of Medicine found that there’s no merit to the fact. Another report by Department of Clinical Medicine, S. Orsola-Malpighi Hospital, Italy stressed that there’s no definitive data existing regarding the role of diet and, in particular, of specific foods or drinks, in influencing GERD clinical manifestations. Both these studies stress that weight loss and head of bed elevation are effective lifestyle interventions for GERD, but changing your diet may not always be necessary.
However, we think it’s important that you find out whether spicy food is a trigger for acid reflux for you or not through a trial and error method. For some people, chilies and cayenne pepper can irritate the gut lining and trigger reflux, but that is not necessarily true for everyone.
Food Triggers Are Not The Only Reason Behind Your Reflux
Smoking, lack of sleep, anxiety, and even second-hand smoke can also cause acid reflux. According to studies, nighttime reflux can lead to sleep disturbance and sleep disturbance may further aggravate GERD by prolonged acid contact time and heightened sensory perception. This facilitates the occurrence of complicated GERD and decreased quality of life. To make matters worse, researchers have also found that reflux patients under stress reported more painful symptoms related to acid reflux, even though there is no increase in gastric acid. Studies have also linked cigarette smoking to worsened reflux disease as tobacco smoke irritates the stomach lining and lowers esophageal sphincter pressure, triggering reflux.
The Way You Sleep Can Lead To Heartburn
Studies have found the elevating the head of your bed can bring relief from acid reflux symptoms. When your head is raised high, stomach acid can’t flow back up into the esophagus. If it’s not possible to raise the headboard, try sleeping propped up on a wedge pillow for the same effect. Some studies show that sleeping on the left reduces incidences of reflux. Experts believe sleeping on the right increases transient LES relaxations that are associated with reflux.
Several Medicines Can Cause Heartburn
You may not know this, but quite a few medications can cause heartburn. The most common offenders are:
- Painkillers like ibuprofen and aspirin because they increase acidity in the stomach.
- Antidepressants like amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil) are muscle relaxants and thus could cause transient LES relaxations.
- Asthma medication, like beta-adrenergic agonists or bronchodilators, relax the muscles controlling the airways but can also relax the LES.
- Sedatives like diazepam (Valium) and temazepam (Restoril) may cause or worsen GERD.
- For some, iron and potassium supplements can also induce reflux.
- Osteoporosis medication like alendronate sodium (Fosomax), ibandronate sodium (Boniva), and risedronate sodium (Actonel), may also cause heartburn and nausea
- Calcium channel blockers such as nifedipine (Procardia) and beta blockers such as propranolol (Inderal) have heartburn as a common side effect.
- Sildenafil, the erectile dysfunction drug, is another cause of heartburn.
Acid Suppressing Drugs Come With Serious Side Effects
Yes, we don’t think PPIs should be prescribed unless diet and lifestyle changes fail to show improvement because suppressing stomach acid only aggravates gastric problems, but for other reasons too. PPIs come with some serious side effects. They will rob your body of essential nutrients and lead to calcium, Vitamin B12, iron, and magnesium deficiencies. The also disrupt gut health by killing off healthy bacteria while at the same time encouraging bad bacterial growth in the gut and intestines. They have been linked to dementia and long-term use can also increase risk of chronic kidney disease. They have also been linked to:
- Increased risk of acute gastroenteritis and community-acquired pneumonia in children
- Increased chances of fungal infections in the gut
- Increased risk of enteric infections
- Increased risk of fractures
- Altering the bacterial flora of the upper gastrointestinal tract
- Lead to Clostridia difficile infections, which is a hard-to-treat bacteria causing diarrhea
- Cause bacterial infections of the small intestines