Acid reflux, also known as heartburn, is a common gastrointestinal problem that affects tens of millions of Americans every month. Although typically an occasional nuisance that manifests after eating or drinking something that triggers the symptoms, acid reflux can also become a persistent problem that recurs again and again; this chronic version is known as gastroesophageal reflux disease (GERD). In either case, one of the most common contributing factors in the development of acid reflux is alcohol consumption.
How is Acid Reflux Defined?
Even though it is sometimes called heartburn, acid reflux actually isn’t related to the heart at all. Instead, it is a purely gastrointestinal condition that is characterized by stomach contents backing up into the esophagus. Under normal circumstances, food that is chewed and swallowed travels down the esophagus and enters the stomach after passing through the lower esophageal sphincter (LES). The LES is a small ring of muscle that automatically opens and closes to allow food to enter the stomach and then prevent anything from moving back up into the esophagus.
In the case of acid reflux, the lower esophageal sphincter fails to close completely or may otherwise malfunction and allow stomach contents to travel back up. One of the reasons this is problematic is the stomach acid that gets mixed in with the food during peristalsis, a sequence of aggressive contractions in the wall of the stomach that helps break down food. The lining of the esophagus is different from the lining of the stomach, and it isn’t equipped to handle the corrosiveness of stomach acid. As a result, the presence of acid in the esophagus can cause a number of symptoms:
- painful burning sensation in the middle of the chest
- possible regurgitation of food and stomach acid into the back of the throat
- difficulty swallowing
- painful swallowing
- coughing or hoarseness
- bad breath
An occasional bout of acid reflux after eating a meal of fried or spicy food is a fairly common experience and isn’t usually a cause for concern. When problems with the function of the LES continue to persist, it is considered a chronic condition and usually then classified as GERD. GERD is less common, but it still is estimated to affect around 20% of the population of the United States. If left untreated, GERD can lead to permanent esophageal damage and a variety of complications like Barrett’s esophagus, reflux esophagitis, an esophageal stricture, or even esophageal cancer (adenocarcinoma).
What Causes Acid Reflux and GERD?
As noted, the underlying problem that leads to the development of GERD is a lower esophageal sphincter that doesn’t relax or close properly, but there isn’t a single reason for this. In fact, there are numerous risk factors that are known to weaken or cause damage to the LES and thus increase the likelihood of GERD:
- Overeating: In general, eating beyond satiety means the stomach is too full and this causes stomach acid to accumulate at the top near the LES. This makes acid reflux more likely, and, over time, a pattern of overeating can damage the LES and lead to the chronic problems associated with GERD.
- Obesity: In addition to the potential problems that come with overeating, being obese can also increase the chances of GERD. This is because carrying excess body weight in the abdomen puts constant pressure on the stomach and LES. This pressure can both harm the LES and exacerbate any other forces that might be negatively affecting its opening and closing.
- Smoking: Smoking is related to many poor health outcomes, and that includes the damage caused by inflammation of the esophageal lining. Yet smoking can also contribute to GERD through the relaxing effect of nicotine on the LES, and it may even increase the acidity of stomach acid.
- Medication: Several kinds of prescription and over-the-counter medications are known to relax the LES in a way that increases the chances of developing GERD. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), proton pump inhibitors (PPIs), calcium channel blockers, tricyclic antidepressants, and some types of asthma medication.
- Hiatal hernia: A hiatal hernia is a condition in which a part of the stomach has pushed up through the diaphragm, the sheet of muscle in the abdominal cavity that aids in breathing and keeps organs in place. When this occurs, it puts pressure on the LES and causes it to become misshapen or damaged.
- Pregnancy: Pregnant women are also more likely to develop GERD symptoms during the course of their pregnancy because of the added weight of the fetus putting pressure on the LES.
How Does Alcohol Affect Acid Reflux?
Another observed risk factor for GERD is related to excessive alcohol consumption. Like with other lifestyle factors, however, the precise relationship between alcohol and GERD is not fully understood. Yet the consensus is that alcohol causes both inflammation of the stomach lining and impaired function of the lower esophageal sphincter. There is also ample evidence that alcohol use exacerbates the symptoms of GERD and increases the likelihood of complications like Barrett’s esophagus, a condition that involves a permanent change in the esophageal lining at a cellular level.
In summary, drinking alcohol may not directly cause GERD, but it’s clear that it can be a contributing factor and will likely make already existing GERD symptoms worse. A person suffering from GERD may be able to drink a small amount of alcohol without immediately triggering symptoms, but it should definitely be limited and only done in moderation. The same basic principle applies to those who haven’t yet been diagnosed with GERD but may have occasional bouts of acid reflux or have some of the other risk factors.
Treatment Options for Acid Reflux and GERD
For mild, temporary acid reflux, the treatment is typically an over-the-counter antacid or simply avoiding alcoholic drinks or any other foods or beverages that can trigger symptoms; some foods that tend to be triggers are fried foods, fast food, spicy foods, fatty meats, cheese, citrus fruits, tomato-based sauces, chocolate, and carbonated beverages. Not all of these foods affect everyone in the same way, however, so a bit of trial and error may be necessary to know which specific foods are best to avoid. Yet even for trigger foods, some may be able to be enjoyed in limited quantities without causing symptoms.
Treatment for GERD naturally involves a similar process of limiting or avoiding the foods that may exacerbate symptoms. Other lifestyle choices can also have an impact, including losing weight if you’re obese or reducing the quantity of food consumed during meals. For the sake of GERD and many other health reasons, it is also important to quit smoking as soon as possible. Symptoms of GERD can also be somewhat mitigated at night while sleeping by elevating the head with extra pillows or a foam wedge; doing this causes gravity to work in your favor by making it less likely to have stomach acid flow up into the esophagus.
For severe or long-lasting cases of GERD, prescription medications may be necessary to get relief from the symptoms. Both H2 blockers and proton pump inhibitors (PPIs) can reduce stomach acid production, and PPIs are also able to heal some of the damage done to the esophagus. In extreme cases, a type of surgery called fundoplication may be necessary; this procedure involves suturing the top of the stomach around the bottom of the esophagus in order to help the lower esophageal sphincter close more completely.
Contact an Expert in Gastroenterology
Whether you only have an isolated incidence of heartburn or you’ve been diagnosed with GERD, problems with the gastrointestinal system can sometimes be very difficult to deal with. These kinds of problems also have a tendency to negatively impact your quality of life. That’s why at Cary Gastro we are dedicated to providing excellent digestive care and are passionate about promoting mindfulness about your health. If you have been experiencing gastrointestinal symptoms that are negatively impacting your life, please contact us today to request an appointment.