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Acid Reflux

Acid reflux or GERD occurs when gas, liquid or food particles in the stomach return back up the esophagus (food tube) into the back of the throat (pharynx), mouth, nose, sinuses, middle ear tube (Eustachian tube), or middle ear. This results in irritation (inflammation) and discomfort of these areas. It is important to note that patients don’t always feel the irritation and the symptoms can be ‘silent’. When this occurs, your doctor might see evidence on your physical exam or note other symptoms that are concerning for reflux.

When the reflux enters the upper airway, it is called laryngeal pharyngeal reflux or LPR. When this occurs, it is called GERD/LPR. Unfortunately, up to 60% of the population will have reflux one or more times per week.

As many as 75% of individuals with asthma are at a higher risk of experiencing acid reflux symptoms. In fact, asthmatics are twice as likely to have GERD. Many severe asthmatics have GERD that makes their asthma more challenging to treat. The stomach contents may trigger nerves associated with asthma (particularly cough) or can actually enter the airways (aspiration) resulting in spasm, irritation and asthma symptoms. For these reasons, reflux needs to be considered in individuals with asthma.

Signs and Symptoms of GERD/LPR

  • Nasal congestion and sometimes runny nose
  • Postnasal drainage
  • Cough
  • Hoarseness (particularly in the morning), throat irritation/burning
  • Unusual or bitter taste in the mouth or the back of the throat (brackish water)
  • Difficulty swallowing or choking (particularly at night)  Recurrent sore throat, pneumonia, bronchitis, sinusitis, or ear infections
  • Constant throat clearing
  • Bad breath (halitosis)
  • Burning chest pain (can mimic heart attacks)
  • Abdominal fullness, gas, or belching after meals
  • Chest pain, burning or tightness in the chest after lying down or bending over

If GERD/LPR is diagnosed, your physician may recommend using medications to help block the effects of acid secretion. Anti-acids (like Rolaids or Tums) weaken and neutralize the acid in your stomach, but don’t affect the production of acid and don’t work to prevent symptoms. H2 blockers (like Zantac or Pepcid) lessen the production of acid in your stomach and help prevent symptoms. They tend to work longer but are not quick to act so they don’t alleviate symptoms quickly. Proton Pump Inhibitors or PPIs (like Prilosec, omeprazole or Nexium) are longer acting and make acid less prevalent in the gut. They work by preventing symptoms and must be taken on an empty stomach 30 minutes prior to eating.

All medications including those for acid reflux have potential side effects and these can be discussed with your provider.

Measures That May Help Alleviate Symptoms of GERD/LPR:

  • Elevate the head of your bed 6-8 inches (This can be done by placing the top bedposts on cinder blocks or using a wedge under the top of the mattress. Elevating your head on pillows is not as effective.)  Eat smaller, more frequent meals rather than large ones.
  • No eating or drinking at least 3-4 hours before bedtime.
  • Drinking fluids of any type before bedtime can result in stretching the stomach opening resulting in reflux.
  • Do not skip meals. This can actually result in a 15% increase in daily caloric intake. Skipping meals usually result in overeating of the remaining meals, which can overfill your stomach and increase acid reflux.
  • Lose weight, if needed. We know that those who are overweight do not respond as well to GERD meds as those who are of healthy weight.
  • Avoid bending over, straining, constipation or wearing tight clothes around the abdomen.

Eliminate the following foods and beverages (totally, if all possible)

  • Caffeinated and/or decaffeinated products
  • Alcohol
  • Carbonated beverages of any type
  • Chocolate
  • Mint (includes gums and toothpaste)
  • All types of citrus
  • Fried foods (includes many spicy or fatty foods)
  • Nicotine of any type
  • Dairy

Recent News

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May is Allergy and Asthma Awareness Month

Breathe Better with Asthma, Wherever You Are

If you have asthma, you know that symptoms can come on quickly, then worsen. The things that make them do that are called triggers. An important part of managing asthma is knowing what your triggers are — at home, work, school, or while you’re outdoors. A healthcare provider can help you figure that out, then you can take steps to avoid those triggers and breathe easier.

At home

Because asthma is usually due to allergies, triggers are often allergens, or things that cause allergic reactions. Allergens such as pet dander, dust mites, pests, and smoke can make asthma symptoms worse in some people, and for others, even trigger an asthma attack. The National Heart, Lung, and Blood Institute (NHLBI) suggests that it may be helpful to combine a few different strategies to help reduce exposure to triggers. People sensitive to dust can clean with a high-efficiency particulate air (HEPA) filtration vacuum and use mattress and pillow covers that prevent exposure to dust mites. If you’re sensitive to pests like cockroaches and rodents, consider integrated pest management, which involves removing and controlling pests through methods such as traps or poison. Avoiding tobacco smoke, including secondhand smoke, can be especially helpful for some people with asthma.

At school

Asthma is one of the leading reasons children miss school. At school, kids may be exposed to dust mites, pests, and mold, which may be asthma triggers for some children. Because children spend lots of time at school, it can be helpful for teachers, school nurses, or coaches to know what to do if your child’s symptoms flare up. Team up with a healthcare provider to develop an asthma action plan and share it with trusted adults at your child’s school.

At work

The workplace can have hundreds of potential triggers, like chlorine-based cleaning products, bleaches, hair dyes, and metal dust. Repeated exposures in the workplace can also lead to new triggers. Report new or worsening symptoms that occur at work to your healthcare provider and your workplace supervisor.

Outdoors

Everyday weather like cold, dry air can set off breathing problems. Air pollution can affect asthma, too. It may be helpful to avoid some of the worst pollution by adjusting when and where you exercise. Try to avoid exercising near busy roads or industrial areas. Visit airnow.gov to check your local air quality so you can plan to avoid outdoor activities when pollution is highest.

Managing your triggers is just one part of keeping your asthma under control. Work with a healthcare provider to develop an asthma treatment plan that includes taking medicines as prescribed and keeping track of your symptoms and where you are when they occur. That way, you can know what’s making your asthma worse or better.

Want to learn more about asthma? Visit NHLBI’s Learn More Breathe Better® program at nhlbi.nih.gov/BreatheBetter. Or make an appointment to meet with one of our asthma specialists at Oklahoma Allergy & Asthma Clinic 405-235-0040.

The post May is Allergy and Asthma Awareness Month appeared first on Oklahoma Allergy and Asthma Clinic.

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