Acid reflux is universal and mostly silent but may cause some unusual symptoms with potentially serious consequences.

       The stomach is made like the mouth and the esophagus is made like the eye.  If one puts a drop of acidic lemon juice into one’s mouth, it causes no harm but if one puts it in one’s eye, it causes problems.
      The control of acid reflux depends upon the competence of the Lower Esophageal Sphincter.  This muscle, if it remains tight, separates the stomach from the esophagus and prevents acid from rushing up the esophagus.  When, for many reasons, the sphincter becomes lax, it allows the stomach acid to creep up the esophagus, which in turn makes the sphincter more lax, and thus a vicious cycle is established.
      Acid reflux from the stomach into the esophagus begins in infancy and continues till the end of life.  When stomach acidity is high and contact time with the esophagus is prolonged, symptoms usually arise.  Otherwise, the disorder tends to be silent because our defenses—which include salivary flow and peristalsis—come to the rescue and clear the stomach acid out of the esophagus.
      The commonest symptom of reflux is heartburn, a feeling of fire in the pit of the stomach.  Other symptoms include cough, sore throat, chest ache, and neck pain, all of which tend to be chronic and unresponsive to symptomatic remedies and treatments.  A feeling of shortness of breath associated with deep, unsatisfying sighs is a less known manifestation.  Unlike heart or lung diseases where the shortness of breath gets worse with activity, the pseudo-shortness-of-breath of reflux tends to get better with exercise.  This simple distinction provides an excellent clue to the cause of the shortness of breath.
      Conditions that encourage reflux are those that either cause laxity of the Lower Esophageal Sphincter or cause an increase in abdominal pressure that can overcome the sphincter's protection.  Alcohol, caffeine, tobacco, certain medications, and certain foods cause the sphincter to become lax.  Big meals, big drinks, overweight, tight belts, bending at the waist, or lying down flat after meals all cause a rise in abdominal pressure.
      The most serious consequence of reflux is a precancerous transformation of the lower esophagus called Barrett’s Esophagus.  This condition can only be diagnosed by biopsy and may lead to cancer of the esophagus if not properly managed.  Looking down the esophagus with a scope is the best way to screen for this condition.
      The treatment of acid reflux is symptomatic.  There are no good medicines that help the Lower Esophageal Sphincter strengthen its weak muscle fibers.  There are, however, medicines that reduce the stomach acidity and, by doing so, reduce the acid burn to the esophagus.  These medicines are of thee types:
            a) The antacids, or medicines that neutralize the stomach acid but do not influence its production, such as Malox, Mylanta, Tums, etc.
            b) The Histamine-2 blockers that reduce the acid production by acting on the stomach histamine receptors, such as Tagamet, Pepsid, Zantac, etc.
            C) The Proton Pump Inhibitors, which inhibit the stomach proton pump that pushes acid into the stomach, such as Prilosec, Nexium, Prevacid, etc.
      Other treatments involve avoiding the above-mentioned offenders such as alcohol, caffeine, tobacco, big meals, big drinks, bending, lying down after a meal, etc.  Elevating the head of the bed about 2-4 inches reduces reflux because stomach juices will not flow against gravity.
      What medicine to take depends upon the severity of the acid reflux:
            a) If the reflux is episodic, then antacids taken as needed are enough.  Taking baking soda (carbonate) is not a good idea because of the high sodium content, which can cause swelling, high blood pressure, and heart failure.
            b) If the reflux is moderate and frequent, then the Histamine-2 blockers such as Tagamet, Pepsid, and Zantac are adequate and are best taken with meals and at bedtime.
            c) If the reflux is severe and constant, then the Proton Pump Inhibitors are the strongest available and work best if taken before or at the beginning of meals.
      Seeing the doctor is not necessary for most people who can treat their own symptoms with the available medicines.  However, it the symptoms prove resistant to treatment or if they progress and become chronic, then it becomes advisable to see the doctor for proper evaluation and management.