Reflux

Reflux refers to the backward flow of material from the stomach or duodenum into the esophagus or upper gastrointestinal tract. The term is most often used to describe gastroesophageal reflux, in which stomach acid irritates the lining of the esophagus. Reflux episodes are common in healthy people, but become a medical concern when symptoms are frequent, persistent, or lead to complications. Bile reflux, the backward flow of bile from the small intestine, can accompany acid reflux in some cases.

The underlying cause usually involves dysfunction of the lower esophageal sphincter (LES), allowing stomach contents to escape into the esophagus. Factors that increase reflux include transient LES relaxations, hiatal hernia, obesity, pregnancy, and certain foods or medications. Lifestyle factors such as smoking and heavy alcohol use can worsen reflux.

Symptoms commonly include heartburn, regurgitation, a sour or bitter taste, chest pain, and dysphagia. Chronic or atypical symptoms may involve chronic cough, laryngitis, asthma-like symptoms, or dental erosion. When reflux is persistent or leads to esophageal injury, it is categorized as gastroesophageal reflux disease (GERD).

Diagnosis starts with symptom assessment and can be supported by tests such as endoscopy to evaluate mucosal damage, ambulatory pH monitoring to measure acid exposure, and esophageal manometry to assess motility.

Treatment emphasizes lifestyle changes and medications. Lifestyle measures include weight loss, elevating the head of the bed, avoiding late meals and trigger foods, and smoking cessation. Medications range from antacids for quick relief to H2 receptor blockers and proton pump inhibitors for longer-term acid suppression. Prokinetic agents may be used in select cases. Refractory GERD or anatomical problems may require surgical intervention, such as fundoplication. Complications include esophagitis, strictures, Barrett’s esophagus, and, rarely, esophageal cancer.