Stomach pain and acid reflux are common symptoms. Every person experiences these symptoms to some extent but often they are self-limited and resolve without the need for treatment. For some patients these symptoms occur regularly causing distress, discomfort with indigestion, and limit what they can eat. Untreated stomach pain and acid reflux can lead to serious conditions such as bleeding, narrowing of the esophagus, perforation (a hole in the gut), or cancer. While most patients with stomach pain and acid reflux self-medicate by using over the counter medications, it is important to get checked. The proper evaluation and treatment are key to control or resolve the symptoms, or in some patients to diagnose other conditions.
What causes stomach pain and acid reflux?
Factors that contribute to or worsen stomach pain and acid reflux include alcohol, autoimmune disease, diabetes, diet (caffeine, citrus fruits, spices), internal hernia of the stomach, infections, late night eating, medications such as non-steroidal anti-inflammatory medications (such as aspirin, ibuprofen, naproxyn), obesity, pregnancy, smoking, and stress. Stomach pain and acid reflux have many potential causes, some more serious than others. Most often the symptoms are related to hyperacidity of the stomach and/or reflux of acid into the esophagus. The bottom of the esophagus has a circular band of sphincter muscle which acts as a gatekeeper to the stomach. When food travels down the esophagus, the muscle relaxes to allow the food to enter the stomach and then it closes. A weakened muscle does not close properly. As such the acid travels upwards inside the esophagus causing inflammation and symptoms. In cases of prolonged and severe reflux, cancerous changes can occur in the esophagus.
It is important to note that many other conditions can mimic these symptoms. The following list provides some basic information and is not intended for self-diagnosis or as a substitute for a formal medical evaluation:
- Achalasia (non-relaxation of esophageal sphincter muscle)
- Cancer and tumors
- Diverticulum (pocket protrusion from the lining of esophagus)
- Infections of the esophagus including yeast infection
- Gastroesophageal reflux disease (the stomach acid flows back into the esophagus due to a weakness of the lower esophagus sphincter muscle)
- Stricture (narrowing of the esophagus)
- Cancer and tumors
- Gastritis (inflammation of the stomach)
- Helicobacter pylori bacteria infection
- Hiatal hernia (a hole in the diaphragm with protrusion of the stomach into the chest)
- Cancer and tumors
- Celiac disease or gluten allergy
- Crohn’s disease
When are stomach pain and acid reflux of concern?
While stomach pain and acid reflux often resolve on their own, it is important to seek medical care if you have any of the following symptoms:
- Bloody or dark stools
- Bloating in the upper abdomen with cramps
- Burning sensation in your chest (worse after eating or at night time)
- Chest pain
- Cough (especially at nighttime)
- Difficulty swallowing food
- Feeling of a lump in your throat
- Frequent need to take over the counter medications
- Hoarse voice, especially in the morning
- Smelly breath or frequent sour taste in the mouth
- Vomiting blood
- Vomiting of undigested food
- Weight loss
What tests are needed to evaluate stomach pain and acid reflux?
When you visit the clinic of Dr. Maher Abbas, he will take a complete history and perform a physical examination to determine the tests that are needed. Often the history and physical examination are sufficient to formulate a diagnosis and treat you. It is important that you bring with you the reports of any previous tests and a list of medications you have used. Depending on the location, duration, type of abdominal pain, and associated symptoms, one or more tests may be needed. Dr. Maher Abbas will customize your tests in order to provide you with the highest quality of care. Tests that are useful to assess stomach pain and acid reflux, include but are not limited to the following:
Blood tests: CBC (complete blood count to assess for anemia or infection), liver function test, renal (kidney) function test, CRP (C reactive protein) to check for inflammation, thyroid test, calcium level, celiac disease serology, helicobacter pylori bacteria serology
Breath test: urea breath test for helicobacter pylori bacteria
Endoscopic procedures: Gastroscopy (endoscopy) with biopsy to check inside the esophagus, stomach, and duodenum. A thin, flexible tube with a light and camera mounted at the tip is inserted down the throat and used to inspect these organs
Radiologic examinations: ultrasound of the abdomen may be needed if there is suspicion that the stomach pain is related to gallstones. In some cases, Dr. Maher Abbas may recommend a CT scan (computed tomography) of the abdomen especially if there are concerning signs or symptoms such as weight loss or an abnormal physical examination
Stool tests: calprotectin level (to check for inflammation), guaiac or the FIT test (fecal immunochemical test) to check for blood in the stool, helicobacter pylori bacteria toxin for bacterial infection
Other tests: additional specialized tests that are indicated in some patients with severe symptoms include: 1] acid (pH) probe test to check for how often acid refluxes inside the esophagus, 2] manometry to check the pressures inside the esophagus, 3] X-ray studies of the digestive system (esophagram) to assess the esophagus during swallowing. For patients who need these additional evaluations, the proper referrals will be arranged.
How are stomach pain and acid reflux treated?
Most people can manage the discomfort of stomach pain and acid reflux with lifestyle changes. Avoiding large meals late in the evening, decreasing alcohol and caffeine intake (such as coffee or chocolate), limiting exacerbating ingredients like heavy spices, garlic or onion, fatty meals, or citrus based products can be very helpful. Ideally the last meal of the day should be 4 or more hours before bedtime. Elevating the head of the bed or sleeping with the head resting on 2 pillows can help with symptoms control. For patients who sleep alone, inserting a wedge between the mattress and the bed to elevate the body from the waist up can be helpful. Alternatively placing a cement or wood block to elevate the head by 15 to 20 centimeters can be helpful.
A large number of over the counter medications are available to treat patients with mild to moderate symptoms. Most of these products contain anti-acid ingredients. Products like Gaviscon, Mylanta, Maalox, Rolaids, and Tums can provide temporary relief. However excessive use may trigger diarrhea or kidney problems. Other medications include H-2-receptor blockers which can suppress acid production. They include Zantac, Tagamet, and Pepcid. These medications are available over the counter in low dosage or by prescription for higher dosage. Other prescription medications include proton pump inhibitors which are more potent medications that block acid secretion by several mechanisms. Numerous medications are currently available on the market and most need to be used daily for a period of time to be effective. Commonly prescribed medications include Nexium, Prilosec, Prevacid, Dexilant, Lanzor, and Protonix. These medications are safe in the short-term but recently there has been concerns about their long-term use leading to bone osteoporosis and fractures.
In addition to medications that neutralize acid or suppress its secretion, patients who are positive for the helicobacter bacteria need antibiotics treatment to eradicate the infection. Patients with other types of conditions need to be treated based on diagnosis.
The majority of patients with stomach pain and acid reflux improve with medical treatment and lifestyle modifications. However, patients with severe acid reflux, symptomatic hiatal hernia, and non-healing ulcers need surgical intervention. Furthermore, some of the other conditions listed earlier such as achalasia, cancer, and tumors require surgery. If surgery is necessary, Dr. Maher Abbas will explain to you the type of surgery needed and will refer you to surgical colleagues who specialize in minimally invasive surgery for the esophagus and stomach.
If you would like to schedule a consultation with Dr. Maher Abbas, click here. If you have previously undergone any testing, kindly bring all outside reports and imaging studies for Dr. Maher Abbas to review the day of your consultation.