Brief summary: Acid reflux occurs when acidic stomach contents flow back into the oesophagus and the mouth. It is most commonly caused by gastro-oesophageal reflux disease (GERD), but it can also be caused by delayed gastric emptying or an ulcer. In cases of persistent symptoms, an upper gastrointestinal endoscopy can help to establish an accurate diagnosis.
The reflux of an acidic, unpleasant-tasting fluid from the stomach affects many people, yet few know what actually causes it. If you regularly experience acid reflux, heartburn or regurgitation, you are not alone – 10–20% of the Western population suffer from similar reflux symptoms. The good news is that the causes of acid reflux are well understood and, in most cases, can be effectively treated.
In this article, we explain in simple terms what gastric acid vomiting is, what symptoms to look out for, and what diagnostic and treatment options are available. We’ll also explain when you should see a specialist and how a pain-free examination under anaesthesia can help identify the root cause of the problem.
What is acid reflux?
During vomiting, the stomach contents – which contain hydrochloric acid and digestive juices – flow back into the oesophagus, and in some cases as far as the mouth. It is important to distinguish between a number of similar phenomena:
- Regurgitation: the effortless reflux of a small amount of stomach contents into the mouth.
- Vomiting (emesis): the forceful emptying of the stomach contents, accompanied by muscle contractions.
- Heartburn (pyrosis): a burning sensation behind the breastbone, which may radiate towards the jaw.
The most common underlying condition is gastro-oesophageal reflux disease, or GERD. According to the 2006 Montreal definition, reflux disease is the totality of all unpleasant symptoms and complications that arise as a result of the backflow of stomach contents. When this reflux of acid is accompanied by nausea or vomiting, it is referred to as acid regurgitation.
What could be the causes of acid reflux?
There may be several physiological processes and medical conditions underlying vomiting of stomach acid. There are two main mechanisms underlying reflux disease:
- TLESR (transient lower oesophageal sphincter relaxation): a reflex triggered by tension in the stomach, which temporarily relaxes the sphincter.
- Impaired oesophageal clearance: The acid in the reflux remains in contact with the mucous membrane for a longer period of time, causing damage to it.
The refluxed fluid may contain hydrochloric acid and pepsin, as well as bile acids and pancreatic juice from the duodenum. In addition to reflux, other possible causes include:
- Delayed gastric emptying (gastroparesis): Slowed gastric emptying can cause a feeling of fullness after a meal, nausea and the regurgitation of undigested food.
- Stomach ulcer: In addition to upper abdominal pain, nausea and, in some cases, vomiting may also occur.
- Helicobacter pylori infection: It can lead to inflammation and the formation of ulcers.
What risk factors increase the likelihood of symptoms?
A number of lifestyle and individual factors play a role in the development of acid reflux and vomiting. The most common risk factors are:
- age and gender
- obesity and hiatal hernia
- smoking and alcohol consumption
- large, high-fat meals, as well as chocolate and caffeinated drinks
- certain medicines (such as calcium channel blockers and sedatives)
- strenuous physical activity immediately after a meal
It is useful to be aware of lifestyle factors because most of them are within your control. Even small changes can help alleviate your symptoms.
What symptoms should you look out for?
Acidic vomiting rarely occurs on its own. It is often accompanied by symptoms characteristic of reflux disease, which can make everyday life difficult. Typical complaints include:
- heartburn and acid reflux
- a burning sensation behind the breastbone after a meal
- a sour or bitter taste in the mouth
- chest pain not caused by a heart problem
- nausea and abdominal discomfort
- atypical symptoms: hoarseness, chronic cough, throat discomfort, bad breath
When should you see a doctor? Warning signs
Certain signs – known as ‘alarm symptoms’ – always require assessment by a specialist, as they may indicate a more serious underlying condition. You should consult a gastroenterologist immediately if you experience any of the following:
- difficulty swallowing (dysphagia) or pain when swallowing
- haematemesis or coffee-ground-like vomit
- black or bloody stools
- unexplained weight loss and loss of appetite
- anaemia due to iron deficiency
- symptoms that do not respond to acid-reducing treatment
These symptoms may indicate a more serious condition affecting the oesophagus or stomach, or even a cancerous process, which is why a thorough examination is essential.
How is vomiting caused by stomach acid diagnosed?
An accurate diagnosis is the basis for appropriate treatment. Typical symptoms and a good response to antacids often confirm the diagnosis of reflux disease in themselves. Several diagnostic methods are available:
- Gastroscopy (gastroscopy): Direct examination of the mucous membranes of the oesophagus and stomach, assessment of the severity of oesophagitis, and histological sampling. This examination is mandatory in the event of warning signs.
- 24-hour pH monitoring: measuring episodes of acidity and confirming their link to symptoms.
- Manometry: to rule out oesophageal motility disorders, typically prior to planned surgery.
- Empirical PPI test: In the presence of typical symptoms, but in the absence of warning signs, a favourable response to acid-reducing treatment confirms the diagnosis.
An upper gastrointestinal endoscopy may seem daunting to many people, yet when carried out using modern techniques under general anaesthesia, it is completely painless. The Gastroscopy under general anaesthesia at Endomedix The examination is carried out under propofol anaesthesia, under the supervision of an experienced anaesthetist. You will be asleep throughout the procedure and will not feel a thing.
What treatment options are available?
Treatment for acid reflux usually involves a combination of lifestyle changes and medication. The aim is to reduce acid exposure and protect the mucous membrane.
Lifestyle changes
Non-medicinal treatment is often the first step. Effective methods include:
- raising the head of the bed for sleeping
- avoiding trigger foods (fatty, spicy and acidic foods)
- eating smaller portions, spreading meals out over the day
- weight loss for those who are overweight
- not eating before going to bed
- giving up smoking and excessive alcohol consumption
Drug therapy
Acid-reducing agents form the basis of treatment:
- Proton pump inhibitors (PPIs): gold standard drugs that inhibit gastric acid production. Ideally, they should be taken 30–60 minutes before breakfast. In typical cases of GERD, the usual treatment is a single daily dose for eight weeks.
- H2 receptor antagonists: They are suitable for moderate symptoms.
- Antacids and alginates: For the rapid relief of occasional, mild symptoms.
Long-term use of PPIs may have side effects; therefore, treatment is always carried out under medical supervision and tailored to the individual. In cases where symptoms persist and do not respond to medication, surgical options, such as laparoscopic fundoplication, may be considered.
Endomedix helps to get to the root of the problem
At Endomedix’s gastroenterology centres, experienced specialists carry out investigations into reflux disease and acid regurgitation. The team’s professional expertise, combined with state-of-the-art equipment, ensures an accurate diagnosis and a personalised treatment plan.
An important professional principle: at Endomedix, endoscopic examinations are not carried out under sedation, but under genuine propofol anaesthesia. This means that you will be in a deep, restful sleep for the entire duration of the procedure, whilst an anaesthetist continuously monitors your vital signs. This ensures that the examination is not only pain-free but also stress-free.
If your symptoms clearly point to reflux, the Gastroscopy provides an accurate picture of the condition of the oesophagus and stomach. If your symptoms also affect the lower digestive tract – for example, if they are accompanied by bowel problems or blood in the stools – it may be worth gastroscopy and colonoscopy under general anaesthesia to request that both examinations be carried out under a single anaesthetic.
Don’t put off getting checked out. Book an appointment for a consultation with a gastroenterologist, where our specialists will discuss your symptoms with you and recommend the most appropriate examination.
Frequently asked questions
What is the difference between regurgitation and vomiting?
Regurgitation is the effortless reflux of stomach contents into the oral cavity, without any muscular contractions. Vomiting, by contrast, is the forceful expulsion of stomach contents accompanied by contraction of the abdominal and diaphragmatic muscles. In the case of acid regurgitation, the contents that come up are acidic, causing the characteristic burning sensation and unpleasant taste.
How dangerous is persistent acid vomiting?
If left untreated, persistent acid reflux can lead to complications such as oesophagitis, oesophageal stricture and the development of Barrett’s oesophagus, which is associated with an increased risk of cancer. For this reason, it is always advisable to have persistent symptoms investigated.
Does a gastroscopy hurt?
A gastroscopy under general anaesthetic is completely painless. Thanks to the propofol anaesthetic, you will sleep through the entire procedure and will not remember anything about it afterwards. The anaesthetist will monitor your vital signs throughout the procedure.
When is medication sufficient, and when is further investigation required?
In cases of typical, mild symptoms and the absence of warning signs, lifestyle changes and acid-reducing treatment are often sufficient. Further investigation is required if warning signs appear, if the symptoms do not respond to treatment, or if they recur after stopping the medication.
Which test should I choose if I’m also experiencing symptoms in my lower digestive tract?
If, in addition to acidic vomiting, you also experience bowel problems, bloody stools or unexplained weight loss, it may be worth having both the upper and lower digestive tracts examined. During gastroscopy and colonoscopy under general anaesthesia, both examinations can be carried out under a single anaesthetic and following a single set of preparatory procedures.
