Chronic acid reflux can quietly dissolve tooth enamel from the inside
Heartburn is the famous symptom of reflux disease, but stomach acid escaping upward can also cause a chronic cough, a hoarse voice, asthma-like wheezing and eroded teeth. Between a tenth and a fifth of people in Western countries live with it, and the culprit is usually a faulty valve at the top of the stomach.
Gastroesophageal reflux disease, known as GERD or GORD, is diagnosed when stomach contents flow back into the oesophagus regularly enough to cause symptoms or damage. A little reflux is normal even in healthy people; it becomes a disease only when it turns into a recurring problem. The usual cause is poor closure of the lower oesophageal sphincter, the ring of muscle where the gullet meets the stomach. Obesity, pregnancy, smoking, a hiatal hernia and some medicines, including certain painkillers, antidepressants and asthma drugs, raise the risk.
The condition has been recognised for about a century. In 1925 Friedenwald and Feldman described heartburn and linked it to hiatal hernia, and in 1934 the gastroenterologist Asher Winkelstein blamed the symptoms on stomach acid. Today it is estimated to affect 10 to 20 percent of the Western population, and between 18 and 28 percent in North America.
Symptoms reach well beyond the chest. Acid in the mouth can wear away enamel, especially on the inner surfaces of teeth, leaving a smooth glazed look; fillings may appear to stand proud because tooth dissolves faster than filling material. Babies are common sufferers: up to 35 percent of American infants may have reflux trouble in their first months, though about 90 percent outgrow it by their first birthday. Over time untreated reflux can inflame and narrow the oesophagus or cause Barrett's oesophagus, a change in the lining that can precede cancer.
Doctors usually diagnose it from typical symptoms, and oesophageal pH monitoring is regarded as the most objective test. Treatment described in the medical literature moves from lifestyle measures, such as avoiding lying down for three hours after meals, raising the head of the bed and stopping smoking, to drugs including antacids and proton pump inhibitors, with surgery reserved for people who do not improve.
Source: Gastroesophageal reflux disease
