Regurgitation is the expulsion of material from the pharynx, or esophagus, usually characterized by the presence of undigested food or blood.
Regurgitation is used by a number of species to feed their young.[rx] This is typically in circumstances where the young are at a fixed location and a parent must forage or hunt for food, especially under circumstances where the carriage of small prey would be subject to robbing by other predators or the whole prey is larger than can be carried to a den or nest. Some bird species also occasionally regurgitate pellets of indigestible matter such as bones and feathers.[rx]
A ring-shaped muscle (sphincter) between the stomach and esophagus normally helps prevent regurgitation. Regurgitation of sour-tasting or bitter-tasting material can result from acid coming up from the stomach. Regurgitation of tasteless fluid containing mucus or undigested food can result from a narrowing (stricture) or a blockage of the esophagus or from an abnormal pouch in the esophagus called a Zenker diverticulum. The blockage may result from acid damage to the esophagus, ingestion of caustic substances, cancer of the esophagus, or abnormal nerve control that interferes with coordination between the esophagus and its sphincter at the opening to the stomach (achalasia).
Causes of Regurgitation
- Eating large meals or lying down right after a meal
- Being overweight or obese
- Eating a heavy meal and lying on your back or bending over at the waist
- Snacking close to bedtime
- Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods
- Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea
- Being pregnant
- Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications
Symptoms of Regurgitation
- Top Symptoms: stomach bloating, nausea, dyspeptic symptoms, bloating after meals, vomiting
- Symptoms that always occur with functional dyspepsia/indigestion: dyspeptic symptoms
- Symptoms that never occur with functional dyspepsia/indigestion: vomiting (old) blood or passing tarry stools, rectal bleeding, bloody diarrhea, fever
If you’re experiencing regurgitation, it can likely be described by the following
- Effortless vomiting
- No presence of nausea
- Sore esophagus and dental problems from acid erosion
Regurgitation is embarrassing but more importantly, repeated episodes can cause considerable damage to the delicate tissue in the throat. Finding the cause of your regurgitation symptoms is important for effective treatment.
Diagnosis of Regurgitation
Your doctor might be able to diagnose regurgitation based on a physical examination and history of your signs and symptoms.
To confirm a diagnosis of GERD, or to check for complications, your doctor might recommend:
- Upper endoscopy – Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Test results can often be normal when reflux is present, but an endoscopy may detect inflammation of the esophagus (esophagitis) or other complications. An endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications such as Barrett’s esophagus.
- Ambulatory acid (pH) probe test – A monitor is placed in your esophagus to identify when, and for how long, stomach acid regurgitates there. The monitor connects to a small computer that you wear around your waist or with a strap over your shoulder. The monitor might be a thin, flexible tube (catheter) that’s threaded through your nose into your esophagus, or a clip that’s placed in your esophagus during an endoscopy and that gets passed into your stool after about two days.
- Esophageal manometry – This test measures the rhythmic muscle contractions in your esophagus when you swallow. Esophageal manometry also measures the coordination and force exerted by the muscles of your esophagus.
- X-ray of your upper digestive system – X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help diagnose a narrowing of the esophagus that may interfere with swallowing.
Treatment of Regurgitation
Your doctor is likely to recommend that you first try lifestyle modifications and over-the-counter medications. If you don’t experience relief within a few weeks, your doctor might recommend prescription medication or surgery.
The options include:
- Antacids that neutralize stomach acid – Antacids, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney problems.
- Medications to reduce acid production – These medications — known as H-2-receptor blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid AR). H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.
- Medications that block acid production and heal the esophagus – These medications — known as proton pump inhibitors — are stronger acid blockers than H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC).
- Prescription-strength H-2-receptor blockers. These include prescription-strength famotidine (Pepcid) and nizatidine. These medications are generally well-tolerated but long-term use may be associated with a slight increase in risk of vitamin B-12 deficiency and bone fractures.
- Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). Although generally well-tolerated, these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency. Chronic use might increase the risk of hip fracture.
- Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects might include fatigue or nausea.
Surgery and other procedures
GERD can usually be controlled with medication. But if medications don’t help or you wish to avoid long-term medication use, your doctor might recommend:
- Fundoplication. The surgeon wraps the top of your stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of the stomach can be partial or complete.
- LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The LINX device can be implanted using minimally invasive surgery.
- Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth with a device called an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance.
Natural Treatment of
If you have a large hiatal hernia, TIF alone is not an option. However, it may be possible if TIF is combined with laparoscopic hiatal hernia repair.
If you’ve been having repeated episodes of heartburn—or any other symptoms of acid reflux—you might try the following:
1. Eat sparingly and slowly
When the stomach is very full, there can be more reflux into the esophagus. If it fits into your schedule, you may want to try what is sometimes called “grazing”—eating small meals more frequently rather than three large meals daily.
2. Avoid certain foods
People with acid reflux were once instructed to eliminate all but the blandest foods from their diets. But that’s no longer the case. “We’ve evolved from the days when you couldn’t eat anything,” Dr. Wolf says. But there are still some foods that are more likely than others to trigger reflux, including mint, fatty foods, spicy foods, tomatoes, onions, garlic, coffee, tea, chocolate, and alcohol. If you eat any of these foods regularly, you might try eliminating them to see if doing so controls your reflux, and then try adding them back one by one.
3. Don’t drink carbonated beverages
They make you burp, which sends acid into the esophagus. Drink flat water instead of sparkling water.
4. Stay up after eating
When you’re standing, or even sitting, gravity alone helps keeps acid in the stomach, where it belongs. Finish eating three hours before you go to bed. This means no naps after lunch, and no late suppers or midnight snacks.
5. Don’t move too fast
Avoid vigorous exercise for a couple of hours after eating. An after-dinner stroll is fine, but a more strenuous workout, especially if it involves bending over, can send acid into your esophagus.
6. Sleep on an incline
Ideally, your head should be 6 to 8 inches higher than your feet. You can achieve this by using “extra-tall” bed risers on the legs supporting the head of your bed. If your sleeping partner objects to this change, try using a foam wedge support for your upper body. Don’t try to create a wedge by stacking pillows. They won’t provide the uniform support you need.
7. Lose weight if it’s advised
Increased weight spreads the muscular structure that supports the lower esophageal sphincter, decreasing the pressure that holds the sphincter closed. This leads to reflux and heartburn.
8. If you smoke, quit
Nicotine may relax the lower esophageal sphincter.
9. Check your medications
Some—including postmenopausal estrogen, tricyclic antidepressants, and anti-inflammatory painkillers—can relax the sphincter, while others—particularly bisphosphonates like alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel), which are taken to increase bone density—can irritate the esophagus.