When you think of acid reflux (heartburn), you usually think of it as being related to issues between your stomach and esophagus. But can there also be a correlation between acid reflux and liver disease?

This article will take a closer look at the possible link between acid reflux and liver disease, as well as the symptoms, treatment options, and prevention strategies for both conditions.

Acid reflux occurs when stomach acid backs up into the esophagus. This is the tube that carries food from your mouth down to your stomach.

Minor cases of acid reflux, which can occur after an especially spicy meal or taking certain medications, generally don’t require medical attention.

A more serious type of acid reflux is called gastroesophageal reflux disease (GERD). It’s characterized by:

  • frequent bouts of heartburn
  • a bitter or sour taste at the back of the mouth
  • difficulty swallowing
  • nausea
  • chest pain, especially when lying down after a meal

GERD often requires prescription medications or other treatment, as well as dietary and lifestyle adjustments.

About liver disease

There are several types of liver disease, all of which can affect the functions the liver performs, including:

  • filtering waste products and toxins out of the blood
  • making bile, a substance that aids in digestion
  • metabolizing nutrients
  • regulating blood levels in the body

When the liver is damaged by disease or injury, some serious health complications can ensue.

Possible links between acid reflux and liver disease

It’s not uncommon for people with serious liver conditions, such as cirrhosis or liver failure, to also have GERD.

In a 2021 study of people with liver cirrhosis, researchers found that 83% of them had GERD. It’s thought that a condition called ascites may largely explain the prevalence of GERD among these individuals.

Ascites is often a complication of cirrhosis. It causes fluid buildup in the abdomen, and the pressure of fluid in the abdomen may contribute to GERD-like symptoms, as well as abdominal pain and shortness of breath.

A separate 2020 study of people with liver cirrhosis suggested that this liver condition is associated with several factors that can cause abnormal activity of the muscles of the esophagus, which can trigger acid reflux.

Possible links between acid reflux and liver health

A 2017 study suggested that people with GERD may be at a higher risk for nonalcoholic fatty liver disease (NAFLD). While the study didn’t demonstrate how GERD may cause NAFLD, the researchers suggest that the two conditions may often coexist because they share similar risk factors, such as obesity.

A more clear-cut example of how GERD may impact liver health was noted in a 2017 study. The researchers found that the use of proton pump inhibitors (PPIs) — a common acid reflux treatment — may raise the risk of alcoholic liver disease among people who use alcohol.

The study suggested that because PPIs reduce the secretion of gastric acid, the medications may inadvertently facilitate the overgrowth of an intestinal bacterium called Enterococcus, which may raise the risk of liver disease.

It’s not always clear when acid reflux symptoms could be related to liver disease or vice versa. However, if you’ve recently been diagnosed with liver disease and you begin to experience acid reflux more often, it could be a complication of liver disease.

An older study found that the following symptoms are also associated with NAFLD:

Liver diseases don’t always show symptoms in their early stages, but when they do, they can include:

Schedule an appointment with your doctor if you experience any of these symptoms or if you start experiencing heartburn frequently without a change in your diet or lifestyle.

Acid reflux is usually treated with medications that either reduce stomach acid production or neutralize stomach acid. Over-the-counter options include:

  • antacids to neutralize stomach acid
  • H-2 receptor blockers to reduce stomach acid production, such as cimetidine and famotidine
  • proton pump inhibitors (PPIs)

For GERD, your doctor may suggest prescription-strength H-2 receptor blockers in addition to PPIs. But given the association between PPIs and NAFLD, you may be advised to try other medications first, especially if liver disease has been diagnosed or if you’re at high risk for liver issues.

Talk with your doctor about having your liver enzymes tested before starting PPIs to determine whether you already have any liver complications.

There are no formal treatments or cures for certain liver conditions, such as cirrhosis and NAFLD. If cirrhosis becomes severe, a liver transplant may be the only treatment option.

Generally, liver conditions are managed by making significant lifestyle changes that focus on weight management and alcohol avoidance.

Liver disease and acid reflux can sometimes be prevented through changes in diet and lifestyle. Some common strategies to manage liver disease symptoms or prevent the onset of liver disease include:

  • drinking little or no alcohol
  • eating a low fat, well-balanced diet
  • eating smaller more frequent meals
  • exercising for at least 30 to 40 minutes most days of the week
  • losing weight if you’re overweight
  • quitting smoking if you smoke

To help prevent acid reflux, consider the lifestyle strategies outlined above as well as the following:

  • Avoid triggers, such as spicy foods, fatty foods, carbonated beverages, citrus juices, and alcohol.
  • Elevate the head of your bed to prevent acid from pooling in the esophagus.
  • Maintain a moderate weight.
  • Sleep on your left side to aid digestion.
  • Wait several hours after eating before lying down.

Acid reflux and liver disease can sometimes accompany each other, especially if you have liver cirrhosis, NAFLD, or liver failure. You may also be at risk of developing liver problems if you take PPIs for acid reflux.

If you’re overweight and sedentary, you may face an elevated risk for both acid reflux and liver disease.

While maintaining a moderate weight, exercising regularly, and limiting your intake of alcohol are good tips for overall health, they can be especially helpful in preventing or managing both acid reflux and liver disease.

If you experience any symptoms of these conditions, make an appointment to see your doctor. Early diagnosis of your symptoms may help you avoid complications later on.