Gastro-oesophageal reflux disease



Introduction

The commonly used medical term for acid reflux is gastro-oeophageal reflux disease (GORD). Acid reflux is when acid from the stomach leaks up into the gullet (oesophagus). This can cause heartburn and other symptoms.

What are the symptoms of acid reflux/ GORD?

  1. Heartburn: is the main symptom, this is a burning feeling which rises from the upper stomach/ or lower chest and towards the neck.
  2. Acidic taste in the mouth
  3. Belching
  4. Nausea (feeling sick)
  5. Burning pain when you swallow hot drinks.

Less common symptoms include

  1. A persistent cough, often worse at night
  2. Gum problems
  3. Sore throat
  4. Halitosis / bad breath
  5. A feeling of a lump in the throat that comes and goes

What causes acid reflux?

There is a circular band of muscle (called a sphincter) at the junction of the oesophagus and stomach, this normally prevents acid reflux. Problems occur when the sphincter does not work well and this can allow acid to reflux in to the gullet (oesophagus). If you have a hiatus hernia, which is when part of the stomach protrudes in to the chest through a hole in the diaphragm then you have an increased chance of developing reflux.

Do you require any Investigations?

If you have typical symptoms then you may not require any investigations and instead may be given medication to treat the problem and see whether there is improvement.
If you require investigation, the most common initial investigation is a Gastroscopy/ upper gastrointestinal endoscopy (see link).

The endoscopy may demonstrate oesophagitis. Oesophagitis is when the gullet (oesophagus) becomes inflamed. At the time of endoscopy the doctor can see inflammation and sometimes ulceration which may be causing the symptoms.

Can I do anything to improve my symptoms?

  1. Stop Smoking: Smoking cigarettes can cause indigestion and excess acid.  The chemicals in cigarettes may relax the sphincter muscle and therefore cause acid reflux. Smoking can decrease appetite and also affecting taste.
  2. Avoid Alcohol: Avoid drinking excessive alcohol. Alcohol in the evenings especially with a heavy meal is also likely to worsen symptoms. Beer, red wine and straight spirits without mixers can make symptoms worse.
  3. Foods: Certain foods can worsen symptoms for certain people. Therefore, if some foods are causing problems try avoiding them. Commonly foods that worsen symptoms are: spicy foods, tomatoes, hot drinks, coffee, alcoholic drinks, chocolate and fried foods.
  4. Avoid Large meals: eating large meals can cause symptoms to worsen, especially in the evening.
  5. Loose excessive Weight: If you are overweight it puts extra pressure on the stomach and encourages acid reflux.
  6. Night time: If you suffer from predominantly night time symptoms when you are asleep. Then aim not to eat or drink anything for at least 3 hours prior to sleeping.  Raising the head end of the bed may help reduce reflux.

Treatment

There are a number of medications for treatment of acid reflux/ GORD.

  1. Antacids: these are alkali liquids or tablets that neutralise the acid in the stomach. They often work very quickly e.g. gaviscon.
  2. Acid suppressing drugs: There are two groups of drugs which your doctor may prescribe you. One group are called proton- pump inhibitors e.g. omeprazole or lanzoprazole and the other histamine (H2)-receptor blockers e.g. ranitidine.
  3. Prokinetic drugs: in some cases doctors may try pro-kinetic drugs to help with emptying the stomach.
  4. Surgery: In severe case, there is an operation that can tighten the lower oesophagus to prevent acid refluxing to the oesophagus.  Usually this is performed by keyhole (laparoscopic) surgery.