Acid Reflux Explained
by Dr Keith Hine
Gastroenterologist Dr Keith Hine discloses the symptoms, causes and possible treatments of Gastro-oesophageal Reflux Disease
The oesophagus (gullet) is the muscular tube that connects the back of the mouth to the stomach. It is about 15 inches in length. After swallowing, food is pushed down the oesophagus by waves of peristalsis – these are rhythmic contractions of the muscles in the wall of the oesophagus. At the lower end of the oesophagus is the cardiac ‘sphincter’, which is a circular muscle that acts as a valve and helps to prevent the stomach secretions getting back into the oesophagus. If this sphincter is weakened, gastro-oesophageal reflux may result. Gastro-oesophageal Reflux Disease (GORD) is the commonest cause of indigestion in the western world with 30% of the population experiencing significant reflux (heartburn) at least once per week.
What causes GORD? Some people are born with a weak sphincter. In others, the presence of a hiatus hernia, where a small part of the upper section of the stomach slips up through the diaphragm, may cause the reflux. Being overweight may increase the pressure inside the abdomen and encourage reflux. Various dietary constituents, such as fats and spices, may reduce the tightness of the sphincter, as do some drugs. Strong alcohol may aggravate the symptoms by irritating the inflamed lining of the oesophagus. Clinical investigation may not be required in younger patients with typical symptoms. However, when the first symptoms occur after the age of 55 years or if there is any difficulty in swallowing, investigation is essential. Usually the investigation of choice is endoscopy but sometimes a barium swallow may be ordered.
What is the treatment? Some people respond to simple measures such as losing weight, avoiding heavy meals shortly before going to bed, and sleeping with their head raised in bed. Lying in bed on the left side is also helpful since the body of stomach, which is mainly on the left side of the abdomen, becomes a sump to hold the gastric contents.
If these simple measures fail to control the symptoms some medication may be helpful. Antacids could help to relieve the heartburn and they are more effective if combined with an alginate which forms a raft on the top of the stomach contents. These alginate/antacids are available over the counter and your pharmacist can advise. If further treatment is required, drugs called ‘H2 receptor antagonists’ or ‘proton pump inhibitors’ both reduce the strength of acid produced by the stomach. Once again, many of these are available over the counter in small doses but if they are required in the longer term or in a larger dose you should consult your GP. Your GP may also decide about surgical intervention which is necessary in the small proportion of patients with GORD in whom medical treatment proves ineffective.