Acid Reflux

Reflux (also known as heartburn & Gastroesophageal reflux disease) is  a painful condition that is caused by the regurgitation of stomach acid back into the esophagus, leading to the typical burning sensation.

When we eat, food travels down the esophagus, at the junction between the esophagus & the stomach  is a small band of muscles known as the lower esophageal sphincter (LES). These muscles open to allow food to pass from the esophagus into the stomach & close to prevent stomach contents coming back up into the esophagus.

There are many reasons this occurs, some of which are;

• Hiatus hernia: The esophagus passes through a hole in the diaphragm known as the hiatus, just before it joins the stomach.  A hiatus hernia  occurs when the upper part of the stomach protrudes through the diaphragm. A hiatus hernia prevents the diaphragm muscles from supporting the lower esophageal sphincter. The sphincter becomes incompetent, and GERD occurs. [1]

• Abnormalities of the esophagus such as weakness or abnormal contractions.

• Gastroparesis: Nerve or muscle disfunction of the stomach which leads to delayed  emptying. This leads to an increased pressure & can lead to acid coming back up into the esophagus.

Reflux causes:

Certain medications can cause reflux, including;

• Anticholinergic drugs: Cogentin (benztropine), Buscopan (hyoscine), Ditropan (oxybutynin), and Pro-Banthine (propantheline).

• Calcium channel blockers.

• Non-steroidal anti-inflammatory drugs such as ibuprofen & aspirin.

Certain foods/drinks, including;

• Fatty foods & alcohol.

Many people reach for milk when they are suffering from reflux but this can in fact stimulate more stomach acid, making the problem worse.

Other causes include;

• Pregnancy.

Reflux symptoms:

The most common symptom of reflux is heartburn. Other symptoms include;

• Acid regurgitation/bad taste in mouth.

• Chest pain.

• Belching/burping.

• Difficulty swallowing (dysphagia).

• Nausea.

Diagnosis of reflux:

Your doctor will obtain a medical history from you & may make a diagnosis of reflux based on symptoms. Tests may be performed in older patients or people with atypical symptoms. These may include;

• Endoscopy (oesophagogastroscopy): This is performed by inserting a fibre optic tube with a tiny camera down the esophagus where the lining can be examined.

• Barium swallow & meal: A solution is drunk & then an x-ray is taken. It is used to detect abnormalities in the esophagus.

Reflux treatment:

Reflux diet:

• Avoiding certain foods that trigger reflux.

• Eat smaller meals more often to avoid excess acid production & speed up emptying of the stomach.

• Eat at least 2 hours before bedtime to allow time for digestion.

• Stop smoking.

• Elevate the head of your bed.

Antacids:

Such as Rennie. These  work by neutralising stomach acid. They may be taken prior to eating or as symptoms occur.

Mucosal protective agents:

Such as Gaviscon. These work by floating on top of the stomach acid, preventing contact between the stomach juices & the esophagus.

Prescription medications:

If the above options don't work then prescription medications may be necessary. These drugs stop by reducing acid secretion.

• H2 blockers:

• Proton pump inhibitors:

• Prokinetics:

Surgery:

In severe cases, surgery may be necessary. This surgery is known as Nissen fundoplication in which the stomach is sewn around the esophagus to stop the stomach contents flowing back into the esophagus.

References:

[1] GI Tract.info

Please note:

The medical articles on this site have not been written by a doctor & should not be considered a replacement for a doctor visit. The articles are provided for informative purposes only.

Always seek immediate medical advice for any problems.

While great care has been made in the creation of these articles, we cannot guarantee the accuracy or omissions on these pages. If in any doubt whatsoever, seek professional medical advice.