Acid Reflux and Heartburn

Acid reflux is a very common problem that affects many people of all ages, and it occurs when the acid that is normally in the stomach leaks back up into the gullet (oesophagus). There are a number of causes of acid reflux, including smoking, being overweight, having a high-fat diet, drinking too much alcohol and coffee, stress, and being pregnant. Having a hiatus hernia - where part of the stomach pushes up through the diaphragm under the ribs – is also a common cause.

What are the symptoms of acid reflux?

The usual symptoms are of ‘heartburn’, where sufferers are aware of a ‘burning’ feeling rising from the stomach into the gullet towards the throat, often causing an unpleasant sour taste in the mouth.

How is it diagnosed?

Doctors can usually diagnose acid reflux from the history alone without needing any specific tests. If the diagnosis is unclear then the best test to diagnose it is a gastroscopy, where a thin fibre-optic tube is placed into the gullet and stomach and the image shown on an external screen. This shows any acid damage in the stomach or gullet, as well as showing if any more serious problems are present, such as ulcers or tumours.

How is reflux treated?

Reflux is treated in a number of ways including lifestyle and medical options. One of the key treatments is to stop smoking as the chemicals in cigarette smoke make acid reflux worse. If you are a smoker and stop smoking then reflux often improves.

Some foods and drinks may also make reflux worse in some people but this varies from person to person so you may need to try altering your diet to find out which foods affect you. If you believe that a particular food is causing reflux, avoid it for a while to see if your symptoms improve. Examples of foods and drinks that can make symptoms worse include alcohol, coffee, hot drinks, chocolate, peppermint, tomatoes, and spicy foods. It can also help if you avoid big meals and eat smaller meals more frequently.

Some prescription medicines may make reflux symptoms worse, with the common ones here being anti-inflammatory painkillers such as ibuprofen or aspirin, nitrates, diazepam, and calcium channel blockers. If you take a drug and feel it is causing reflux then tell your doctor.

If you are overweight or obese, try to lose weight since being overweight puts extra pressure on the stomach and makes acid reflux more likely.

Make sure your body posture is good since lying down or bending a lot during the day increases the chances of reflux occurring. Sitting hunched over – such as when working at a computer - or wearing tight belts can put extra pressure on the stomach and make reflux worse.

Some people find that their reflux is worse at night. If this is the case try to go to bed with an empty stomach by not eating in the three hours before bedtime. Try raising the head of the bed by 10-20 cms by putting bricks or books under the legs of the bed as this helps prevent acid reflux.

What medical options are there?

Antacids are commonly used to treat reflux. These are liquids or tablets of alkali medicine that help to neutralise the acid, and often give quick relief although are not a permanent cure. There are many brands which you can buy from a pharmacist or you can get them on prescription from your doctor. These can be taken as needed for mild or occasional attacks of reflux and heartburn.

If simple treatments do not help then acid-suppressing drugs can be given by your doctor. There are two main groups of acid-suppressing drugs - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). These both reduce the amount of acid that the stomach makes. In general, proton pump inhibitors often work better than H2 blockers. If long term daily treatment is needed with these treatments it is generally thought to be safe, and side-effects are uncommon. Other drugs that are sometimes prescribed include prokinetic drugs that speed up the passage of food through the stomach and can be particularly helpful with symptoms of bloating or belching.

Surgery is usually the last resort when treating reflux and is considered only when all other treatments have failed. Usually done as laparoscopic or ‘keyhole’ surgery this aims to tighten the bottom of the gullet to prevent acid from leaking up from the stomach.

It is important to tell your doctor if you have pain or difficulty with food sticking in the gullet when you swallow, or if you have unexpected weight loss or abdominal pain.