Acid reflux is when acid from the stomach leaks up into the gullet and causes symptoms such as a burning chest pain known as heartburn. At the entrance to your stomach is a ring of muscle called the lower oesophageal sphincter (LOS).
Normally this acts as a valve that lets food into the stomach but not back up into the oesophagus. When this valve fails, acid produced by your stomach can move up into your oesophagus causing symptoms such as heartburn.
If this happens more than twice a week on a regular basis, you may have acid reflux disease which is also known as gastro-oesophageal reflux disease (GERD or GORD). Exact figures vary but acid reflux is very common and is thought to affect 20-30% of the population in the developed world.
What causes acid reflux?
One common cause of acid reflux is a stomach abnormality called a hiatal or hiatus hernia. This occurs when the upper part of the stomach and LOS move above the diaphragm, a muscle which separates your stomach from your chest. Pregnancy is also sometimes a cause of acid reflux because of the extra pressure being placed on the internal organs. Other risk factors may include:
- Being overweight or obese
- Eating large amounts of fatty or spicy foods
- Smoking or the consumption of alcohol, coffee or chocolate. These may relax the muscles at the bottom of the oesophagus
- Stress
- Certain medications such as calcium channel blockers used to treat high blood pressure, nitrates used to treat angina and non-steroidal anti-inflammatory drugs (NSAIDS)
What are the symptoms of acid reflux?
Common symptoms include:
- Heartburn which is a burning pain or discomfort that may move from your stomach to your abdomen or chest
- Regurgitation when a sour or bitter tasting acid backs up into your throat or mouth
- Chest pain especially after eating, bending over or lying down
- Dysphagia which is a narrowing of the oesophagus creating the sensation of food being stuck in your throat
- Bloating
- Burping or hiccups
- Nausea or sickness
- Weight loss for no known reason
- Chronic sore throat, hoarseness or a dry cough
What treatments are available?
Heartburn and gastro-oesophageal reflux disease can often be treated with self-help measures such as detailed below or over the counter medicines. These medicines include antacids to neutralise the effects of stomach acid, alginates that produce a protective coating in the oesophagus and stomach or low dose proton-pump inhibitors (PPIs) that reduce the amount of acid produced by your stomach. If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.
The main surgical procedure used is called a laparoscopic Nissen fundoplication (LNF). This procedure is carried out using keyhole surgery and tightens the ring of muscle at the bottom of the oesophagus.
Alternative techniques have been developed recently including the LINX band which we, at The Best of Health, reported on. You can read about it by clicking on the link above.
What foods that trigger heartburn should I avoid?
Heartburn can be triggered by different things for different people so it is important to monitor your diet and it’s effect on your condition. By avoiding your food and drink triggers and by eating smaller meals, you may reduce the frequency of your symptoms. Some foods which are common triggers include:
- Meats especially fatty cuts such as minced beef, chicken wings and marbled steak
- Fats, oils and sweets such as chocolate, crisps, biscuits, cakes and creamy salad dressings
- Fried and fatty foods, such as bacon, in general
- Certain fruits, vegetables and juices such as citrus fruits and juices, tomatoes, mashed potatoes and raw onions
- Dairy products such as soured cream, ice cream, cottage cheese and milkshakes
- Wines and spirits, fizzy drinks, coffee and certain teas, such as peppermint
- Strong seasonings such as black pepper
- Added sugars – try to stick to natural sugars such as honey and maple syrup
What other lifestyle changes should I make?
- Keep a heartburn and food diary. Record symptoms, the time they occurred and what you ate that may have triggered your discomfort.
- Control your portion sizes. Larger meals tend to stay in the stomach for longer so the LOS and oesophagus are potentially exposed to acid or stomach contents for a longer time.
- Consider switching to a low-carb diet as some evidence suggests that undigested carbohydrates lead to an increase in gas, bloating and belching.
- Limit your intake of coffee or consider switching to decaffeinated coffee as some evidence points to caffeine as a possible culprit increasing the risk of acid reflux.
- Take care when eating out. Try to avoid large portions or high fat foods as these are one of the prime triggers for heartburn.
- Try not to eat at least three hours before bedtime to allow your stomach to empty before you lie down
- If you smoke, try stopping as smoking can reduce the effectiveness of the LOS muscle.
- Try to keep control of your weight as excess abdominal fat can press against the stomach, forcing acids up into the oesophagus.
- Exercise may protect against the acid reflux that leads to heartburn
- Wear loose fitting clothes and loosen your belt to avoid putting extra pressure on your abdomen
- Raise the head of your bed by up to 20cm to reduce your symptoms at night. Don’t just use extra pillows as this may put a strain on your tummy.
- Try to relax as stress can make your symptoms worse.
What are the possible complications?
Ulcers can form when the acid damages the lining of the oesophagus. These ulcers can bleed, causing pain and making it difficult to swallow. Medications such as proton pump inhibitors (PPIs) can help ulcers heal by reducing the amount of acid in the gullet.
Changes in the cells in the oesophageal lining can develop and is known as Barrett’s oesophagus. It is estimated that about 1 in every 10 people with GORD will develop this condition.
Your doctor may suggest an endoscopy every few years to check for this. In rare cases this condition may lead to oesophageal cancer so it is important that you speak to your doctor if you experience any swallowing difficulties or any other unusual or persistent symptoms.
If you would like more information about acid reflux, GORD or heartburn click on the link.
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