Acid Reflux & Heart Burn
Acid Reflux is an extremely common and normal phenomeon that is experienced by most people at some stage during their lives. 'Gastro-oesophageal Reflux Disease' (GORD) is a condition that occurs when excessive amounts of acid regurgitate back into the oesophagus from the stomach on a regular basis.
The oesophagus is a muscular tube from the mouth to the stomach and the lower portion remains contracted the majority of the time to prevent food regurgitating back out of the stomach. This is called the 'Lower Oesophageal Sphincter' (LOS). The stomach is connected to the oesophagus (gastro-oesophageal junction) at the level of the diaphragm, which surrounds the oesophagus just above the stomach. The diaphragm is also made up of muscle tissue and by surrounding the oesophagus, helps prevent reflux. As the LOS is not a true one-way valve, it is quite common for some stomach contents to regurgitate into the oesophagus after large meals or when lying down after eating. These stomach contents consist primarily of acid, which irritates the normal oesophageal mucosal lining and causes a burning pain in the chest, radiating up to the throat, commonly referred to as 'heartburn'.
GORD occurs due to a variety of reasons. Caffeine, alcohol, hot drinks, smoking, fatty foods, pregnancy (hormonal changes and increased intra-abdominal pressure) and a variety of medications (beta blockers, calcium channel antagonists, hormonal medications) can all cause relaxation of the LOS and consequently reflux. Obesity causes increased intra-abdominal pressure and excessive pressure on the LOS. Some people have disordered contraction of the oesophagus and delayed emptying of the stomach, which can both contribute to reflux. Occasionally, the area of the diaphragm surrounding the LOS can actually permanently widen, allowing the top portion of the stomach to slide up and through, which relaxes the LOS and causes reflux. This is called a Hiatus Hernia.
The most common symptom of acid reflux is heartburn. This is a burning sensation in the middle of the chest, which can radiate up to the throat. It has been known to radiate through to the back and most commonly occurs after eating or when lying down. Patients commonly experience nausea and sometimes regurgitation of a small volume of stomach contents into the mouth. Rarely it has been known to cause vomiting.
Mild GORD is usually uncomplicated, but with persistent increased acid levels in the oesophagus complications can occur.
Chronic inflammation of the oesophageal lining can occur called 'Oesophagitis'. If the inflammation is severe, rarely it can ulcerate which if severe can result in bleeding or even perforation. Chronic inflammation may cause scarring, which
has the potential to cause strictures of the oesophagus. This is where the normal tissues of the oesophagus undergo fibrosis and narrow the channel, causing food to stick. In severe chronic inflammation the normal cells in the oesophagus can change to a pre-cancerous state called Barrett's Oesophagus.
The acid reflux can affect other areas too. If the reflux reaches the throat, it can cause inflammation of the throat and larynx, resulting in pain and hoarse voice. The acid can also trickle down into the trachea and lungs, particularly at night, causing a chronic cough or precipitating asthma.
It is important to remember that most cases of GORD are not due to any significant underlying abnormality and can easily be treated with simple lifestyle changes.
If the reflux appears to occur mainly at night, it is wise to avoid eating or drinking hot fluids within 2-3 hours of going to bed. It may also help to sleep propped more upright as gravity plays a big part in reflux. This can be done either by adding a few extra pillows or by putting some blocks/books under the head of the bed.
Obesity and smoking are significant causes of reflux. Simply losing weight and/or stopping smoking can resolve the symptoms entirely.
Reflux often occurs after eating. Reducing the size of meals may help reduce the symptoms, as will avoiding excessive amounts of caffeine, citrus fruits, tomato juice, chocolate, peppermint, spicy foods, fizzy drinks and alcohol.
There are a variety of over the counter medications available for the treatment of reflux that, work in a variety of ways. Some neutralise the stomach acid, some act as a form of foam barrier at the gastro-oesophageal junction and some reduce the secretion of acid into the stomach. Further details of all of these will be available through your local pharmacist.
It is best to start by trying simple acid neutralising antacids either an hour before food or when symptomatic for infrequent and uncomplicated heartburn. If lifestyle measures and over the counter medications are ineffective or if there are any other associated features such as asthma, hoarse voice or sore throat, you should consult your General Practitioner for further assessment.
Important To Note:
Heartburn is extremely common and is invariably due to acid reflux. It can, however be confused with a number of potentially more serious conditions, so if there are any other associated symptoms which are not typical, or the symptoms do not settle with antacids please seek medical attention.
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