Reflux

Gastro-Oesohageal Reflux (Heartburn)

Reflux or heartburn occurs when stomach contents regurgitate up into the oeosphagus (gullet). Unlike vomiting, which is quite a violent activity, reflux mostly occurs without us being aware that it is happening.  Reflux causes the following symptoms: 

  • Heartburn – a burning sensation in the chest
  • Belching
  • Nausea
  • Sour taste in the mouth
  • Occasionally, reflux can cause a persistent cough and a hoarse throat

Heartburn often seems worse after rich meals, citrus fruits, hot beverages or alcohol.. Occasionally it can be felt deeply within the chest – almost within the back.  Heartburn is very common. Most people who have symptoms can help themselves a lot by changing what they eat and drink, and maybe also by taking antacids or other indigestion remedies. But if these do not work or if you are worried, it would be a good idea to seek medical advice. It is also appropriate to consult your doctor if you have begun to have symptoms that just don’t seem to settle down. You should definitely see your doctor if you are having trouble swallowing and food seems to get stuck on its way down.

How does reflux occur?

There is a muscular ring (called a sphincter) which is at the junction between the lower oesophagus and stomach which helps to prevent reflux from occurring. In many cases it does not function properly although the reasons for this are often unclear. In other patients, reflux occurs because of a hiatus hernia - hiatus hernia is when part of the stomach slides upwards into the chest. It does this by pushing itself through a hole (called the hiatus) in the diaphragm muscle. Hiatus hernias are common, especially in people over 50.

Other factors which make people more prone to developing reflux are:

  • Smoking
  • Alcohol
  • Coffee
  • Citrus Fruits
  • Rich fat containing foods such as red meat and cheeses
  • Wearing tight clothes,
  • Weight gain
  • Lying down soon after eating

What is oesophagitis?

Sometimes, even in people who have quite marked reflux symptoms, the oesophagus may look entirely normal. However, some patients can develop oesophagitis, which means that there is inflammation within the oesophagus. The lining of the inflamed oesophagus looks red and sore. If the inflammation is severe, ulcers can form. The commonest cause of oesophagitis is reflux of acid from the stomach. 

How does reflux cause oesophagitis?

The stomach makes acid which helps start off digestion by mixing with whatever we have to eat or drink. The acid is very strong so if it refluxes in sufficient quantities and often enough, it will begin to cause damage to the lining of the oesophagus.

At first the lining may just appear rather more red than normal. Later on the lining of the oesophagus may begin to wear away and, in severe cases, an ulcer may form. The damage to the lining of the oesophagus may be made worse by the reflux of bile and pepsin.

Is reflux oesophagitis ever serious?

For most people with the condition, reflux is just a nuisance and little more than that. In a few people, especially where there is severe inflammation of the oesophagus, there is a risk of complications which can include internal bleeding and narrowing of the gullet. In some patients Barrett’s oesophagus can develop. Barrett’s oesophagus can lead to oesophageal cancer, which develops in a minority of reflux patients. If you are worried about these complications, it is best to have a chat with your doctor. 

What is Barrett’s Oesophagus?

Barretts oesophagus occurs when the cells which line the oesophagus undergoes change to look more like the cells which are found in the stomach. The cause of Barrett’s oesophagus is not known, but is thought to be due to persistent reflux of acid from the stomach up into the oesophagus.

Barrett’s oesophagus itself does not cause any symptoms – most people diagnosed with the condition with have had symptoms of reflux (heatburn). However Barrett’s Oesophagus can very occasionally lead to complications such as ulcers in the gullet, bleeding, difficulty in swallowing due to a narrowing of the gullet (stricture), and occasionally cancer. Once Barrett’s oesophagus has been diagnosed, then patients often undergo a gastroscopy every 2-3 years to monitor the condition.

What tests will I need?

Reflux is often diagnosed just by listening carefully when you describe your symptoms and there may not be a need for tests. Tests are usually used if people do not respond to simple treatment or to see whether you have Barrett’s oesophagus or oeosphagitis.

The investigation that is usually performed is endoscopy. This involves passing a thin, flexible tube through the mouth and down into your oesophagus. Although not used routinely, sometimes a test is undertaken to measure the amount of acid that is refluxing into the oesophagus. This is done by measuring the amount of acid in your oesophagus over a 24 hour period using a very narrow tube passed through the nose.