What is acid reflux?
Acid reflux, also called Gastroesophageal Reflux Disease or GORD or GERD, is a common problem. It is caused by the backflow of liquid from your stomach into your oesophagus (gullet). The stomach makes acid for digestion, but the lining of the lining of the oesophagus is not built to tolerate acid. Some reflux occurs normally in most people. The reflux becomes a problem – a disease – when it causes troublesome symptoms or complications.
What causes acid reflux?
The lower end of your oesophagus (gullet) has a natural barrier or valve (called the lower oesophageal sphincter) to prevent the backflow of acid from the stomach. Excessive stomach acid can enter your oesophagus if the valve does not work properly. One condition that can cause weakness of the valve is a hiatus hernia. This is a condition in which your stomach moves upwards from the abdomen (tummy) into the chest. But, not all patients with acid reflux have a hiatus hernia. There may not be any obvious cause for malfunction of the valve.
What are the symptoms of acid reflux?
Heartburn is the most common symptom of acid reflux. You feel a painful burning sensation that starts at the top of your abdomen (tummy). The burning pain radiates up behind your breastbone, towards your neck. Also, you can have backflow of partially digested food or liquid from your stomach into your mouth. This is called regurgitation. Some people with acid reflux disease will have both heartburn and regurgitation. Others may have only heartburn or only regurgitation. Also, you may get a sensation of food sticking behind your breastbone or pain whilst swallowing. Some people get chest pain, chronic cough, hoarseness of voice and asthma. These are called atypical symptoms of reflux.
What are the complications of acid reflux?
Acid reflux can cause inflammation and erosions in the inner lining of your oesophagus (gullet). This condition is called erosive oesophagitis. Because of the inflammation, your oesophagus can become narrow and you may get difficulty to swallow. This is called stricture or stenosis of the oesophagus. Long standing reflux can cause a condition called Barrett’s oesophagus. In Barrett’s oesophagus, the normal cells in the lining of the oesophagus are replaced by abnormal cells called intestinal metaplasia. These abnormal cells are in themselves benign, but have increased risk of turning into cancer. Barrett’s oesophagus is a pre-malignant condition of the oesophagus.
What is the medical treatment for acid reflux?
Acid reflux should be suspected if you are getting heartburn. The treatment of heartburn starts with simple lifestyle changes. Healthy eating, weight loss, stopping smoking and not eating before bedtime can be very helpful. Your doctor may prescribe some medicines called Proton Pump Inhibitors or PPIs, like omeprazole, lansoprazole, esomeprazole or pantoprazole. These drugs reduce the secretion of acid from the lining of your stomach. PPI drugs can be given in different doses, according to the severity of your problem. It is very important to take the PPI on an empty stomach. If you take a PPI in the morning, it should be 15-30 minutes before breakfast. If you take it in the evening, it should be 15-30 minutes before your evening meal and not just before going to bed. Antacid medications, like Gaviscon®, can be helpful along with PPIs. You may be prescribed another acid-reducing drug, called ranitidine, if your heartburn is not controlled by a PPI. Ranitidine should be taken just before going to bed. It is really important to take the medicines at the right times to get the best effect.
Do I need to have any tests if I am getting heartburn?
Not everyone with heartburn needs to have tests for acid reflux. No tests may be needed if your heartburn is well controlled with lifestyle changes and PPI medicines. But, an endoscopy should be done if you have ‘alarm’ symptoms or high-risk factors or if the medicines do not control your symptoms.
What are the tests for acid reflux?
Tests are done for two reasons. First, to make sure that your heartburn and other symptoms are because of acid reflux and not some other problem. And second, to find out the severity of the reflux. There are three types of tests for acid reflux. Depending on your individual condition, you may need to have only one or more tests.