Reflux Disease

Acid reflux or gastro-oesophageal reflux disease (GORD) occurs when the lower sphincter fails to close tightly and stomach acid backs up into the oesophagus. It is a common condition causing indigestion and heartburn in an estimated 10 to 20% of the population at least once a week. The condition however can become chronic and recur throughout life.  The symptoms of GORD are:

• heartburn, a burning sensation that rises from the stomach or lower chest up towards the neck
• regurgitation of acid into the throat or mouth causing an unpleasant sour taste
• less common is a persistent cough, particularly at night, caused by acid irritating the windpipe
• occasionally mouth and throat symptoms including gum problems, bad breath, sore throat and hoarseness

In most cases, using over-the-counter indigestion remedies and making changes to diet and lifestyle will help reduce symptoms.  Conditions known to aggravate GORD are:

• being overweight or obese
• eating foods high in fats as the stomach takes longer to digest a fatty meal
• regularly using tobacco, alcohol, coffee, or chocolate
• taking certain medications e.g. calcium-channel blockers, benzodiazepines, and anticholinergics
• pregnancy due to changes in hormone levels and an increase in the pressure on the stomach
• hiatus hernia where part of the stomach pushes through the diaphragm
• stress

Symptoms can be eased by taking antacids - the alkali liquids or tablets that neutralise stomach acid. Many brands are available from a chemist and can be used 'as required' for mild heartburn.  However, if symptoms are severe or occur regularly then a GP should be consulted. Acid-suppressing drugs that reduce the amount of acid secreted by the stomach are normally prescribed.  There are two types:

• proton pump inhibitors e.g. omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole. Usually a short course helps to reduce symptoms
• histamine receptor blockers (H2 blockers) e.g. cimetidine, famotidine, nizatidine, and ranitidine.  These are preferred if long-term treatment is needed

Keyhole surgery can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. In general, it is no more successful than acid-suppressing medication. However, it is an option for some people where drug treatment is not working well or not wanted long-term

GORD rarely develops into more severe conditions.  However, long-term acid inflammation can cause scarring and narrowing (a stricture) of the oesophagus.  Barrett's oesophagus is a condition in which the cells that line the area around the sphincter become changed with an increased, albeit small risk of developing oesophageal cancer.