Acid Reflux

Acid reflux is often known as heartburn or gastroesophageal reflux disease (GERD). 

Acid reflux happens when the valve at the entrance of the stomach does not close completely.  

Under normal conditions, the valve - known as the lower esophageal sphincter (LES) will close as soon as the food passes through it.  

If the LES does not close properly, or if it opens frequently, the acid that is produced in the stomach can travel to the oesophagus.  

This causes the burning sensation in the chest, commonly referred to as heartburn. 

If acid reflux symptoms occur more than twice a week, you are likely to be diagnosed with acid reflux disease (GERD). 

GERD is a version of acid reflux that can occur at least twice a week, with both moderate to severe symptoms. 

For many people, GERD can be managed through a combination of lifestyle changes and over-the-counter medication.  
 
Some people who suffer from GERD may require surgery to ease symptoms. 

The main symptoms of acid reflux include:

• Heartburn: a burning pain or major discomfort that moves from the stomach to the abdomen or chest, sometimes even up to a person’s throat
• Regurgitation: the backing up of a sour or bitter-tasting acid in the throat and mouth

Other symptoms include:

• Bloating
• Burping
• Fluctuation 
• Nausea
• Hiccups
• Weight loss
• Wheezing, dry cough
• Chronic sore throat
• Dysphagia — the sensation of food being stuck in your throat and struggling to swallow

While these symptoms are generally milder, they can still cause discomfort and the severity can vary from person to person.

Acid reflux symptoms tend to be worse after eating, when lying down or bending over.

If you are struggling with acid reflux symptoms, you should first speak to your GP or pharmacist.

Many people suffer from acid reflux every day. There are a number of common triggers, but for some people, there is no known cause.

Some of the most common triggers of acid reflux include:

• Being overweight
• Smoking
• Drinking alcohol and caffeine products
• Certain foods
• Pregnancy
• Stress and anxiety
• Some medicines, such as anti-inflammatory painkillers (including ibuprofen)
• A hiatus hernia (this occurs when part of your stomach moves up into your chest)

The diaphragm helps to keep the acid in your stomach because it contains muscles that stop the food/acid from coming up your oesophagus.

If you have a hiatal hernia, acid can move up into your oesophagus, causing acid reflux symptoms.

Food is one of the most common causes of acid reflux and heartburn. Certain foods can trigger the esophageal sphincter to relax. This delays the digestive process, causing food to sit in the stomach for longer.

Large, heavy meals are a common cause of acid reflux. Eating 3-4 hours before you go to bed can also cause acid reflux, as food does not have enough time to be processed in the stomach.

When you lie down, you are likely to experience acid reflux symptoms.

Foods that are known to cause acid reflux include:

• Foods with high fat, salt and spice quantities
• Fried food
• Fast food
• Processed snacks
• Chilli powder and peppers
• Fatty meats
• Daisy products
• Tomatoes and tomato-based sauces
• Citrus fruits
• Chocolate
• Peppermint
• Fizzy drinks

Reducing your intake of these types of food and drinks can help to reduce acid reflux symptoms. 

You should also avoid eating just before bedtime, so food isn’t sitting in your stomach and rising through your oesophagus while you lie down. 

To reduce the chances of developing acid reflux, you can eat more:

• Baked, broiled or grilled chicken breast (with the fatty skin removed)
• Lettuce, celery and sweet peppers
• Brown rice (boiled, not fried)
• Melons (including watermelon, cantaloupe and honeydew)
• Oatmeal
• Fennel
• Ginger (including ginger tea)

Eating smaller, more frequent meals rather than larger, heavier meals can also help. You should also avoid bedtime snacks.

Acid reflux itself isn’t a dangerous condition. However, if left untreated it can lead to more serious health issues. This include:

• Esophagitis
• Oesophageal ulcers
• Oesophagal stricture
• Aspiration pneumonia
• Barrett’s oesophagus
• Oesophagal cancer

Over time, chronic inflammation in your oesophagus can also lead to:

• The narrowing of the oesophagus: damage to the lower oesophagus from stomach acid can cause scar tissue to form. This can cause the food pathway to narrow, causing swallowing problems
• Precancerous changes to the oesophagus (Barrett's oesophagus): stomach acid can damage the tissue lining of the lower oesophagus

The speed symptoms develop and the time symptoms continue can vary depending on the cause of acid reflux. 

Mild heartburn may occur immediately after consuming eating, and last until the food has been digested. 

Heartburn symptoms can return after several hours if you are bending or lying down. 

Acid reflux is most commonly treated with long-term lifestyle and diet changes.

To get rid of acid reflux symptoms, you can try:

• Avoiding food and beverages that trigger acid reflux symptoms and heartburn 
• Eating smaller meals throughout the day and modifying the types of foods intaken 
• Quitting or reducing smoking 
• Raising your head while you sleep to between 4 and 6 inches 
• Eating no later than 2 to 3 hours before bed 
• Sleeping upright during daytime naps 
• Wearing lighter clothes 
• Taking steps to lose weight through exercise or diet changes 
• Consulting your doctor about medication that may be triggering symptoms

After making these changes, you should speak to a pharmacist if you still experience symptoms. They will be able to recommend medicines to ease symptoms.

There are some over the counter preparations available, to treat acid reflux. These include antacids like Rennies.  

Preparations that act as rafting agents by coating the stomach and oesophagus to help protect them from the stomach acid are also available.

Prescription medications include Omeprazole and Lansoprazole. These work by decreasing the amount of acid produced in the stomach.

It does this by blocking a system in the cells of your stomach called the proton pump 

You can also be prescribed:

• Foaming agents, which coat your stomach to prevent reflux 
• H2 blockers, to decrease acid production in your stomach 
• Proton pump inhibitors to reduce the volume of acid your stomach makes 
• Prokinetics, which can help empty your stomach faster and reduce acid reflux 

You should be careful not to combine more than one type of antacid medication with another form of prescription medication without your doctor’s guidance. 
In most cases, lifestyle changes and medications can reduce and control acid reflux symptoms.

If medication and lifestyle changes don’t resolve your symptoms and they are adversely affecting your life, your doctor may recommend surgery. 

There are two types of surgery used to relieve the symptoms of acid reflux/GERD. 

One procedure involves the surgical placing of a ring (known as a LINX device) around the outside of the lower end of a person’s oesophagus. 

The ring consists of magnetic titanium beads held together by titanium wires that wrap around the tube connecting the mouth to the stomach.  

This device prevents stomach contents from backing up into the oesophagus, limiting the impact of acid reflux.  

However, this procedure should be avoided by anyone allergic to certain metals and patients should not take any type of MRI test afterwards. 

The other option is fundoplication. 

This involves wrapping the upper part of the stomach around the LES to strengthen it, prevent acid reflux, and repair a hiatal hernia.   

The procedure is performed through one of two options, either an open incision in the abdomen or chest or through a keyhole incision in the abdomen. 

Surgical treatment is generally seen as a last resort to treat acid reflux. Dietary, lifestyle and medical solutions should be followed first.