Acid Reflux

acid reflux

Acid reflux is a condition wherein acid from the stomach leaks up into the food pipe (oesophagus). This may cause heartburn and other symptoms. A drug which reduces the amount of acid made in your stomach is a common treatment and usually works well. When we eat, food passes down the esophagus into the stomach. Cells in the lining of the stomach make acid (hydrochloric acid) and other chemicals (enzymes) which help to digest food -principally the protein part of the meal. Stomach cells also make mucus (a thick gel like secretion) which protects them from damage from the acid. However the cells lining the esophagus are different and have very poor protection from the stomach acid.

A circular band of muscle at the junction between the esophagus and stomach exists called the Lower Esophageal Sphincter (LES). This acts like a valve and relaxes to allow food down, but then normally tightens up and stops food and acid leaking back up (refluxing) into the esophagus.

What do you mean by reflux and esophagitis?

Acid reflux is when some acid leaks back (refluxes) into the esophagus. Esophagitis means inflammation of the lining of the esophagus. The lining of the esophagus can cope with a certain amount of acid. However this ability to tolerate reflux is quite variable and patients with poor tolerance soon develop symptoms.

How do I know that I have acid reflux and esophagitis?

Heartburn is the principal symptom. This is a burning feeling which rises from the upper abdomen or lower chest up towards the neck. Other common symptoms include: pain in the abdomen and chest, a sour- acid taste in the mouth, bloating, belching, and a burning pain when you swallow hot drinks or have spicy food. However there are some uncommon symptoms such as a persistent cough. Asthma symptoms of cough and wheeze can sometimes be due to acid reflux.

What causes acid reflux and who does it affect?

The sphincter at the bottom of the esophagus normally prevents acid reflux in normal people with a healthy body weight. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, the overweight, and those aged between 35 and 64.

What tests might be done?

Tests are not usually necessary if you have typical symptoms. However if symptoms are very severe your doctor may advise endoscopy. This is where a thin, flexible telescope is passed down the esophagus into the stomach. This allows a doctor or nurse to look inside. With esophagitis, the lower part of the esophagus looks red and inflamed

Other tests such as ECG, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

What can I do to help with symptoms?
  • Symptoms may ease if you are a smoker and stop smoking.
  • Some foods and drinks may make reflux worse in some people. If it seems that a food is causing symptoms, then try avoiding it for a while to see if symptoms improve.
  • Some drugs may make symptoms worse. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin).
  • If you are overweight it makes the lower esophageal sphincter (valve mechanism) incompetent and encourages acid reflux. Losing some weight may ease the symptoms.
  • Lying down or bending forward a lot during the day encourages reflux.
  • Go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime, and don't drink in the last two hours before bedtime.
  • Try raising the head of the bed by 10-20 cms
Treatments for acid reflux and esophagitis?
  • Antacids
  • These are alkali liquids or tablets that neutralise the acid. A dose usually gives quick relief.

  • Acid-suppressing drugs
  • An acid-suppressing drug will usually be advised by the doctor in case the symptoms are serious enough for you to have sought medical advise. Two groups of acid-suppressing drugs are available - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. Proton pump inhibitors include: omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers include: cimetidine, famotidine, nizatidine, and ranitidine.

    However, some people need long-term daily acid suppressing treatment. Long-term treatment with an acid-suppressing drug is considered to be safe, and side-effects are uncommon.

  • Surgery
  • An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery. Surgery is to beconsidered as an option for some people who do not seem to achieve the necessary relief even after maximal medical therapy or those not wanting long-term medical management.

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