Heartburn & Gastrooesophageal Reflux Disease (GERD)

Heartburn is a symptom of gastro-oesophageal reflux that is characterised by a burning pain in the chest and is often experienced after eating.

What is gastro-oesophageal reflux?

Gastro-oesophageal reflux occurs when the acid in the stomach comes back up the gullet (the oesophagus) and this usually happens after eating. Ordinarily, when you eat the food travels down into the stomach through the oesophagus; however, in some cases, the food or stomach acid comes back up and this can cause pain and discomfort.

Gastro-oesophageal reflux disease is a common condition and is usually associated with the ring of muscle at the bottom of the oesophagus not working properly. This ring is called the lower oesophageal sphincter and acts as a gateway which should open to allow food down into the stomach and then close to prevent two-way traffic.

What causes gastro-oesophageal reflux?

In many cases, it is not known why people experience reflux, though the most common cause is poor function of the lower oesophageal sphincter. The sphincter is located at the bottom of the oesophagus and acts as a valve to let food into the stomach and prevent acid from leaking from the stomach and going back up into the oesophagus. If acid leaks into the oesophagus, this can cause heartburn and discomfort in the abdomen and chest.

Some people are more likely to suffer from reflux than others, with risk factors including:

• Being overweight.
• Smoking.
• Pregnancy.
• Eating a lot of fatty foods.
• Having a hiatus hernia: this is when part of the stomach pushes through the diaphragm.

Symptoms of reflux

Many people have reflux without experiencing any symptoms at all, though reflux does often cause symptoms and the most common symptom is heartburn, a pain that feels like a burning sensation in the chest. Other symptoms include:

• Problems with swallowing (known as dysphagia).
• Regurgitating acid into your mouth or throat: this causes a bitter, unpleasant taste in the mouth.

Less common symptoms include:

• Nausea.
• Tooth decay.
• Pain when you swallow.
• Laryngitis.
• Chronic cough.

Complications of reflux

In the vast majority of cases, reflux is not a serious problem and it is rare for people to experience severe symptoms. However, in some cases reflux can cause oesophagitis, which is an inflammation of the oesophagus. The lining of the oesophagus may become swollen, sore and red and ulcers can develop. In some cases, these ulcers can bleed and cause pain, especially when you swallow. During the path of time, damage to the lining of the oesophagus can cause scar tissue to form and this may make the gullet narrower. In rare cases, there is a risk of internal bleeding caused by irritation of the oesophagus.

When should I see a doctor?

Heartburn is very common and it is normally nothing to be anxious about. Taking antacid medication should help to alleviate symptoms, but if this does not work and you are suffering from pain on a regular basis, it is best to visit your doctor. You should see your GP if you experience difficulty swallowing or your food seems to be getting stuck.

How is reflux diagnosed?

In most cases, doctors will be able to diagnose reflux based on your symptoms and prescribe treatment without any investigations. If you have moderate or severe symptoms, your GP will probably refer you for further tests including an endoscopy. An endoscopy involves using an endoscope (a long, thin tube) to look inside your oesophagus, which your doctor will use to check for signs of inflammation and any abnormalities. The procedure is not painful but nobody is going to force you into it. There is an alternative test for those who do not want to have an endoscopy, which is called a barium X-ray test where you eat a barium meal that enables doctors to see X-ray images of your oesophagus.

If an endoscopy does not show signs of damage to the oesophagus but you are experiencing symptoms of reflux, a test called manometry may be ordered. Manometry is used to assess how well the lower oesophageal sphincter is working by measuring the levels of pressure inside the muscle. The test involves passing a small, thin tube into the nostrils and down into the oesophagus.

Treating reflux

Treatment depends on the individual and the severity of symptoms. In many cases, taking antacid medication will be sufficient to ease symptoms and no treatment will be required at all. There are also lifestyle changes you can make to help to ease symptoms. These include:

• Stop smoking (help is available from your GP).
• Reduce alcohol intake.
• Lose weight if you are overweight.
• Cut down on fatty foods.
• Avoid eating large meals: try eating smaller meals throughout the day rather than 3 big meals.
• Keep a record of foods or drinks that make your symptoms worse, such as spicy food, caffeine and chocolate, and try to limit your intake of these foods.
• Avoid eating late at night and going to bed on a full stomach.

If you notice symptoms and require medication, your GP will prescribe you drugs based on your medical history and the severity of your condition. Antacids are very effective but they should not be taken with other medications, as they prevent the body from absorbing other medicines properly. It is imperative to you tell your doctor if you are taking any other medications. If you cannot take antacids you may be prescribed alginates or proton-pump inhibitors.  

How long will I have to take medication?

Some people find their symptoms clear up quickly once they start taking medication or adapt their lifestyles and diet. However, others find that they experience symptoms without their medication and they may be urged to take the medicine on a long-term basis.