Acid reflux

Acid reflux or to give it its medical name ‘gastro-oesophageal reflux’ is a medical condition where stomach acid flows back up the oesophagus and into the throat and mouth.

This flow is also known as ‘reflux’.

This is often caused by a ‘fault’ in the cardiac sphincter (muscular ring of tissue) at the bottom of the oesophagus which acts as a valve. This valve normally enables food to pass into the stomach and then closes to prevent stomach acid from flowing back up the oesophagus.

This valve acts as a ‘one-way’ mechanism in that it stops gastric acid and/or stomach contents from flowing upwards.

But what happens with acid reflux is that this valve fails to work properly and relaxes which then allows these contents to travel back up the oesophagus and into the throat.

This is a common cause of heartburn, dysphagia, globus pharyngeus and throat ulcers. Another common condition is oesophagitis.

Causes of acid reflux

There is no single identifiable cause of acid reflux but the following conditions can result in this problem.

They include:

• Overweight or obese
• Hiatus hernia
• Fatty meals
• Pregnancy
• Constipation
• Smoking

There are also certain foods and/or liquids which aggravate this problem. They include alcohol, fruit juices, chocolate and mints.

Acid reflux is more likely to occur if there is excess food and/or gastric acid or excess pressure is applied to the stomach.

Overweight or obese

If you are overweight or obese then you are likely to have an excess of body fat within your abdomen - known as visceral fat. This fat puts extra pressure on the internal organs inside this area and forces acid up into the oesophagus.

Hiatus hernia

A hiatus hernia occurs when a section of the stomach protrudes through the diaphragm and into the chest area. This causes pain, hiccups, belching and symptoms of asthma. This hernia also puts pressure on the sphincter at the lower end of the oesophagus. This pressure stops it from closing which allows stomach acid to flow up into the oesophagus.

Fatty meals

Eating large, fatty meals also causes acid reflux. These heavy meals stretch the stomach as well as slowing down the emptying of its contents. This increases the risk of reflux.

It’s a good idea to avoid rich or high fat meals late on in the evening.

Pregnancy

Pregnancy causes the womb to increase in size to accommodate the growing baby. This presses against the stomach which increases pressure inside it and also increases the chance of reflux.

Plus hormonal changes in pregnancy often cause the oesophageal sphincter to relax which allows acid to flow upwards.

Constipation

Constipation increases pressure inside the stomach, often caused by straining which then forces acid to escape back up the oesophagus.

Smoking

Smoking causes a range of health problems which also include an increase in stomach acid, a slowing of the rate at which the stomach empties and stops the oesophageal sphincter from functioning as normal.

Symptoms of acid reflux

These include:

• Failure to digest food properly (regurgitation)
• Heartburn
• Sore throat
• Indigestion
• Sour or nasty (metallic) taste in the mouth
• Excessive belching
• Dysphagia (difficulty in swallowing)

These are the most common symptoms of acid reflux. Other less common symptoms include nausea, chest pain and excessive salivation.

In some cases acid reflux can cause damage to the oesophagus, for example, ulcers or a narrowing of this tube which then causes problems with swallowing.

There are suggestions that acid reflux contributes to laryngitis, sinusitis, pharyngitis and hypersensitivity of the teeth although this is largely unproven.

Acid reflux occurs after a high fat or particularly large meal or after consuming alcohol. Smoking worsens the symptoms as does lying down, bending over or lifting an object.

How often does acid reflux occur?

Episodes of acid reflux vary between individuals. Some people experience this on a weekly or even daily basis whereas others are barely affected. Those people who have several episodes of this and on a regular basis report that it affects their everyday lives.

Problems of acid reflux

Persistent acid reflux can result in a condition called oesophagitis which is inflammation of the oesophagus. Over time this causes scar tissue to develop which then narrows a part of the oesophagus.

This causes difficulty in swallowing.

Other problems include the formation of ulcers within the oesophagus which can bleed and lead to anaemia.

The risk of developing acid reflux can be reduced by making a few lifestyle changes. These include stopping smoking, reducing the amount of fat in your diet, losing weight if overweight and reducing caffeine intake.

If your symptoms occur infrequently then they can be treated with over the counter medicines such as antacids. But frequent or serious cases will require further investigation.

Treatment for acid reflux

Your GP will prescribe medication such as ‘proton pump inhibitors’which reduce the amount of stomach acid produced. These can be taken over the long term.

If these are unsuccessful then medicines called ‘prokinetic agents’can be given which increase the rate at which the stomach empties. These will reduce the likelihood of acid escaping back up the oesophagus.

Surgery is performed as a last resort.