The stomach is constantly producing strong acid to aid in digestion. Within the stomach this acid is usually not dangerous but if some of it makes its way into the gullet then serious problems can occur.
Acid can enter the gullet due to relaxation or looseness of the valve which divides the stomach from the gullet. This acid then irritates the lining of the gullet causing the burning pain of reflux, or may even irritate the voice box (causing cough) or sometimes even make its way back into the mouth giving a bitter taste. Where the acid from the stomach goes so too can any food or drink in the stomach resulting in regurgitation or vomiting.
Usually the strong muscular action of the gullet quickly returns any stomach acid back into the stomach and little or no damage results, but sometimes these muscles are weak and do not return the acid to the stomach well enough, or sometimes just too much acid is refluxed back through the valve into the gullet for the muscles to cope.
Certain things weaken the valve including having a hiatus hernia, drinking alcohol, caffeine containing drinks including tea, coffee and cola drinks, and smoking. Large meals or bending over put extra pressure on the valve and sometimes acid escapes through it.
Weakening of the muscles in the gullet itself tends to occur with age and some rare diseases
When acid enters the gullet the delicate lining is exposed to damage which can result in ulceration. Ulceration can lead to pain, bleeding, and scarring which may lead to difficulty swallowing. Prolonged acid exposure may increase the chance of cancer of the gullet occurring. If acid reaches the voice box, laryngitis, a cough, a hoarse voice or even asthma can occur.
For these reasons if you have heartburn it is important that it be properly assessed and treated.
The most common test to diagnose reflux is a gastroscopy. This simple test allows the doctor to directly see the lining of the stomach and gullet and to see if any damage has been caused by acid.
Other tests include Barium and other XRays, direct measurement of the acid in the gullet (pH study), and direct measurement of the muscle activity of the gullet (motility study).
Your doctor can determine which tests are needed for your particular problem.
Once a diagnosis of reflux is made the first step is to decrease acid entering the oesophagus. Simple measures such as avoiding foods or drinks which bring it on may be enough for some people. Raising the heads of the bed, avoiding bending, and eating smaller meals may all help.
However, many people require medications. These are divided into four main types.
|Quik Eze||Zantac||None available||Zoton|
Most people should expect good, but often not complete, relief of symptoms on one or more of these medications. Your doctor can advise you as to which drugs are the best for your problem.
If you remain unwell and the tests you have had indicate that reflux is the problem then in some cases surgery may be helpful. The operation involved is called an anti-reflux procedure and these days is often able to be done through a telescope thereby decreasing the size of any scar and lessening your time in hospital. Your doctor can advise you of the potential risks and benefits of any operation for reflux. The risks include failure to control symptoms, or precipitation of new ones, and the benefits (if the operation is successful) include no longer needing to rely on drugs for control of the disease.
In the first instance you should talk to your family doctor. If you still have questions a referral to a specialist in the field may be helpful.
Created 28 July 1997
Updated 14 May 2010