Heartburn is a very familiar problem, but should be taken seriously because it can cause damage if it becomes chronic.

Heartburn, also called “acid reflux” or “gastro-oesophageal reflux”, occurs when gastric (stomach) acid flows back up into the oesophagus (gullet).

This happens because the lower oesophageal sphincter (a muscular ring at the lower end of the oesophagus) is abnormally relaxed and allows gastric juices to flow back or "reflux" into the oesophagus. Usually, the sphincter prevents stomach contents from flowing upward, working like a one-way valve.

Some reflux is normal. Sometimes, the sphincter does not close tightly enough after food has passed through it and acid reflux occurs. The reflux tendency increases when the stomach contains a lot of gastric juice or food, and when there is increased pressure in or on the stomach.

If this happens often enough however, the acid can damage the gullet lining and symptoms worsen. This condition is called Gastro-Oesophageal Reflux Disease (GORD).

Causes


The cause is usually a sphincter that relaxes spontaneously more frequently than normal.A weakened valve occurs in 20% of cases.

Factors that may contribute to reflux:

    • Food. The more the stomach is stretched by food, the higher the tendency to reflux. Fatty foods also increase this, because fat delays stomach emptying. Foods that hinder action of the oesophageal sphincter include chocolate, peppermint, coffee, fruit juices and alcohol.

    • Hiatus hernia. Part of the stomach protrudes through the diaphragm (the layer separating the abdomen from the chest cavity), preventing the muscle fibres of the diaphragm from closing the lower end of the oesophagus. The oesophagus remains open, allowing stomach acid to enter.

    • Overweight. Excess fat in the abdominal cavity increases pressure inside it. This can push the stomach contents up into the gullet.

    • Pregnancy. Hormonal changes during pregnancy cause the oesophageal sphincter to relax. Also, as the uterus grows, it presses on the stomach. Both factors increase the tendency to reflux.

    • Smoking prevents the oesophageal sphincter from working properly, increases gastric acid production and slows stomach emptying.

    • Medications e.g. for asthma and cardiac conditions, can cause reflux through sphincter relaxation.

    • Body position. Tendency to reflux increases when lying down, bending over or bending and lifting.

    • Digestive imbalance. The above risk factors all combine to create digestive imbalance. Taking a probiotic may be necessary for those who cannot adjust their lifestyle to address such digestive imbalance. Some nutritionists also recommend taking chlorophyl to help aid restore digestive balance.



Who is at risk?


Anyone can get reflux, but risk is higher for these groups:

    • Pregnant women

    • Overweight people

    • Smokers

    • Babies do not have fully developed lower oesophageal sphincters. This explains their tendency to vomit, which should decrease during the first months as anti-reflux mechanisms become stronger.



Symptoms


For most people, symptoms are rare, but some experience reflux weekly or daily. Symptoms include:

    • Painful or burning sensation in the upper abdomen or chest, sometimes radiating to the back (heartburn). This usually lasts only a few minutes. Some describe it as a “must-sit-up” feeling.

    • If acid reflux reaches the throat and mouth it tastes sour and can burn.

    • Non-burning chest pain

    • Persistent laryngitis, hoarseness or even difficulty breathing: refluxed fluid irritates the larynx (voice box) and respiratory tract.

    • Persistent sore throat.

    • Excessive burping.

    • Difficulty swallowing , or food getting stuck

    • Chronic cough

    • New onset of asthma or asthma only at night

    • Sense of lump in throat

    • Worsening dental disease

    • Recurrent pneumonia

    • Chronic sinusitis

    • Waking up with a choking sensation



Other conditions with similar symptoms include gallstones, ulcers, angina and gastritis.

Call your doctor if:



    • You experience heartburn twice a week or more, or if symptoms are very unpleasant.

    • If you have difficulty swallowing, are losing weight or feel fatigued, please see your doctor without delay.



Your doctor will consider whether tests such as gastroscopy should be performed, and whether stronger medication is required. (Gastroscopy examines the inside of the oesophagus and stomach with a thin tube attached to a tiny camera that is passed into your mouth and digestive tract).

Treatment


GORD is mainly treated by medication. Most people find that antacids, taken before and after meals and at bedtime, successfully control symptoms. Antacids neutralise acids in the gastrointestinal system. Their main potential side-effect is a change bowel habits, causing flatulence, constipation or diarrhoea.

If simple antacids are insufficient to control symptoms, then drugs to reduce acid secretion, histamine antagonists, may be recommended. If these are unsuccessful, then a class of drugs called proton pump inhibitors are used. These work by preventing the stomach from producing acid.

A type of keyhole surgery called fundoplication, in which the oesophageal sphincter is strengthened, is indicated in a few cases.

Help prevent GORD by:



    • Maintaining your correct weight.

    • Stopping smoking.

    • Avoiding large, high-fat meals, particularly at night.

    • Limiting coffee and alcohol.

    • Raising the head of your bed 10-15 cm.



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