What is Reflux
The long tube of muscle that runs from the mouth to the stomach is called the oesophagus.
Reflux is when acid leaks out of the stomach into the oesophagus, also known as the gullet, and can frequently move up into the throat or mouth. Longstanding acid reflux, where the stomach acid repeatedly irritates the lining of the oesophagus causing it to become sensitive, can lead onto a condition called gastro-oesophageal reflux disease (GORD).
When the lining of the oesophagus appears reddened and inflamed this is known as oesophagitis. The lower oesophageal sphincter (LOS) is a muscle in between the oesophagus and stomach that acts like a valve to allow food/ drink into the stomach but closing afterwards to prevent stomach acid from rising up into the oesophagus. There are many factors that contribute to GORD. It can be due to diet, being overweight, having weaknesses in the gullet muscles and pregnancy are just a few.
The main symptoms of GORD include:
- heartburn – experiencing burning chest pain or discomfort especially after eating
- an unpleasant sour taste in the mouth
- pain and/or difficulty swallowing
- excessive belching
- stomach pains
- sore throat
- lump in the throat
- chest pains
Many people experience infrequent episodes of the above symptoms, but if these are lasting and reoccurring it is normally regarded as a condition that needs treatment.
An estimated 1 in 5 people will experience some form of GORD each week, and 1 in 10 people experience daily symptoms of GORD, so this is quite a common functional gut disorder.
This is not an age-related condition, but most cases affect people over the age of 40. Males are more likely to develop complications with GORD, although it is thought to affect both sexes equally.
For this condition a structured approach is normally undertaken. You may first be advised on changing your diet, losing some weight and not eating late at night. If the condition still persists, then over the counter medicines can be tried such as antacids (Rennies and Gaviscon, for example). These can neutralise the stomach acid and reduce symptoms.
If symptoms persist further, stronger medicines can be prescribed by your doctor. These can be medicines such as Zantac (ranitidine) which is a H2 antagonist or proton pump inhibitors such as Losec (omeprazole) or Prevacid (lansoprazole). If a medical approach does not work then anti-reflux surgery maybe considered. The traditional operation is a Nissen Fundoplication, where the top of the stomach is ‘wrapped’ around the bottom of the oesophagus to form a more effective valve.
There are also other new approaches such as ‘Stretta – an endoscopic treatment or LINX and implantable magnetic ring device which augments your lower oesophageal sphincter preventing reflux. You should carefully discuss all these options with your doctor so you clearly understand the risks and benefits of each approach.
Reflux Treatment Continued
The present gold standard for the diagnosis of GORD is oesophageal pH/Impedance monitoring as it allows us to measure both acidic and non-acidic reflux as well as observe behaviours such as aerophagia (air swallowing) which can make patient’s symptoms worse.
Other approaches include standard pH monitoring which can be done with a nasogastric tube or using a BRAVO capsule which is clipped to the oesophagus during endoscopy. These tests should be performed if you have failed standard medical therapy and certainly before you consider surgery to ensure you have a clear diagnosis of reflux disease and to confirm a good association between your symptoms and reflux events.
By the time you come to see us at The Functional Gut Clinic you may well have had these symptoms for some time and tried many different treatments. It is our aim to use our advanced testing techniques to find out exactly what is and isn’t working properly with your oesophagus. We can then use this information to help personalise your treatment and improve your reflux symptoms.