Overview
A ring of muscle sits where the food pipe joins the stomach and normally keeps stomach contents down. When it is weak, or relaxes at the wrong time, acid washes back up. That is acid reflux, and the burning it causes is heartburn.
Almost everyone gets this now and then. When it happens repeatedly, or inflames the lining of the food pipe, it is called gastro-oesophageal reflux disease, or GERD.
Symptoms
- A burning feeling in the middle of the chest, often after meals
- A sour or bitter taste, or food coming back into the throat or mouth
- Symptoms that are worse on lying down or bending forward
- Bloating, burping and feeling sick
- A dry cough or hoarse voice that keeps returning
When to see a doctor
See a doctor in the next few days if heartburn comes most days or has lasted over three weeks, if antacids no longer help, if swallowing is painful, if weight is falling without trying, or if a cough or hoarse voice keeps returning.
Causes
Reflux happens when the valve between the food pipe and the stomach is weak or opens when it should not. A hiatus hernia, where part of the stomach slides into the chest, makes this more likely.
Some medicines also relax the valve or irritate the lining, including anti-inflammatory painkillers, certain and asthma medicines, and some used for sleep or low mood.
Risk factors
- Being overweight, especially around the middle
- Pregnancy
- Smoking, or breathing in other people's smoke
- Large or late meals, and lying down soon after eating
- Alcohol, coffee, chocolate and fatty or spicy food
- A hiatus hernia, and tight clothing around the waist
Complications
Long-standing reflux can inflame the lining of the food pipe, which may bleed. Scarring can narrow it so that food sticks, and in some people the lining changes into a different tissue, called Barrett's oesophagus, which needs regular checks because it carries a small risk of cancer.
Prevention
- Eating smaller meals more often, rather than one large meal
- Leaving about three hours between the last meal and lying down
- Raising the head end of the bed by 10 to 20 centimetres, rather than piling up pillows
- Losing extra weight if overweight
- Stopping smoking and chewing tobacco, and cutting down on alcohol
- Cutting out only the foods and drinks that clearly set symptoms off
Diagnosis
Most of the time a doctor recognises reflux from the story and a short trial of treatment. Tests are used when symptoms are severe, do not settle, or come with warning signs.
A gastroscopy, a thin camera passed through the mouth, looks directly at the food pipe and stomach and can take small samples. A breath, stool or blood test may be done for the H. pylori germ. Less often, the acid level in the food pipe is measured over a day.
Treatment
Treatment begins with the changes listed under prevention, which help many people on their own. Antacids and alginates bought from a pharmacy settle occasional symptoms quickly but are meant for short-term use.
For frequent symptoms a doctor usually prescribes a medicine that reduces acid production, as a course of several weeks that is then reviewed. Another group of acid-reducing medicines is used if the first does not suit. If the H. pylori germ is found, are added to clear it.
Surgery to tighten the valve is considered only for the few whose severe symptoms do not respond to medicines. A narrowing of the food pipe can be stretched during a gastroscopy.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A burning pain in the chest is always just gas or acidity.”What is true?
Fact
Reflux and heart problems can feel very similar. Chest pain with sweating, breathlessness, or pain spreading to the arm, neck or jaw should be treated as a possible heart attack and checked urgently. It is safer to be examined and told it was acidity.
Myth“Spicy Indian food is the cause, so anyone with acidity must eat bland food forever.”What is true?
Fact
Spicy and fatty food, coffee, chocolate, tomatoes and alcohol can set symptoms off in some people, but they are triggers rather than the cause. The underlying problem is the valve at the top of the stomach letting acid back up. Most people only need to avoid the few things that clearly upset them.
Myth“Cold milk or a fizzy drink cures acidity.”What is true?
Fact
These may dull the burning for a few minutes, but they do not treat the cause. Heartburn on most days, or symptoms that keep returning once a home remedy wears off, is a reason to see a doctor rather than to keep treating it at home.
Myth“Acidity tablets are harmless, so I can buy them for years whenever it burns.”What is true?
Fact
Acid-reducing medicines are usually prescribed as a course of a few weeks and then reviewed. Taking them on your own month after month can mask a problem that needs a camera test, such as an ulcer, a narrowing of the food pipe or a change in its lining.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How do I tell acidity from a heart attack?
You often cannot, and that is the point. Reflux tends to burn, comes after meals and is worse lying down, while heart pain is more often a heavy pressure that comes on with effort. But the two overlap, so chest pain with sweating, breathlessness, giddiness or pain spreading to the arm, neck or jaw should be checked as an emergency.
Is it safe to take acid-reducing tablets for a long time?
They are widely used and generally well tolerated, but they are meant to be prescribed for a reason and reviewed rather than repeated indefinitely. If symptoms return every time the course ends, tell your doctor, because that is a reason to look more closely rather than to keep buying the same tablet.
Do I need a camera test for simple heartburn?
Usually not. A gastroscopy is suggested when there are warning signs such as difficulty swallowing, vomiting blood, black stools, weight loss or anaemia, when symptoms start later in life, or when treatment has not worked. Your doctor will explain why it is being advised in your case.
Will reflux go away if I lose weight?
Losing extra weight is one of the changes most likely to help, especially weight carried around the middle, because it reduces pressure on the stomach. It does not help everyone, and it works best alongside smaller meals, a later gap before lying down and stopping tobacco.
