Reflux is the welling-up of stomach contents into the oesophagus (gullet), where they do not belong. The travel of food and fluid in the wrong direction is due to a failure in the valve mechanism at the lower end of the oesophagus, just above the stomach. This ‘lower oesophageal sphincter’ is a complex muscular mechanism that can fail for a number of reasons, including the presence of a hiatus hernia.
The common kind of hiatus hernia occurs when the upper part of the stomach becomes displaced upwards through the diaphragm. The hole in the diaphragm through which the gullet normally passes is called the oesophageal hiatus – hence ‘hiatus hernia’. If food and fluid come up into the mouth, we call this regurgitation.
What are the symptoms of gastro-oesophageal reflux?
There may be no symptoms at all, but patients most often have heartburn (a burning pain behind the breast bone, usually worse after meals or on lying down). A hoarse voice, persistent cough, an acidic taste in the mouth or difficulty or pain when swallowing can also occur.
Why is reflux important?
The symptoms can make people feel very anxious and unwell. The welling-up of stomach contents into the gullet may cause inflammation in the gullet (oesophagitis) that can lead to ulcers, narrowing of the gullet causing difficulty with swallowing, or Barrett’s oesophagus.
What is the treatment for gastro-oesophageal reflux?
Avoiding foods known to worsen reflux can often control heartburn; these include alcohol, chocolate, caffeine and fatty foods.
Overweight sufferers should lose weight and smokers should stop. Reducing food and fluid intake before bedtime and raising the head of the bed may also help.
Indigestion remedies can be bought over the counter and may be enough if the symptoms are mild. A doctor can prescribe more powerful anti-acid medicines that are usually very effective.
A surgical operation may be needed if symptoms cannot be controlled by medication.
When do I need to see a doctor?
See your doctor if lifestyle changes and over the counter medication do not resolve the symptoms.
Always see a doctor if you are having difficulty in swallowing or food is getting stuck. Gastroscopy will usually be suggested to find the cause. Inflammation, or narrowing of the gullet due to scarring or, less likely, cancer are possibilities. A barium swallow X-ray is a possible first test, but gastroscopy may also be needed.
How is gastro-oesophageal reflux diagnosed?
The symptoms are often diagnostic, but investigations may be necessary. These include gastroscopy or measurement of the amount of acidity in the oesophagus, either by a wireless device implanted in the oesophagus, or by a 24 hour tube test.