Although many people experience mild heartburn from time to time, persistent symptoms of acid reflux can cause significant discomfort and affect your overall wellbeing and quality of life. In this informative article, consultant neurogastroenterologist Dr Natalia Zarate-Lopez shares her insight on the most common causes of acid reflux, diagnostic tests and also discusses the most effective lifestyle changes to help manage symptoms.
What causes acid reflux?
Acid reflux symptoms happens when acid from the stomach moves towards the oesophagus (food pipe) causing symptoms of heartburn, chest pain or regurgitation. This can be due to a weak lower oesophageal sphincter (LES), a ring of muscle that works as a valve and separates your oesophagus and stomach or a hiatus hernia. One third of patients might have symptoms, equally severe, due to an increased sensitivity of the oesophageal nerves to normal levels of acid. Management of acid reflux depends greatly on the mechanism/s contributing to symptoms generation.
What are the symptoms of acid reflux?
The main symptoms of acid reflux are heartburn, a burning sensation in the middle of your chest, an unpleasant sour taste in your mouth caused by stomach acid, chest pain, dysphagia and less frequently chronic cough or a hoarse voice.
Are acid reflux symptoms influenced by lifestyle factors?
Yes, acid reflux can be influenced by our diet, weight and meal routines. Coffee, alcohol, oily fatty foods, spicy foods or acidic foods (juices, tomatoes) can exacerbate symptoms. Avoiding meals before going to bed can also help symptom control.
Which lifestyle changes can help to relieve acid reflux?
Lifestyle changes that may help reduce the frequency of acid reflux include:
- maintaining a healthy weight and losing excess weight
- stopping smoking
- eating smaller and more frequent meals
It can also help to raise the head end of your bed by ten to twenty centimetres so your chest and head are above the level of your waist, which can stop stomach acid travelling up towards your throat.
What investigations can be considered for patients with acid reflux symptoms?
Patients not responding to first line therapies, like life style modifications, antiacids or a short course of acid reducer drugs should be considered for a gastroscopy. This is a test to check inside your throat, food pipe and stomach. It allows to determine if there is inflammation in the food pipe or factors like a hiatus hernia contributing to the symptoms.
Oesophageal physiology tests involve measuring for a period of time how much acid there is in the oesophagus and the relation between this and symptoms. It is important that the timing, rational and interpretation of these tests are performed by doctors with appropriate expertise.
What types of treatment are available?
Treatments for acid reflux symptoms depend on the mechanism responsible for the symptoms. Proton pump inhibitors and H-2-receptor blockers can provide symptom relief when acid is the main culprit for symptoms. The dosage and duration of treatment depends on the severity of symptoms and presence or absence of reflux related complications. Surgery may also be an option in more severe cases.
Neuromodulatory medication can be considered when symptoms are severe but oesophageal nerve sensitivity rather than excessive acid is the mechanism behind the symptoms.
If you are concerned by symptoms of acid reflux and wish to schedule a consultation with Dr Zarate-Lopez, you can do so by visiting her Top Doctors profile.