What is that burning feeling in your chest? A bitter taste in the mouth, burping, hiccups, bloating, and nausea can all be signs of a condition called acid reflux. Respected gastroenterologist Dr Stuart Bloom is here to explain:
What is acid reflux and is it a serious condition?
Acid reflux is common. The stomach produces acid, which is important in the early stages of digestion. The problem arises when the valve between the oesophagus or gullet and the stomach (also known as the lower oesophageal sphincter) becomes incompetent and allows leakage of very acidic stomach content into the oesophagus, which is not adapted to an acid environment. This causes the sensation of heartburn and can result in acid contents refluxing up the gullet.
About 5% of the population have symptoms of heartburn and acid reflux or a bitter acid taste in the mouth. By itself, it’s not serious, but occasionally it can lead to complications.
What are the symptoms of acid reflux?
As stomach acid refluxes up into the oesophagus, it causes symptoms such as:
- Heartburn (a burning sensation felt in the middle of the chest)
- Passage of acidic gastric content up into the back of the throat, and even in the mouth
- Burping and/or hiccups
- A bitter, acid taste in the mouth
- Night-time reflux can cause some stomach contents to spill into the lungs which can cause nocturnal cough and wheeze.
Characteristically, the symptoms are worst on lying flat or after eating a big meal or one containing spicy food, alcohol, or citrus fruits.
How can I relieve a flare up of acid reflux?
Since the usual cause of reflux is a leaky valve, the ideal treatment is to tighten this valve. Unfortunately, we don’t have a perfect medicine to do this; some medicines have been trialled, but they all have side-effects. Consequently, the two main treatments that have evolved are surgical treatments, known as anti-reflux procedures, and drugs which suppress gastric acid.
The simplest kind of acid-suppressing medication are antacids, such as Gaviscon®. These are effective at neutralising stomach acid, but don’t last long and have to be taken very frequently. The next step up in acid suppression are drugs called histamine-receptor antagonists and the commonest of these at the moment in the UK is ranitidine, taken usually at night. These drugs have been available for a long time, are available over the counter, and are very safe to take even for a prolonged period.
The strongest type of acid suppressant medication are called proton-pump inhibitors (PPIs) and there are four on sale in the UK: omeprazole, lanzoprazole, rabeprazole, and pantoprazole. These are available as over-the-counter medicines, although they are expensive.
In most cases, these drugs will effectively relieve acid reflux and only in a small minority of patients is further investigation required with a view to carrying out anti-reflux surgery.
Anti-reflux surgery usually involves wrapping the upper end of the stomach around the lower oesophagus – this operation is called fundoplication. Although effective in the right patient, it can lead to side effects of bloating, inability to burp, and difficulty swallowing.
Is acid reflux the same as GERD/GORD?
Not quite. GORD stands for gastro-oesophageal reflux disease (known as GERD (gastro-esophageal reflux disease) in the US – “oesophageal” is spelt without the “O” in America). While most cases of GORD are due to acid, some people reflux bile from the stomach, and bile is alkaline, not acidic, so the term GORD includes alkaline as well as acid reflux.
Can acid reflux lead to serious complications if chronic?
There are some serious complications of acid reflux, although these are not common. The most common abnormality accompanying reflux is a hiatus hernia. This occurs when a portion of the stomach herniates through the diaphragm into the chest because the valve at the lower end of the oesophagus is floppy. Most hiatus hernias are associated with reflux, but produce no further complications.
In a small number of patients, GORD causes a change in the lining of the lower oesophagus. First described by Norman Barrett in the 1950s, this change is therefore called Barrett’s oesophagus. This is a risk factor for oesophageal cancer, although the risk is very low (approximately 0.5-1% per year). Patients with Barrett’s oesophagus need regular screening examinations with endoscopy to monitor the lining of the lower oesophagus.
Another potentially serious complication of reflux is aspiration of gastric contents into the lungs, which can cause a chest infection. This can occur at night when gastric contents can reflux up the oesophagus and into the trachea (windpipe). This reflux can cause a troublesome nocturnal cough or even wheeze, which can be mistaken for asthma.
Acid reflux is very common and can usually be effectively managed with medicines, which are safe and can be taken either regularly or when a flare of symptoms occurs. A sudden change in symptoms such as loss of appetite, difficulty swallowing, increased pain, or vomiting blood should prompt an appointment with your GP.