What is gastro-oesophageal reflux?

Gastro-oesophageal reflux is a condition where the lower oesophageal sphincter (the muscular ring at the lower end of the oesophagus) is abnormally relaxed and allows the stomach's acidic contents to flow back or 'reflux' into the gullet (oesophagus). It can also cause heartburn.

Gastro-oesophageal reflux is a common condition and the most frequent cause of indigestion in the U.S.

What is oesophagitis?

Oesophagitis is inflammation of the inner lining of the oesophagus caused by repeated episodes of gastro-oesophageal reflux.

What are the symptoms of gastro-esophageal reflux oesophagitis?

• A painful or burning sensation in the upper abdomen or chest, sometimes radiating to the back (heartburn).
  
   

• The acid reflux may reach the pharynx (throat) and mouth. It is sour and may burn.
  
   

• A small number of patients have difficulties breathing and suffer from hoarseness because the refluxed fluid irritates the larynx and respiratory tract.
  
   

• Excess belching

When does gastro-oesophageal reflux occur?

• Symptoms typically occur after eating a large or fatty meal or drinking alcohol.
  
   
• Lying down, bending over or bending and lifting can all cause reflux.
  
   
• It is made worse by smoking.
  
   
• Reflux symptoms may have no apparent cause.
  
   

• The frequency with which the symptoms occur varies. For most people, they are rare but weekly and daily episodes of refluxes are not uncommon.

How does gastro-oesophageal reflux affect your health?

It is an unpleasant condition that can have a big influence on your lifestyle.

Many people feel that their quality of life is lowered by the symptoms.

Prolonged exposure to refluxed acid leads to oesophagitis (inflammation of the oesophagus). Long-standing oesophagitis may be complicated by the formation of scar tissue that contracts and results in a narrowing (stricture) in the affected part of the oesophagus. This can make it difficult or even impossible to swallow. It is a serious condition that requires urgent assessment and treatment, but, fortunately, this complication is relatively rare.

It can cause ulceration leading to bleeding and an iron deficiency, which may develop into anemia due to a chronic blood loss.

Why does stomach acid travel up the oesophagus?

The trouble is caused by the faulty oesophageal sphincter, the muscular ring at the lower end of the oesophagus, near the diaphragm. The sphincter is designed to prevent the stomach contents from flowing upward - it functions as one-way valve.

If the sphincter does not work properly, stomach acid flows into the oesophagus. The reflux tendency increases when the stomach contains a lot of gastric juice or food and when there is increased pressure in or on the stomach.

Which conditions can cause gastro-oesophageal reflux?

In many cases, the disorder cannot be attributed to any specific cause but the following conditions can contribute to the problem.

Hiatus hernia

The stomach pokes through the diaphragm, preventing the muscle fibers of the diaphragm from closing the lower end of the oesophagus. The oesophagus remains wide open which allows stomach acid to get into the oesophagus.

Overweight

If the person is overweight the excessive fat in the abdominal cavity increases the pressure inside it. This causes the contents of the stomach to travel up into the gullet. Loss of weight reduces stomach acid reflux.

Pregnancy

Because the uterus increases in size during pregnancy, it presses on the stomach, creating higher pressure inside it, which increases the tendency to reflux. In addition, hormonal changes lead to relaxation of the oesophageal sphincter during pregnancy.

Meals

The more the stomach is stretched by food, the higher the tendency to reflux. The tendency is also increased by eating fatty meals as fat delays gastric emptying. Try to avoid large rich meals, particularly in the evening and this will reduce the tendency to reflux.

Foods

Chocolate, peppermint, coffee, fruit juices and alcohol prevent the oesophageal sphincter from working properly.

Tobacco

Tobacco prevents the oesophageal sphincter from working properly, reduces the rate at which the stomach empties and increases stomach acid production.

Constipation

Constipation increases the tendency to reflux by raising pressure inside the stomach cavity.

Lying down

The tendency to reflux increases when you are lying down. This is just due to gravity. A simple way to change that is to use a pillow under the mattress or to raise the head of your bed by 10cm (4 inches) with blocks or a house brick under the bed frame.

How are gastro-oesophageal reflux disorders diagnosed?

The symptoms of gastro-oesophageal reflux may be so obvious that no tests are needed.

If the doctor is in doubt, or if the symptoms are very troublesome, a gastroscopy will be considered. During the procedure oesophagitis, hiatus hernias, peptic ulcers and other conditions can be either found or ruled out.

Another possibility is to measure the acidity in the lower end of the oesophagus during a 24-hour period. This will give an indication of how often and how long the reflux episodes last.

Lastly, it is possible to measure the pressures within the oesophagus by means of a technique called oesophageal manometry. This is not often used in uncomplicated cases.

The symptoms of gastro-oesophageal reflux can resemble those of a peptic ulcer, chest pains (angina pectoris), muscle pains, back problems, constipation, irritable bowel syndrome, gallstones, pancreatic disease etc. These conditions will sometimes have to be ruled out before the diagnosis can be made.

What can be done to prevent gastro-oesophageal reflux?

The following changes in lifestyle can reduce the risk of developing reflux:

• try to lose weight if you are overweight
  
   
• avoid large, high-fat meals and bedtime snacks
  
   
• limit coffee intake
  
   
• reduce alcohol consumption
  
   
• stop smoking

If the symptoms are not frequent - less than five times a month - they can be treated with over-the-counter medications such as antacids and histamine antagonists. Your doctor or pharmacist will be able to provide advice about the most appropriate ones for you.

When should the doctor be called?

If the heartburn is frequent or the symptoms very unpleasant, see your doctor. He or she will consider whether further tests, such as a gastroscopy, should be carried out, and whether stronger medication is required. If you have any difficulty swallowing, you should see your doctor as soon as possible

How are gastro-oesophageal reflux disorders treated?

Gastro-oesophageal reflux disorders are mainly treated by medicines. In most cases, antacids successfully control the symptoms. If simple antacids are insufficient to control the symptoms, then tablets to reduce acid secretion will usually be tried. This often starts with medicines called histamine antagonists. If these are unsuccessful, then a class of medicines called proton pump inhibitors are used. These are very effective and will also prevent the complications of gastro-oesophageal reflux.

In a small number of cases where medical therapy has been unsuccessful, the problem may be solved by a laparoscopical (key hole) surgical procedure in which the oesophageal sphincter is strengthened (fundoplication).