What is Gastroesophageal reflux disease also known as Heartburn?
Heartburn, commonly referred to as acid reflux or by its medical term, gastroesophageal reflux disease (GORD), is a condition where stomach acid flows back up into the oesophagus. This backward flow leads to a burning sensation or pain that can move up from your stomach to the middle of your abdomen and chest, and even up into your throat and sinuses.
Why Does GORD or heartburn Occur?
The root cause of heartburn is the improper functioning of the lower oesophageal sphincter (LOS), a circular band of muscle around the bottom part of your oesophagus. Normally, the LOS closes as soon as food passes through it, but if the LOS doesn’t close all the way or if it opens too often, acid produced by your stomach can move up into your oesophagus. This can cause symptoms such as a burning chest pain called heartburn. If acid reflux symptoms occur more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GORD).
What are the common causes of Heartburn?
- Diet: Certain foods and beverages can exacerbate acid reflux symptoms. These include spicy foods, onions, citrus products, tomato products, fatty or fried foods, peppermint, chocolate, alcohol, caffeinated beverages (such as coffee, tea, and soda), and carbonated beverages.
- Eating habits: Large meals and eating before bedtime.
- Lifestyle factors: Being overweight, smoking, and alcohol consumption.
- Other factors: Stress and lack of sleep can also increase the risk of GORD.
What is the management and treatment of GORD or Heartburn?
- Dietary changes: Avoiding the foods and beverages that trigger your acid reflux. Eating smaller, more frequent meals rather than three large meals a day.
- Weight loss: If you are overweight, losing weight can reduce the pressure on your stomach, preventing the stomach acid from rising into your oesophagus.
- Avoid lying down right after a meal: Wait at least three hours after eating before lying down or going to bed.
- Elevate the head of your bed: Lifting the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach.
- Avoid smoking and reduce alcohol intake: Both can worsen GERD symptoms.
- Medication: Over-the-counter antacids can neutralise stomach acid and provide quick relief. For more severe cases, other medications such as H2 blockers or proton pump inhibitors (PPIs) might be prescribed.
How is GORD or heartburn diagnosed?
While most cases of GORD can be diagnosed based on symptoms and response to treatment, more severe or atypical cases may require further tests:
- Upper Endoscopy: A procedure where a thin, flexible tube with a light and camera (endoscope) is used to look inside your oesophagus and stomach to check for any irritation or changes to the tissue.
- Oesophageal manometry: To check the function of the oesophagus and lower oesophageal sphincter.
- PH monitoring: To measure acid levels in the oesophagus and help determine if you have GERD.
By understanding these aspects of heartburn and GORD, you can take proactive steps to manage your symptoms and improve your quality of life. Always consult a healthcare professional for a diagnosis and appropriate treatment.
How is gastroesophageal reflux disease or Heartburn treated?
Treatment Options:
Antacids
For mild or infrequent reflux symptoms, antacids can be very effective. These medications neutralise stomach acid and provide quick relief. They’re available over the counter and can be taken as needed.
Acid-reducing drugs
For those who experience more frequent or severe symptoms, medications that reduce the production of stomach acid may be required. These include:
- H2-receptor antagonists (H2 blockers): Reduce acid production and provide longer relief than antacids. Examples include famotidine and ranitidine, available both over the counter and by prescription.
- Proton pump inhibitors (PPIs): Stronger acid blockers that are often prescribed when H2 blockers are insufficient. Common PPIs include omeprazole, esomeprazole, pantoprazole, and lansoprazole, with some forms available over the counter.
Effectiveness and Safety
These treatments are generally safe and effective for managing symptoms of reflux.
Will I need to take medication forever?
- Continuous medication: Some individuals may need to continue medication indefinitely to manage symptoms effectively.
- Intermittent use: Many people manage their reflux by taking medications only when symptoms arise or are anticipated, known as "as required" dosing.
Discuss with your specialist whether a long-term or as-needed medication regimen is best suited to your case. Your specialist can help tailor a strategy based on the severity and frequency of your symptoms.
Are there surgical options for treating gastroesophageal reflux disease?
Surgery may be considered for those with severe symptoms, inadequate relief from medications, or a preference to avoid long-term medication use. The common procedure is:
- Laparoscopic anti-reflux surgery (often a Nissen fundoplication): This minimally invasive surgery enhances the barrier between the stomach and oesophagus to prevent acid reflux. It's done through small incisions using a laparoscope, which reduces recovery time and associated risks.
In summary, treatment for reflux can range from simple dietary changes and over-the-counter antacids to prescription medications and even surgery, depending on the individual’s specific symptoms and medical history. Lifestyle modifications can also play a significant role in managing and reducing symptoms. Consultation with a gastroenterologist is essential to determine the most appropriate treatment approach for each person.
