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When we eat or drink it passes from the mouth, down the oesophagus (gullet) into the stomach. A muscular ring (lower oesophageal sphincter) which joins the oesophagus to the stomach should ensure that this flow is one way. Acid reflux occurs when this one-way system fails and whatever happens to be in your stomach travels in the wrong direction back up into the oesophagus. The stomach makes acid, which aids digestion by breaking down food and drink.
Whilst the stomach can resist acid, if it refluxes in sufficient quantities into the oesophagus it will cause pain (heartburn) and sometimes the lining of the oesophagus can become inflamed i.e. oesophagitis. If the inflammation is severe, ulcers can form.
Certain lifestyle factors appear to increase the risk of heartburn and reflux, these include:
However, many people can suffer from heartburn symptoms when there is no apparent lifestyle or other factor. It’s also quite common for people to develop symptoms because of reflux when there are no signs of oesophagitis.
Acid reflux symptoms often seems worse after rich meals, citrus fruits, hot beverages, or alcohol. Occasionally it can be felt deeply within the chest, almost within the back, although sometimes the burning feeling can reach all the way up to the throat.
Some patients notice acid reflux symptoms when some of the contents of their stomach ‘repeat’ by coming back up the oesophagus as far as the throat or even the mouth. A few patients notice discomfort or pain as they swallow and may often experience frequent throat clearing, coughing, and choking. It is quite common for these symptoms to be worse at night or when lying down.
For most people with the condition, heartburn and reflux is just a nuisance and little more than that.
In a few people, especially where there is severe inflammation of the oesophagus, there is a risk of complications that can include internal bleeding and narrowing of the gullet.
When you speak with your GP about the issue, they will ask you to describe your acid reflux symptoms and the length of time you’ve had them and review the need for prescribing you acid-suppressant medication. Should you require such medication long-term or the treatment is not working, your GP is likely to request a gastroscopy.
A gastroscopy is something that can be carried out in our Ambulatory Care Unit (ACU) and will help ensure there are no underlying problems with your oesophagus or stomach.
Up to half of all patients with symptoms that suggest they have reflux turn out to have only mild inflammation or an oesophagus that looks quite normal.
A gastroscopy is usually carried out as an outpatient procedure and involves passing a thin, flexible tube through the mouth and down into your oesophagus, stomach and start of your small intestine. The Consultant will be looking for signs of inflammation. The procedure is not painful, but it may be uncomfortable at times.
Most acid reflux treatments revolve around lifestyle changes as your symptoms are likely to lessen if you take measures to reduce the amount of reflux that you have. For example, stopping smoking and drinking less alcohol can all make a big difference to the discomfort you experience. Some foods are more likely than others to trigger reflux symptoms so you may find it helpful to look at how you eat as well as what you eat.
Many people find their acid reflux symptoms improve greatly if they change their lifestyle. Others may need to take medicines from time to time or long-term, depending on the results of a gastroscopy. There are some people for whom drug treatment is not suitable for one reason or another. In such cases, your GP may then refer you to the hospital’s Gastroenterology Department for their advice.
The Consultant may choose to measure the amount of acid you’re refluxing over a 24-hour period and this is known as pH monitoring. The test is often useful when considering if anti-reflux surgery would be appropriate.
One in ten people with acid reflux have Barrett’s Oesophagus. This is a condition that can, very rarely, progress to cancer of the lower oesophagus. If you’re worried about these complications, discuss them with your GP. This is the term used for a pre-cancerous condition where the normal cells lining the oesophagus, also known as the gullet or food pipe, have been replaced with abnormal cells.
The abnormal cells start from where the oesophagus meets the stomach and spread upwards. The main concern is that, although the majority of patients with Barrett’s Oesophagus do not progress to cancer, oesophageal cancer is the 6th most common cause of cancer death in the UK and 4th most common cause of cancer death in the UK in men.
Although the exact cause remains unknown, it is strongly associated with long-term Gastro-Oesophageal Reflux Disease (GORD), which can cause the symptom of heartburn. Approximately 1 in 10 patients with GORD will develop Barrett’s Oesophagus and the risk increases with length and frequency of symptoms. GORD involves reflux of acidic and non-acidic stomach contents into the oesophagus, which irritates and injures the lining. Over time, in some patients with GORD, the lining of the oesophagus changes from the normal structure, to an abnormal type.
Other risk factors that can lead to Barrett’s Oesophagus include older age, male sex, family history, obesity, smoking, high alcohol intake and a hiatus hernia (where the stomach extends abnormally from the abdomen into the chest). Barrett’s Oesophagus can affect men and women, though it is significantly more common in white men, who have a three-fold increased risk for the condition.
The main symptom of Barrett’s Oesophagus is reflux, which can cause heartburn symptoms, regurgitation of food (bringing food back up), nausea and pain in the upper abdomen.
You may also experience a metallic taste in your mouth or a chronic sore throat particularly in the mornings as reflux is usually worse after a period spent lying down. Reflux symptoms that wake you at night time are a particularly strong risk factor. Often though, patients with Barrett’s Oesophagus do not report acid reflux symptoms, or manage with over the counter antacids, and this can lead to delay in diagnosis.
Barrett’s Oesophagus is diagnosed by examining the oesophagus lining through an endoscopy procedure, which is available at Benenden Hospital. A small tube with a camera on the end is inserted into the oesophagus and stomach via the mouth or nose. Sedation can be used to make the procedure more comfortable.
The area of interest is where the oesophagus meets the stomach. Biopsies are then taken to confirm diagnosis and look for abnormal cells (dysplasia). A pathologist will grade the dysplasia into high grade or low grade.
If low grade dysplasia is found, then a repeat endoscopy in six months is ordered to reassess and consider if referral to a specialist centre for treatment is needed. Patients found to have high grade dysplasia are typically referred more quickly to a specialist centre, as the risk of progression to cancer is higher.
*Guts UK is the charity for the digestive system.
This charity was set up to increase levels of research into diseases of the gut, liver, and pancreas so no one suffers in silence or alone.
Since 1971 Guts UK have funded almost 300 projects and invested nearly £16 million pounds into medical research that leads to better diagnoses and treatments for the millions of people who, like us, don’t have the luxury of taking our guts for granted.
The charity’s vision is of a world where digestive disorders are better understood, better treated and everyone who lives with one gets the support they need.
Guts UK is the only charity funding research into the digestive system from top to tail: the gut, liver & pancreas.
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