I have a question about heartburn treatment

What is heartburn?

Heartburn, or acid reflux, is a burning sensation in your chest caused by acid in your stomach leaking back into your oesophagus (gullet). Heartburn is not related to your heart.

Heartburn is also known as gastroesophageal reflux disease (GORD) or reflux disease. GORD is where the valve (or sphincter) between the bottom of the oesophagus and the top of the stomach prevents acid from leaking back into your oesophagus. The acid irritates the sensitive lining of the oesophagus causing the burning sensation known as heartburn.

For most, occasional heartburn is no cause for concern and symptoms of heartburn can be managed by over-the-counter medications or lifestyle changes. If heartburn becomes more frequent and interrupts your daily life, this could be a sign of something more serious that requires attention.

What are the main acid reflux and heartburn causes?

Certain lifestyle factors appear to increase the risk of heartburn and acid reflux symptoms. Heartburn causes include:

  • Smoking
  • Drinking excess alcohol
  • Pregnancy
  • Stooping or bending forwards
  • Weight gain
  • Stress and anxiety
  • Some anti medications
  • A hiatus hernia

However, many people can suffer from heartburn symptoms when there’s no apparent lifestyle cause or other factor. It’s also quite common for people to develop symptoms because of reflux when there are no signs of oesophagitis.

What are the usual heartburn and acid reflux symptoms?

Occasional heartburn is very common. The frequency of heartburn or acid reflux symptoms varies widely between people, as does the severity of the symptoms. For some, it’s just an occasional nuisance, but if you get heartburn all the time, it can significantly affect your long-term quality of life.

Heartburn affects people more as they get older, and it is much more common in people who are overweight, who overeat or who smoke. It is also commonly experienced during pregnancy.

Heartburn symptoms are often 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 heartburn 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 heartburn symptoms to be worse at night, when lying down or bending over.

What’s the difference between heartburn and indigestion?

Heartburn and indigestion are talked about interchangeably, but they're very different conditions.

Indigestion (also known as dyspepsia)

Indigestion covers a wide range of digestive issues, including a stomach ache or upset stomach. It’s usually caused by eating too much or too fast or eating food that’s high in fat. Eating with your mouth open and swallowing air can also cause you to burp, which is another form of indigestion.

Symptoms of indigestion include stomach pain, burping, nausea or vomiting and diarrhoea - and can leave you with an acidic taste in your mouth. Symptoms normally go away after a couple of hours.

Indigestion can be linked to more serious conditions including stomach ulcers or problems with your pancreas. You should speak to your GP if your symptoms are severe or last for more than a couple of weeks.

Heartburn

Heartburn is just one of the symptoms of indigestion and occurs in your upper abdomen when stomach acid leaks into your oesophagus. Heartburn is usually triggered by fatty or spicy foods, fizzy drinks or alcohol, eating too much or eating a big meal before bed. It can last for a few minutes, or several hours, and can affect your sleep.

If you’re overweight, you’re more prone to suffering from heartburn. Even a few extra pounds can put pressure on your stomach, causing acid to back up into your oesophagus.

If your heartburn symptoms persist, you should speak to your GP.

How is heartburn and reflux diagnosed?

When you speak with your GP about a heartburn issue, they will ask you to describe your acid reflux symptoms and the length of time you’ve had them. Your GP may 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.

What are acid reflux or heartburn treatment options?

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 heartburn 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 acid reflux. 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.

What is Barrett’s Oesophagus

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.

What causes Barrett’s Oesophagus?

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.

What are the symptoms of Barrett’s Oesophagus?

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.

Dr Adam Harris

How is acid reflux treated?

Dr Adam Harris, Consultant Gastroenterologist at Benenden Hospital, discusses diagnosis and treatment of acid reflux at Benenden Hospital.

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