Acid reflux: Key insight on recommended lifestyle changes and treatment options

Although many people may suffer mild or occasional bouts of heartburn, effective treatment is available for recurrent or severe symptoms of acid reflux. In this in-depth guide, highly respected consultant surgeon Mr Nagammapudur Balaji outlines the most common symptoms and causes of acid reflux. The leading specialist also shares his expert insight on the most impactful lifestyle modifications patients can make to help manage their symptoms and reveals how medication, and in some cases surgical intervention, can help to resolve the issue.

What is acid reflux?

To explain what acid reflux is, we first have to establish where acid is produced. Acid is normally produced in the stomach, and as we know, this is an organ which is present in the abdomen. Therefore, all the acid in the stomach should be only in the tummy. Sometimes this acid goes up into the food pipe in the chest and sometimes even reaches all the way up to the mouth. This should not happen normally, and when it does so this is called acid reflux.

What causes acid reflux?

Usually, a valve which is present between the food pipe and the stomach prevents acid from going up into the chest, or up to the mouth. If for any reason that mechanism becomes diseased or it is not functioning well, then acid goes up.

The most common cause of acid reflux is excessive weight and as a result, people who are obese can have a lot of acid reflux. Other causes can be due to the valve or the food pipe not functioning properly. We can only determine this malfunction when we investigate patients for this problem.

What are the symptoms of acid reflux?

The most common symptom of acid reflux is heartburn, which is essentially a burning sensation in the region where your heart or the breast bone are found in your chest. It’s important to remember that heart burn relates to a feeling where the heart is found, up in the chest, as many people think symptoms can be felt somewhere in the belly. However, heartburn is only felt in the chest.

Another symptom of acid reflux is what we call regurgitation. Regurgitation means a feeling or the flow of something going from your belly all the way up into your chest and into your throat. Rarely, some people may get some difficulty swallowing if the food pipe is also not working properly. When patients report difficulty swallowing, we typically perform more tests to rule out more serious conditions like cancer.

What is the difference between heartburn and acid reflux?

Heartburn is a symptom which is caused by acid reflux. This is also true of regurgitation, which is another symptom which results from acid reflux. Patients often come to me concerned about acid reflux, and the most important thing I ask is, “Tell me what you are feeling…”. That way, we can establish the right diagnosis and find the most appropriate treatment option.

What are the available treatment options for acid reflux?

First of all, we try to address factors which are within our control and establish the cause of a patient’s acid reflux. As the most common cause is excess weight, we will look in to this and if we find this as a cause of worsening reflux, we will advise patients to lose some weight.

Lifestyle changes can also help, such as cutting down on alcohol, fatty foods and spicy foods, because all these things make acid reflux worse. People typically note that their symptoms are worse after alcohol or a heavy meal, so making some changes in this regard can be very beneficial.

Another key piece of advice we give to patients is that they should always go to bed at least three to four hours after having their last meal. This can be helpful because if the stomach is full, on lying down acid tends to reflux with a weak valve. Lifestyle changes, weight reduction and cutting down on alcohol, fatty foods and smoking are very effective steps patients can take to help control their acid reflux.

The next steps are medicines which also do a fantastic job. There are many medicines on the market which work differently. Many people might have heard of Gaviscon, which is a good medicine. There are also very effective medications like Omeprazole and Pantoprazole, which we call proton pump inhibitors.

The next step is surgery. Surgery for acid reflux is only when the symptoms are very severe. We don’t operate on all patients with acid reflux and in fact, only with a specific group of patients who are unable or unwilling to take acid reflux medications in the long term. Patients who require medication for acid reflux will have to take it throughout their life, and so if they suffer side effects from this medication or do not wish to continue to take them in the long term for some other reason, we might offer surgery.

Surgery is the last resort in treating acid reflux and we always set out to aim for effective control of symptoms with lifestyle modifications and medication. It is a common misconception that surgery is for patients whose acid reflux cannot be effectively treated with medication. This is not accurate as patients who benefit from medications may also benefit from surgery, while those who do not benefit from medications may also find that surgery does not improve their condition. This is why we perform a number of tests, such as endoscopy, manometry and pH testing, before we offer surgery as we have to be sure that surgery will actually help the patient.

Much like any type of operation, surgery for acid reflux has side effects and a risk of complications. Therefore, we have to be very sure that we are giving the patient a procedure which has a small risk of complications and will be of benefit to them. The last thing we want is for a patient to undergo surgery and have no benefit from it.

What are the key lifestyle changes to help to manage acid reflux?

As discussed earlier, lifestyle changes are the most important and they come as a part of healthy and sensible living. It’s best to:

• Keep yourself fit
• If you think you may be overweight, try to reduce your weight
• Be sensible with your consumption of alcohol
• Avoid smoking
• Reduce your intake of unhealthy foods (which are extremely common in modern daily life)

If these steps don’t help, we have to think about implementing medications. Although I am a surgeon and performing operations is part of my daily life, I advise my patients to avoid surgery if at all possible. Despite the fact that we achieve excellent results for most patients, there is always a small risk of harm associated so if it’s possible to avoid undergoing a surgical procedure, that is the best thing to do.

If you are concerned about symptoms of acid reflux and wish to schedule a consultation with Mr Balaji, you can do so by visiting his Top Doctors profile.