Acid reflux: symptoms, cause and treatment of gastro-oesophageal reflux disease (GORD)

Acid reflux (or gastro-oesophageal reflux) occurs when material from the stomach moves upwards into the gullet (or oesophagus). Although this may happen to a small extent every day in most people,  in everyone, regular acid reflux can cause troublesome symptoms or damage to the gullet, in which case it is termed gastro-oesophageal reflux disease (GORD). Up to twenty per cent of the population suffer from gastro-oesophageal reflux disease. In this informative article, revered consultant gastroenterologist Dr Sarmed Sami explains more.

What are the symptoms of acid reflux?

The main symptoms of gastro-oesphageal reflux disease are heartburn (a burning feeling behind the breastbone) and regurgitation (an unpleasant sensation of material moving upwards behind the breastbone).

Less commonly, GORD can also be responsible for a number of other symptoms including swallowing difficulties, chest pains, abdominal burning, cough, wheeze, sore throat and hoarse voice. Occasionally there are no symptoms at all, so-called 'silent reflux'. A small proportion of patients with GORD are at increased risk of oesophageal cancer.

What causes acid reflux?

The main reason GORD occurs is due to a weakening of the so-called 'anti-reflux barrier' between the stomach and gullet. There are two main components of this barrier: the lower oesophageal sphincter muscle and the diaphragm.
 

The lower oesophageal sphincter is a muscle at the bottom of the gullet that opens to let food through when you swallow, and then closes to stop stomach contents refluxing back into the gullet. If this muscle is weaker, the person may be more prone to GORD.
 

The diaphragm is the muscle that separates your chest from your abdominal cavity. This also contracts to prevent reflux.
 

The lower oesophageal sphincter and diaphragm are usually positioned closely together, and work together to prevent reflux. When they become separated, the barrier against reflux is less effective. The most common reason this occurs is when the patient has a hiatus hernia. Here, part of the stomach moves above the diaphragm into the chest, and reflux becomes much more likely.

How is acid reflux treated?

Lifestyle measures

• Eating smaller meals - avoiding meals within the 4 hours before bedtime, and avoiding eating or drinking things that make your reflux worse (e.g. alcohol) can help.
• Propping the head on the bed can help night time symptoms - others find that lying on their left side helps.
• There is evidence that stopping smoking can help reflux symptoms. 
• Weight loss helps if you are overweight.

For expert guidance on stopping smoking or losing excess weight, visit our medical dictionary. 

Medication

For intermittent symptoms, over the counter medications such as an antacid or alginates can be helpful in offering fast relief. For more troublesome symptoms proton pump inhibitor tablets can be beneficial. These usually require a prescription, but are the most effective medications to block acid production in the stomach. They are generally very safe drugs but, as with all medications, can have side-effects and many people continue to take them long term.

Are there any surgical procedures to treat acid reflux?

For some people surgery is a very good option. It is very important that expert opinion is sought before having surgery for reflux disease to ensure the best chance of success.
 

Surgery can be particularly useful for people who are experiencing side effects from medications, or have persistence of symptoms (particularly regurgitation) when taking tablets. It usually involves a keyhole operation to fix any hiatus hernia and strengthen the anti-reflux barrier.
 

In selected people, an endoscopic procedure (Stretta) can be helpful. This is a non-operative procedure that does not involve any cuts or scars. High frequency radio waves are passed through small needles into the lower oesophageal sphincter muscle, and this results in “bulking” of the muscle and reduction in reflux and symptoms.

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