Burning in your chest: GORD and hiatal hernias

Have you ever felt a burning sensation in your chest after eating? Has it ever felt like food was coming back up from your stomach, but you haven’t been sick? Did it leave a bitter, acidic taste in your mouth? Heartburn is the main symptom of gastroesophageal reflux disease (GORD/GERD) – a condition which has the potential to cause serious consequences, and may go hand in hand with a hiatal hernia. Top surgeon Mr Zak Rahman is here with further facts about GORD.

What is gastroesophageal reflux?

Gastroesophageal reflux, better known as acid reflux, is the return of the stomach's contents back up into the oesophagus.

Normally, a number of mechanisms prevent food from coming back up into the oesophagus. Some of these are related to the muscles within and around the lower part of the oesophagus before it enters the stomach, while gravity also plays a part. Food passes down the oesophagus in a coordinated pattern and the lower oesophageal sphincter (LOS) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the oesophagus.

Gastroesophageal reflux can occur when the LOS is weak or relaxes inappropriately, allowing the stomach's contents to flow up into the oesophagus.

A number of factors can contribute to GORD and these include dietary and lifestyle factors. Being overweight, pregnancy, smoking and certain food types may trigger heartburn. In a significant proportion of cases, the muscles around the oesophagus, known as the crura (singular: crus), become weakened and separate, causing a hiatus hernia.

What is the role of hiatal hernia in gastroesophageal reflux disease?

A hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the abdomen from the chest. As we breathe, the crura pinch the lower end of the oesophagus and create an artificial valve-like effect to stop acid coming back up into the chest. Hiatal hernias are very common; however not all people with hiatal hernias will have symptoms of GORD.

What causes hiatal hernias?

Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen, resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition.

What to do about hiatal hernias

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply) or is complicated by severe GORD or oesophagitis (inflammation of the oesophagus).

Getting rid of GORD

The mainstay of treatment of GORD is lifestyle changes: losing weight, quitting smoking, and avoiding foods that may precipitate symptoms. Propping up the head end of the bed to adopt a more upright posture also helps some patients.

Antacids can help neutralize acid in the oesophagus and stomach and stop heartburn. Many people find that non-prescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. Long-term use of antacids, however, can result in side effects, including diarrhoea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and a build-up of magnesium in the body. Too much magnesium can be serious for patients with kidney disease.

For chronic reflux and heartburn, patients might be prescribed H2 blockers like cimetidine, and ranitidine, which inhibit acid secretion in the stomach.

Alternatively, proton pump inhibitors, such as esomeprazole, lansoprazole and sodium bicarbonate inhibit an enzyme (a protein in the acid-producing cells of the stomach) necessary for acid secretion. However, it is becoming increasingly recognised that long term treatment with PPIs is associated with its own complications.

In some cases, surgery may be necessary.

There are several types of surgery and, as with all operations, there are risks involved.

If you are suffering from frequent heartburn, consult your doctor or a specialist to get a diagnosis and the right treatment for you.