Acid reflux or gastro-oeosophageal reflux disease (GORD for short) is caused by the washing back (reflux) of stomach (gastro) juices into the gullet (oesophagus). This occurs because a muscular valve (sphincter) at the junction of the lower oesophagus and stomach fails to work properly. What are the symptoms of acid reflux? Heartburn is the most common symptom of acid reflux. It is a burning sensation or pain in the upper abdomen or behind the breastbone that moves up towards the neck. Some patients experience the bitter or sour taste of the acid in the back of the throat (acid regurgitation). Occasionally, the stomach contents may reach the vocal cords and airway, causing cough, hoarseness and asthma. These symptoms typically occur after food, while lying down, or when bending over. Heartburn can be mistaken for the pain associated with heart disease (angina). Heartburn is less likely to be associated with physical activity.

view of acid injury to the lining of the gullet during gastroscopy

Is acid reflux a serious condition? Most people with acid reflux do not have any damage to their oesophagus. In severe cases, the wash-back of stomach juices damages the lining of the oesophagus, causing inflammation or ulceration of the oesophagus (oesophagitis). Oesophagitis can cause painful swallowing and also bleeding. In 1% of patients with longstanding reflux, the oesophagus tries to repair itself from oesophagitis by replacing the original cell lining with one more akin to the lining in the intestine. This new lining is called Barrett's oesophagus. It has the potential of developing into cancer cells. Patients with Barrett's oesophagus should therefore undergo regular endoscopy. Damage to the lining of the lower oesophagus over time may cause scarring and a narrowing of the oesophagus called a stricture, resulting in difficulty swallowing. When should I consult my doctor? If you find that you have to take antacids more than twice a week regularly, you don't get any relief of your symptoms, or you have heartburn associated with food sticking, painful swallowing, weight loss, vomiting of blood, or choking attacks, it is best to visit your doctor. What tests are available to diagnose acid reflux? Gastroscopy. Barium meal or swallow. Oesophageal manometry. This test involves passing a small flexible tube through the nose into the oesophagus in order to measure how the sphincter works as well as the movement of food through and the emptying ability of the oesophagus. Oesophageal pH monitoring. A small tube is inserted through the nose and into the oesophagus to record acidity in the oesophagus, usually for 24 hours at home. A small battery-powered box (like a Walkman), carried on a belt, makes the recordings. As a sufferer, is there something that I can do? For those with night-time symptoms, their symptoms can be reduced by raising the head of the bed e.g. by using an under-mattress foam wedge, allowing gravity to keep the acid in the stomach where it should be. Avoid eating large meals. It is better to eat 'little and often' than to over-fill the stomach. Avoid foods and beverages that can weaken the sphincter, including chocolate, peppermint, greasy or spicy foods, curry, coffee, and alcohol. Citrus fruits and juices, as well as tomato products can irritate the oesophageal lining and should also be avoided. Do not eat for at least two hours before bedtime. This decreases the amount of stomach acid available for reflux. Stop smoking as tobacco inhibits saliva, which is the oesophagus's major buffer against acid. Tobacco may also stimulate stomach acid production and relax the muscle between the oesophagus and the stomach, permitting acid reflux to occur. Reduce weight if too heavy. Avoid bending from the waist or stooping just after meals. Avoid tight belts and underclothes as they increase pressure on the stomach. Try an antacid when heartburn occurs. Antacids neutralise acid in the oesophagus and can provide temporary or partial relief of the heartburn. Does my doctor have more powerful medicines for my heartburn? H2 blockers. These stomach acid suppression agents reduce the amount of stomach acid. Proton pump inhibitors. The proton pump inhibitors inhibit an enzyme (a protein in the acid-producing cells of the stomach) necessary for acid secretion. They have been found to provide better symptom relief and to heal oesophagitis more rapidly than H2 blockers. Promotility agents. These drugs tighten the lower oesophageal sphincter and improve the return of refluxed juices back into the stomach. Will acid reflux go away by itself? Medications have no permanent effect on the abnormalities that cause reflux. Thus, reflux disease usually recurs if treatment is stopped. Recurrent reflux problems can usually be prevented by continuous medication. Sometimes an operation to improve the function of the sphincter may be appropriate when the person requires large doses of medications, cannot tolerate the medications, or does not wish to take life-long medications.