10% of people experience heartburn (or acid reflux) at least once per week, but for most people it is mild and temporary. While many report that certain foods (citrus, chocolate, caffeine, spicy foods, garlic, tomatoes) exacerbate the pain, these are not universal. Heartburn is more common in people who are overweight or obese, pregnant or at times of stress. Heavy meals, bending over forward, or lying down can bring the reflux on.
Sometimes it is associated with regurgitation, or fluid coming up from your stomach to your throat, perhaps like a “wet burp”.
Usually, reflux causes no complications, but if you have any difficulty swallowing, or find that you need to chew more thoroughly than before, it is important to investigate further. Other symptoms which should be carefully considered are weight loss, blood in vomit, or black stools.
Because the acid can affect your throat, sinuses, ears and lungs there are other symptoms which may be related, including wheezing, cough, voice changes, sore throat, bad breath, sinusitis, ear infections.
Treatment with acid-suppression medications (like Quick-Eze, Ranitidine, or prescription medications like pantoprazole) are usually effective at preventing the reflux from causing pain. However, the stomach contents will still be sneaking up into the esophagus just as often as before, and for some people it remains a problem.
Most people who suffer from regular reflux have a hiatus hernia. The Hiatus is the gap between the muscle-fibres of the diaphragm which allows the esophagus to pass through (connecting the mouth to the stomach). When this gap is a little too big, it is called a hernia, as it allows the stomach to slip up into the chest. Rarely, very large hiatus hernia can also allow other organs to slip up into the chest.
Although a Barium Swallow (an Xray taken while you swallow some dye – which tastes a bit like chalk) can show whether there is reflux, and whether there is a hiatus hernia, an endoscopy can provide other very useful information, such as how irritated the esophagus has become.
An Endoscopy is done in a medical facility under light sedation, with no need for over-night admission to hospital. A Fibreoptic camera is gently introduced down the throat to look at the esophagus and stomach, and if required simple procedures (such as a biopsy) can be performed using the tube containing the camera.
Esophageal Manometry is a way of testing how strongly and efficiently the esophagus contracts. It can be used to determine whether there are problems with the mechanism of swallowing. A thin tube is inserted through the nose and down the throat, and the pressures along it are measured while you swallow several foods of different texture.
Most mild cases of reflux and heartburn are treated with medications, and most of the time, the problem settles down. Other methods of reducing heartburn include –
- Cut down on foods which aggravate it
- Do not lie down for three hours after eating
- Eat smaller meals, eat more slowly
- Reduce your stress levels
- Avoid tight clothing
- Lose weight
- Stop smoking
- Put blocks, bricks or telephone directories under the head-end of the bed, or try a wedge pillow to elevate your head and chest by 15 cm.
Where these simple lifestyle measures aren’t enough, a course of acid suppression is warranted. Generally, three to six months of acid suppression allow the body’s natural defences to recover, but some people find that without the medication, the heartburn returns as if it had never left.
If you don’t wish to continue to take the medication for your lifetime, but the reflux returns without it, you might like to consider AntiReflux Surgery. This is particularly useful if you also have a hiatus hernia.
The surgery is usually laparoscopic (keyhole surgery), and most people stay only one night in hospital. The hiatus hernia is repaired with three or four stitches to the diaphragm, and the muscle at the end of the esophagus (where it joins the stomach) is reinforced by wrapping the stomach around it. The reflux stops immediately, but for the first two weeks after surgery, you will only be able to drink. As the swelling settles down, you will gradually return to normal eating. Most people are unable to burp or vomit in the first few months after surgery, so do not try any fizzy drinks in this time, and always eat slowly and chew carefully. Many people lose a few kilograms as they recover from surgery, but once your diet returns to normal, the weight will also return. Because you are no longer able to burp, the frequency of passing wind is usually increased, and some people may find this embarrassing.