Heartburn & Reflux Disease

Heart burn, also referred to as reflux or indigestion is characterised by discomfort and a burning sensation behind the breastbone. It is a symptom resulting from upwards flow of stomach acid into the food pipe or the oesophagus. It is a common symptom and the severity of this varies from a minor annoyance to a major issue for an individual’s quality of life. It is also sometimes referred to as gastro – oesophageal reflux disease (GORD).

The lower end of oesophagus is normally guarded by muscle tissue forming a valve which regulates the normal movement of food from the food pipe into the stomach and prevents backflow of acid and other contents into oesophagus. This valve can lose effectiveness over time and also improper functioning can be a result of other abnormalities or conditions.

Heartburn is usually the first symptom of valve dysfunction. Other symptoms may include regurgitation (food coming back into the mouth), difficulty swallowing, chronic cough, chest pain, oesophageal ulcers and aspiration pneumonia. In severe cases heartburn may result in ulcers and then vomiting blood or blood in stool.

When the acid travels backwards, up the oesophagus, it may result in bitter and sour taste in the mouth, and regurgitation of actual food into the mouth.

The precise diagnosis of reflux disease and a measurement of severity is assessed with various tests such as upper gastrointestinal (GI) endoscopy, various x-rays and also oesophageal manometry and 24-hour pH monitoring.

  • Upper GI endoscopy, (Gastroscopy) is a camera test. A fine camera is passed under anaesthetic into the oesophagus and stomach. The tiny camera enables your surgeon to check for the diagnosis of reflux, assess whether any damage has occurred and also the function of the valve to some degree.
  • Upper GI imaging (X-rays), requires swallowing of fluids visible on X-Ray images, to view stomach and oesophagus.
  • Oesophageal manometry is a procedure which measures the functioning of the muscles in the oesophagus. It is important as there are other rare conditions which can mimic reflux disease.
  • Twenty four-hour pH monitoring – This procedure helps measure the severity of reflux disease and also which symptoms are likely to be improved following surgery. In this test a tube is inserted through the nose into the oesophagus and positioned above the muscle tissue at the lower end. This measures the acid content of the oesophagus for 24 hours. Patients do not require a hospital stay and are encouraged perform their regular activities over the test period.

People with bothersome reflux disease should modify certain lifestyle habits such as

  • Stopping smoking
  • Maintaining a healthy weight
  • Do not eat directly before bed or laying down
  • Avoid taking highly acid foods that will cause heartburn such as chocolate, fried fatty foods, caffeine, alcohol, citrus, tomato’s
  • Eating appropriate portion sizes
  • Elevating the head of the bed if symptoms are mainly at night time

Heartburn can then be initially treated using medications including;

  • Antacids, which help to neutralise gastric acid.
  • Histamine-2 receptor blockers which decrease the amount of acid produced by the stomach.
  • Antiemetic and gastroprokinetic agents, which help to empty the food and acid from the stomach.
  • Proton pump inhibitors (PPIs) which are very strong medications which can almost neutralise stomach acid completely.

Surgery is an option for patients in whom medications do not provide heartburn relief, for patients who do not want to take medications or for patients who have had complications of reflux disease.

Anti-reflux surgery is referred to as a fundoplication. This involves improving the function of the lower oesophageal sphincter muscle (the lower oesophageal valve) to reduce acid traveling backward up the oesophagus. This is a very effective treatment for true reflux disease.