There are many names, and acronyms to describe what most people commonly know as heartburn or reflux. The most common is gastro-oesophageal reflux disease, which is often shortened to either GORD or GERD depending on whether you live in the USA or not. Reflux is normally prevented by a muscular sphincter at the lower end of the oesophagus, which acts as a valve to prevent the contents of the stomach especially gastric acid refluxing up into the oesophagus.
Heartburn, a burning sensation typically felt behind the breast bone is the most common symptom of gastro-oesophageal reflux disease, but other symptoms include regurgitation with a bitter taste in the back of the mouth, and difficulties with swallowing. Less commonly reflux may aggravate the upper airways causing problems such as asthma or cause hoarseness of the voice.
In most cases of reflux there is an underlying weakness of the sphincter at the lower end of the oesophagus, so that the barrier preventing the movement or reflux of the contents of the stomach, which includes gastric acid, is greatly impaired. Weakness of the oesophageal sphincter maybe made worse by food or drinks containing caffeine such as coffee and chocolate, and is also impaired by smoking.
Obesity an ever increasing problem also worsens reflux. Acid, which enters the oesophagus, can damage the lining of the oesophagus, causing inflammation, and even ulceration when the damage is particularly severe. In response to this damage the lining of the oesophagus may even change so that it is more resistant to the effects of acid. This change in the lining is known as Barrett’s oesophagus and whilst it may be seen as an adaptation the down side is that it does carry a small chance of turning cancerous.
The effects of reflux can be seen on endoscopy. A procedure where a flexible scope is passed through the mouth in to the oesophagus, stomach and first part of the small intestine. This is normally done whilst the patient is sedated and allows direct visualization of the lining of the oesophagus to detect changes such as inflammation and ulceration. Biopsy of any areas of concern may also be taken. Other tests which maybe used to diagnose reflux include oesophageal manometry and 24 hour Ph monitoring, these test are usually performed before contemplating anti-reflux surgery.
Mild or occasional reflux is extremely common in the general population and most patients with such symptoms can be managed with simple antacids along with lifestyle changes such as weight loss and avoiding food or fluids, which aggravate reflux symptoms. Other patients with more persistence symptoms may require suppression of stomach acid production by medications. A small group of patients despite medications will still have severe symptoms, these patients may be candidates for anti-reflux surgery.