Acid reflux

What are the common causes of acid reflux?

A number of things can make this valve weaken or relax at the wrong time. Common causes and risk factors include:

• A hiatus hernia: part of your stomach pushes up through your diaphragm (the sheet of muscle below your lungs), which can squeeze your oesophagus and disturb the valve.
• Being overweight: extra weight puts pressure on your stomach, pushing acid upward.
• Pregnancy: rising hormone levels and increased pressure in your tummy can relax the valve.
• Smoking: this can relax the valve, increase stomach acid and worsen reflux.
• Certain medicines: including anti-inflammatory painkillers such as ibuprofen and aspirin, calcium channel blockers (for blood pressure), some antidepressants and sedatives called benzodiazepines.
• Large meals or lying down soon after eating: this puts pressure on the valve before your stomach has had time to empty.
• Certain foods and drinks: fatty or fried food, spicy food, chocolate, mint, caffeine, alcohol, fizzy drinks and acidic fruits such as citrus and tomatoes don't cause reflux on their own, but they can make it more likely.

Are there different types of acid reflux?

Yes. Doctors usually think of acid reflux on a scale:

• Occasional acid reflux: happens now and then, often after a big meal or when lying down too soon after eating. It's uncomfortable but not usually a cause for concern.
• Gastro-oesophageal reflux disease (GORD): reflux that becomes chronic, with episodes happening twice a week or more over several weeks.
• Silent reflux (laryngopharyngeal reflux, or LPR): acid travels all the way up to your throat and voice box. It can cause a hoarse voice, a sore throat or a persistent cough, sometimes without the burning chest feeling of typical heartburn.

How is acid reflux diagnosed?

In most cases, your GP can diagnose acid reflux by asking about your symptoms and medical history. Tests are usually only needed if your symptoms don't improve with treatment, or if you have symptoms that suggest a more serious problem. If you do need tests, your doctor may refer you to a specialist in digestive conditions, called a gastroenterologist, who may arrange:

• Gastroscopy: a specialist passes a thin, flexible tube fitted with a small camera down your throat, usually while you're sedated, to examine your oesophagus directly.
• Oesophageal pH monitoring: a small sensor measures how much acid reaches your oesophagus, usually worn for 24–48 hours.
• Barium swallow (oesophagram): you swallow a chalky liquid so that moving X-rays can show how it travels down your oesophagus.
• Oesophageal manometry: a thin tube measures the strength and coordination of the muscles in your oesophagus.
• Biopsy: a small tissue sample may be taken during an endoscopy and checked in a laboratory.

How is acid reflux treated?

Treatment usually starts with changes you can make yourself, then moves on to medicines, with surgery considered only in a small number of cases.

Lifestyle changes

Changes that may ease your symptoms include:

• keeping to a healthy weight
• stopping smoking
• cutting down on alcohol
• eating smaller meals, and avoiding food and drink that triggers your symptoms
• eating 3 to 4 hours before you lie down
• Raise the head end of the bed by 10-20cm using blocks/bed riser
• avoiding tight clothing around your waist.

Medicines

Your doctor may recommend:

• Antacids, which neutralise stomach acid and ease mild, occasional symptoms.
• Alginates, which form a protective barrier between stomach acid and your oesophagus.
• Proton pump inhibitors (PPIs), the most effective option if your GORD is severe or your oesophagus is damaged.
• H2 blockers, which reduce how much acid your stomach makes.

Surgery

Surgery is usually only considered if lifestyle changes and medicines haven't controlled your symptoms, or if you've developed complications. Options include:

• Nissen fundoplication: the most common operation for GORD. Your surgeon wraps the top of your stomach around the lower oesophagus and stitches it in place to tighten the valve, using keyhole surgery (small cuts). Recovery is usually quick, and many people go home the same day.
• LINX device: a small ring of magnetic beads is fitted around the valve through small cuts in your tummy, helping to keep it closed.

When should I see a doctor?

See a GP if:

• you have acid reflux several times a week
• your symptoms don't improve with over-the-counter medicines or lifestyle changes
• you have persistent heartburn that's new or getting worse.

Get medical help promptly if you have:

• difficulty or pain when swallowing
• unexplained weight loss
• persistent nausea or vomiting
• signs of anaemia, such as unusual tiredness.

Get emergency medical help for chest pain or discomfort, or if you vomit blood or pass black, tar-like stools, as these can be signs of a more serious problem.