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Patient information: irritable bowel syndrome (ibs)Patient Information: Reflux Disease
This information sheet is for general information and is not to provide specific medical advice. You should discuss your medical condition with your doctor to ensure correct diagnosis, management and care.
What is Reflux Disease?
After a meal the stomach secretes acid to start the digestionprocess. Reflux disease, also known as Gastro-oesophageal reflux,occurs when acid backwashes up into the gullet (oesophagus) as seenin the picture. This occurs because the sphincter muscle at thebottom of the oesophagus fails to work properly.
What causes Reflux Disease?
We do not know what causes the sphincter muscle to not function andrelax too often. Some lifestyle factors can affect the way thesphincter muscle works, how long it takes for the stomach to emptyand likelihood of reflux developing.
Diet is important, avoid large meals, avoid fatty food and certain foods and beverages can affect the sphincterpressure or irritate the oesophagus lining, including chocolate, alcohol, tea and coffee, spicy food, citrus fruit andjuices, and tomato products. The reaction to various foods is differs for everyone.
Lying down soon after a meal and bending over will provoke reflux Some medications can affect the function of the sphincter muscle or directly cause ulcers in the oesophagus, checkwith your doctor Pregnancy is often associated with reflux, probably due to hormonal factors and the pressure of the baby. Itresolves as soon as the baby is born.
Obesity causes additional pressure on the stomach forcing the contents up into the oesophagus.
What are the symptoms?
Heartburn, which is a burning feeling that rises from the chest to the throat and/or a sour/bitter taste in the mouthare the typical symptoms of reflux disease. Symptoms tend to be worse after, a meal and lying down.
Other symptoms described are, bloating and excess gas, nausea and vomiting, a rush of saliva in the mouth, a sensation offood sticking in the oesophagus, cough, sore throat, hoarse voice, and in asthmatics wheezing.
Reflux disease is not serious, it tends to be a nuisance, bothering people some of the time and on a recurring basis, it canhowever also cause regular discomfort and disrupt people’s lives.
Chronic acid exposure rarely leads to ulcers developing in the lower oesophagus which can then be complicated by astricture, which is due to tight scar tissue. A stricture causes a feeling of food sticking in behind the breastbone orchest.
If Reflux Disease is common, should I see my doctor?
Your doctor can make a diagnosis of reflux disease based on your symptoms and their response to medication.
Further tests may be suggested, particularly if symptoms do not respond to medications, symptoms recur off medicationand if any of the following are present, difficulty swallowing, vomiting blood, weight loss and new symptoms in a personaged ~40 years or more.
Endoscopy, is a simple test, after mild sedation a flexible camera is passed through the mouth into the oesophagusand stomach. Often the Endoscopy is normal in reflux disease, as the acid has not caused any visible damage to theoesophagus. At other times erosions (acid burns) and ulceration of the lower oesophagus are seen, a stricture and Barrett’s Oesophagus can also be diagnosed. Barrett’s oesophagus is found in 10% of reflux patients, due to acidexposure of the lower oesophagus, the cells change to a more resistant type to protect themselves. This is not cancer but should be monitored with further Endoscopies. Endoscopy also excludes other problems such as, stomachulcers and cancer and Helicobacter Pylori infection.
Barium meal, X-ray pictures are taken after swallowing liquid that outlines the oesophagus and stomach. It is auseful test in people with difficulty swallowing.
Oesophageal acidity or pH monitoring. A fine wire is passed through the nose into the gullet to record acidity in theoesophagus, usually for 24 hours at home. A small box, carried on a belt, makes the recordings. It is especially usefulwhen the diagnosis is still uncertain, even after Endoscopy. Oesophageal pressure testing or manometry measures how the muscles of the oesophagus work. This information issometimes useful in people with reflux symptoms.
What treatment is available?
Conservative measures should be tried if your reflux is mild and infrequent, Avoid large meals, eat regularly, avoid fatty food, and avoid those specific food types that make your refluxworse.
Do not eat with-in 2 hours of lying down or going to bed.
Prop up the head of the bed with a housebrick if night-time symptoms are troublesome.
Antacids can be purchased at the chemist and used when reflux symptoms occur, Quick-eze, Mylanta, Tumsand Rani-2 are some examples. These products work at the time but symptoms tend to recur quickly.
The most effective drugs for reflux disease are called Proton Pump Inhibitors, Losec, Zoton, Somac, Pariet andNexium are the individual drug names. They are effective at suppressing reflux symptoms and healing erosionsor ulcers of the oesophagus. They can be taken long term or in a course followed by as required dosing. Discussthe best option for you with your doctor. Adjustment of the medication and dose maybe necessary at followconsultations.
Anti-reflux surgery to improve the function of the sphincter muscle may have a place for some patients.
Although reflux disease is a chronic disorder, symptoms come and go and may remit for periods of time. The Proton PumpInhibitors work by reducing acid output form the stomach without reversing the abnormal function of the loweroesophageal muscular sphincter. Therefore symptoms may recur off medication. You may wish to consider Endoscopy toexclude other disorders if this occurs. Patients on long term proton Pump Inhibitors should have the stomach infectioncalled Helicobacter Pylori tested and treated if present. Talk to your doctor about tests for Helicobacter Pylori.
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