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Acid Reflux and Heartburn, a Duty of Care

Lifestyle changes can usually neutralise this unpleasant condition.

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Heartburn has become almost an international epidemic – a third of us now suffer regularly. This burning pain behind the breastbone is usually caused by stomach acid flowing up into the gullet (oesophagus) and burning its delicate lining (oesophagitis). As well as aiming to relieve the discomfort, heartburn should be taken seriously, as it can have other significant causes (including genuine heart pain), or trigger complications, such as bleeding and precancerous cell changes (Barrett’s oesophagus).

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The Causes

Stomach acid is kept in place by a muscular ring that lets food through when we swallow, then closes again. However, if this valve is weak, or the stomach slides up through the diaphragm (hiatus hernia), acid leaks upwards – gastro-oesophageal reflux disease (GORD). Pregnancy, obesity and lifestyles can increase acid and upward pressure, but GORD can also run in families and even affect babies.

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The Symptoms

As well as heartburn, you may feel a burning sensation at the back of your throat or taste acid, watery liquid, or even regurgitated food, specially when lying down or burping. Tiny amounts of acid can trigger a persistent irritating cough or sore throat. You may also notice excess wind, tummy distension and or discomfort, bloating and nausea. Oesophagitis can make swallowing painful, hurt between the shoulder blades, or feel as though food is sticking.

These symptoms can also occur in peptic ulceration, stricture (narrowing/ scarring) and oesophageal or other types of digestive cancer. So see your GP quickly if symptoms are new, persistent (more than three weeks), if existing symptoms become more frequent or severe, or you develop problems with swallowing, weight loss or bring up blood.

The Tests

Depending on your symptoms, your GP may check your blood for anaemia, inflammation and liver, gall bladder, pancreatic or even ovarian problems. A breath or stool sample can detect infection with Helicobacter pylori; this bacteria is linked to several digestive disorders and can be cured with antibiotics and drugs called proton pump inhibitors (PPIs). You may also need a gastroscopy (telescope examination of your gullet, stomach and duodenum), X-rays, ultrasound, MR or CT scans, a barium swallow or oesophageal manometry/pH studies to see what actually happens during and in between swallowing. If you have Barrett’s oesophagus you’ll need follow-up gastroscopies; researchers are trialing genetic tests that may predict cancerous changes years before they develop.

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GORD Treatment

Lifestyle changes are essential and can abolish symptoms. For heartburn, an antacid, will neutralise acid and coat the gullet lining. If GORD is severe you’ll be prescribed a course of PPI drugs, which switches off acid production, or an ‘H2-blocker’. You’ll need a long-term PPI for Barrett’s oesophagus, but for simple GORD you may need an occasional or daily low-dose PPI. However, PPIs can have side-effects, including diarrhoea, tummy pain, headaches and rashes and possible effects on bones and other organs. Difficult-to-control symptoms are sometimes treated with keyhole surgery, for example to ‘tighten’ the muscular ring.

8 Ways To Ease Reflux

1. Maintain a healthy weight to reduce pressure on your stomach; avoid tight clothing.

2. Eat smaller portions, and avoid eating in the evenings.

3. Eat a healthy, balanced diet with fresh fruit and veg, oily fish, avocados and nuts.

4. Don’t smoke. Give up.

5. Keep a diary to spot and avoid triggers, such as spicy or fatty foods, coffee and alcohol.

6. Sleep propped up on pillows, or use blocks to raise the head of the bed.

7. Reduce stress which can boost stomach acid, and/ or learn stress-reduction and relaxation techniques.

8. Read the labels on your medication/ask your GP whether it may be contributing to your reflux.

E254 – Acid Reflux and Heartburn –

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