Heartburn & Reflux

The esophagus leads into the stomach at the cardio-esophageal junction. This junction is controlled by the lower esophageal sphincter which acts as a valve to allow food to enter the stomach while preventing the stomach contents from refluxing back into the esophagus. 

In people with Gastroesophageal reflux disease (GERD), the stomach contents and digestive juices reflux back into the lower esophagus as a result of inadequate closure of the lower esophageal sphincter. 

Heartburn is the symptom described as a burning discomfort or pain behind the sternum in the centre of the chest. It can be associated with a sour taste in the mouth as a result of reflux of acidic contents. 

What conditions do heartburn and reflux point to?

Heartburn and a sour taste in the mouth  are the most common symptoms of Gastroesophageal Reflux Disease (GERD). 

GERD is a digestive disorder involving the valve at the end of the oesophagus, otherwise referred to as the lower oesophagal sphincter (LES). When the LES is not adequately closed, contents from the stomach can reflux back up the oesophagus and cause pain

Possible Complications

Chronic inflammation of the oesophagus caused by GERD or repeated acid reflux can result in several complications:

  • Esophageal Stricture is the narrowing of the lower oesophagus which then makes it difficult and painful to eat or drink normally. A narrowed lower oesophagus can make you feel like the food is stuck at the lower part of the chest and can result in vomiting 
  • Esophageal Ulcer is an open sore caused by gastric acid wearing away the tissue in the oesophagus. Recurrent esophageal ulcers can lead on to strictures. 
  • Barrett’s Esophaghus is a condition where long term damage from acid reflux causes abnormal changes in the lining. This condition is associated with an increased risk of oesophageal cancer.

In GERD, the frequent occurrence of acid reflux causes a burning sensation that rises from the stomach to lower chest, through to the neck. This sensation normally happens after food, and can last for as long as 2 hours. The symptoms can also manifest as chest pain which can be confused with a heart attack. Besides heartburn, you may also experience difficulty in swallowing, nausea, bad breath, breathing difficulty, chronic cough or even vomiting.

Several factors such as obesity, pregnancy, late meals, alcohol, smoking and hiatal hernia all increase the risk of GERD.

GERD has been linked to hiatal hernia – a condition where the upper part of your stomach shifts upwards into the chest via a small opening in your diaphragm. This enables stomach contents to travel up into the oesophagus more easily. 

Hiatal hernias are usually not repaired. The symptoms of GERD can often be managed with anti-acid medications and lifestyle changes. Any surgery for hiatal hernia and GERD will require a combination of correcting the hiatal hernia and appropriate anti-reflux surgery

When should I seek help?

With heartburn, the pain in the chest can be mistakenly related to the heart. That said, any pain in the chest should not be ignored. 

Other indications of when it’s time to consult a healthcare provider include persistent heartburn that does not subside even with over-the-counter medication or that changes in intensity or frequency, acid reflux that affects the ability to go about daily chores or the quality of life, difficulty swallowing, nausea or vomiting, and unexplained weight loss.

In general, symptoms that last for over two weeks require medical attention.

What are the investigations into heartburn and reflux? 

Reflux and heartburn can occasionally be addressed with over-the-counter medication such as antacids. Your healthcare provider may recommend a proton pump inhibitor and other medications to lower the acid levels in the stomach.

Dietary and lifestyle adjustments can alleviate GERD-related symptoms in most cases and rarely would patients require long term medication or surgery. For example, avoiding a heavy meal within 2 hours of bedtime or lying down just after a full meal can allow your body more time for digestion. If there are foods you know would trigger reflux and heartburn, you may reduce consumption of those food or be required to eliminate those foods completely from your diet.

More in-depth investigation into heartburn and reflux would be to identify the underlying issue that is causing GERD. A gastroscopy, for one, is often required for further evaluation. For persistent cases, a 24-hour pH study may be carried out to study the amount of acid in your stomach and oesophagus.

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