When acid from the stomach leaks up into the gullet (oesophagus), the condition is known as acid reflux. This may cause heartburn and other symptoms. A medicine which reduces the amount of acid made in your stomach is a common treatment and usually works well. Some people take short courses of medication when symptoms flare up. Some people need long-term daily medication to keep symptoms away.
When we eat, food passes down the gullet (oesophagus) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.
There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down, but then normally tightens up and stops food and acid leaking up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.
The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms with only a small amount of reflux. However, some people have a lot of reflux without developing oesophagitis or symptoms.
This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.
The circular band of muscle (sphincter) at the bottom of the gullet (oesophagus) normally prevents acid leaking up (reflux). Problems occur if the sphincter does not work very well. This is common but in most cases it is not known why it does not work so well. In some cases the pressure in the stomach rises higher than the sphincter can withstand - for example, during pregnancy, after a large meal, or when bending forward. If you have a hiatus hernia (a condition where part of the stomach protrudes into the chest through the diaphragm), you have an increased chance of developing reflux. (See separate leaflet called Hiatus Hernia.)
Most people have heartburn at some time, perhaps after a large meal. However, about 1 adult in 3 has some heartburn every few days, and nearly 1 adult in 10 has heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, those who are overweight, and those aged between 35 and 64 years.
Tests are not usually necessary if you have typical symptoms. Many people experiencing acid leaking up (refluxing) into the gullet (oesophagus) are diagnosed with 'presumed acid reflux'. In this situation they have typical symptoms and the symptoms are eased by treatment. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.
The following are commonly advised. However, there has been little research to prove how well these lifestyle changes help to ease reflux:
Antacids are alkaline liquids or tablets that reduce the amount of acid. A dose usually gives quick relief. There are many brands which you can buy. You can also get some on prescription. You can use antacids 'as required' for mild or infrequent bouts of heartburn.
If you get symptoms frequently then see a doctor. An acid-suppressing medicine will usually be advised. Two groups of acid-suppressing medicines are available - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers include cimetidine, famotidine, nizatidine, and ranitidine.
In general, a PPI is used first, as these medicines tend to work better than H2 blockers. A common initial plan is to take a full-dose course of a PPI for a month or so. This often settles symptoms down and allows any inflammation in the gullet (oesophagus) to clear. After this, all that you may need is to go back to antacids 'as required' or to take a short course of an acid-suppressing medicine 'as required'.
However, some people need long-term daily acid-suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment with an acid-suppressing medicine is thought to be safe, and side-effects are uncommon. The aim is to take a full-dose course for a month or so to settle symptoms. After this, it is common to 'step down' the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed by some people.
These are medicines that speed up the passage of food through the stomach. They include domperidone and metoclopramide. They are not commonly used but help in some cases, particularly if you have marked bloating or belching symptoms.
An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery. In general, the success of surgery is no better than acid-suppressing medication. However, surgery may be an option for some people whose quality of life remains significantly affected by their condition and where treatment with medicines is not working well or not wanted long-term.
Another procedure being used involves placing a small magnetic device around the lower oesophagus. The device allows you to swallow but then tightens to stop acid reflux. Because there is not much research into this procedure, it is not often used in the UK at the moment.
It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty (food 'sticking') when you swallow, which may be the first symptom of a complication.