Gastroesophageal Reflux, Heartburn – Causes, Treatment, Symptoms

In gastroesophageal reflux, acidic juices are regurgitated into the oesophagus from the stomach. This regurgitation causes a pain or discomfort in the upper abdomen and chest, known as heartburn. One cause is a hiatus hernia.

Gastroesophageal reflux (GOR); commonly known as heartburn or acid reflux, is probably the most common cause of indigestion. The discomfort is due to acidic juices from the stomach flowing back up into the oesophagus (the gullet, the tube leading from the throat to the stomach).

The lining of the oesophagus does not have adequate defence against the harmful effects of stomach acid, which causes inflammation, sometimes even ulceration, and a burning pain known as heartburn. Obesity, a high-fat diet, drinking too much coffee or alcohol and smoking are risk factors.

Causes of Gastroesophageal Reflux

The stomach contents are prevented from entering the oesophagus by a double-action valve mechanism: the lower end of the oesophagus has a muscular ring, known as the
lower oesophageal sphincter, which forms one part of the valve mechanism, and the other part consists of the hiatus, a narrow opening in the diaphragm muscle. The combination of these two muscular gateways provides an effective one-way valve.

Neutralizing the stomach acid and providing the walls of the gullet with a protective coating. Acid-blocking drugs such as ranitidine may be needed for the most severe symptoms.
Swallowed food progresses down the gullet to the stomach.

There is a muscular system that should prevent stomach contents from escaping back into the gullet, but this mechanism frequently fails. Strong stomach acid then irritates the walls of the gullet and is felt as heartburn. It can happen that the gullet becomes inflamed spontaneously, called oesophagitis, when the mere act of swallowing causes discomfort.

GORor may develop as a result of several factors acting together to make the valve leak. These factors include:

• poor muscle tone in the sphincter
• Increased abdominal pressure due to pregnancy or obesity
• a weakness in the hiatus that allows part of the stomach to slide into the chest (a hiatus hernia)

Many people develop mild attacks of GOR after eating rapidly or eating certain foods, especially pickles, fried or fatty meals, or drinks, especially carbonated soft drinks, alcohol or coffee. Smoking worsens symptoms too.

Symptoms of Gastroesophageal Reflux

Soon after eating a burning sensation spreads across the front of the chest. Belching often accompanies the pain; acid may rise into the mouth. It is important to distinguish it from chest pain arising from exertion, which may come from the heart.

The main symptoms of GOR are usually most noticeable immediately after eating a large meal or when bending over. They include:

• A burning pain or discomfort in the centre of the chest behind the breastbone, known as heartburn.
• An acidic taste in the mouth due to regurgitation of acidic fluid into the throat or mouth.
• Erosion of the teeth due to acid.
• A persistent cough and sometimes asthma at night and sore throat.
• Hoarseness of the voice.
• Belching.
• Streaks of blood in the vomit or faeces.

GOR that persists over many years can cause scarring in the oesophagus, which may eventually be severe enough to cause stricture (narrowing). A structure can make swallowing very difficult and may lead to weight loss. Chronic GOR may result in the oesophageal lining replacing the stomach lining, increasing the risk of developing oesophageal cancer.

Treatment of Gastroesophageal Reflux

Often it is enough simply to avoid the foods you find cause your heartburn, for example acidic foods and alcohol. Simple antacids are the next step in treatment. These work by neutralizing the stomach acid and providing the walls of the gullet with a protective coating. Acid-blocking drugs such as ranitidine may be needed for the most severe symptoms.

The good news is that many products and treatments are now available to alleviate chronic Heartburn and prevent stomach acid from Damaging cells or the oesophagus, which have no protection against a frequent bath of acid, Acid reflux may also be aggravated by drugs You can take for other conditions, so consult your doctor about the effects of both over-the-Colinter and prescription medications you take and ask whether substitutions may be helpful.

• More severe cases that do not respond to diet and lifestyle changes alone require medication, starting with over-the-counter antacids. Histamine blockers such as Tagamet (cimetidine) and Zantac (ranitidine) help, but may not be strong enough to control acid reflux fully. If not, your doctor can prescribe more potent acid suppressors called proton-pump inhibitors, such as Losec. Other potentially useful drugs protect the lining of the oesophagus and speed stomach emptying.
• If acid reflux cannot be controlled through diet habits and drugs, surgery may be required.
• Une of the newest procedures, done through a laparoscope, involves wrapping a defective oesophageal sphincter to strengthen it against reflux.

Experts agree that it’s not enough merely to calm all the symptoms of heartburn. Rather, acid reflux must be prevented and any cellular damage that has occurred must be healed.

• It isn’t enough to treat chronic heartburn sporadically, stopping treatment when symptoms subside. It has to be long-term. To protect the oesophagus adequately, treatment must be aggressive, continuous and indefinite and so involves some significant changes to your life.
• If you have heartburn two or more times in a week, see your doctor and perhaps request a consultation with a gastroenterologist.
• If the problem has been long-standing, an examination and biopsy of the oesophagus through an endoscope is the only good way to assess what damage has been done, if any. If there are abnormal cell changes, endoscopic.
• examinations should be done every year or two to check for possible progression towards cancer.
• Should a pre-cancerous condition develop, the oesophagus can be removed and replaced with a piece of intestine or stomach. There are also experimental treatments that use laser or other forms of heat to obliterate the abnormal cells and allow healthy cells to replace them.

Complementary Treatment

Western herbalism – the following herbs improve digestion and reduce acid production and inflammation: meadowsweet; caraway; dill; aniseed; ginger; chamomile and peppermint. Other therapies to try: most have something to offer.

Dangerous Heartburn

If heartburn (gastroesophageal reflux) is a daily occurrence, it can develop into something far more severe. The irritating acid causes changes in the cells lining the lower end of the oesophagus, leading to a severe form of cancer.

The chances of getting cancer of the throat is eight times higher in people who have chronic heartburn, and it’s increasing faster than almost any other cancer. So take your heartburn seriously and talk to your doctor about it. Simply taking antacids doesn’t reduce the danger.

The oesophagus isn’t lined like the stomach and so stomach acid irritates the lower oesophagus and over time triggers pre-cancerous changes that can progress to cancer.

Heartburn and Cancer

Researchers reported recently that having frequent, inadequately treated heartburn increased the risk of oesophageal cancer nearly eight-fold. Among those in the study who had particularly severe and long-standing heartburn the risk of cancer rose more than 40 times. The relationship was so strong, and researchers concluded that chronic heartburn was likely to be the cause of this cancer.

Pre-cancerous changes in the oesophagus develop in 10-15 percent of patients with chronic heartburn, and these patients face a risk of cancer that is 30-40 times greater than the risk in the general population.

Heartburn is obviously a disease that demands more respect than it gets. It’s estimated that at least half the people who suffer from chronic heartburn are not getting the kind of medical care that may protect them from the serious consequences found in the study. The overall risk of developing oesophageal cancer is very low, but only 5-10 patients out of 100 survive more than five years after getting the disease.

Measures You Should Take

If you have chronic heartburn:

• Chew food well, and eat slowly.
• Watch what you eat. Stay away from or limit spicy or fatty foods, as well as chocolate, citrus juice, coffee, tea and alcohol.
• Eat five or six small meals rather than two large meals a day.
• Immediately after a meal, avoid exercising, bending over or lying down.
• Lose weight if you need to.
• You will feel better if there is some food in your stomach, so eat little and often.
• Raise the head of your bed by about four inches or sleep on at least four pillows.
• Antacid tablets will help to neutralize the acids and protect the oesophagus.
• Give up smoking.
• Consult your doctor if the problem occurs two or more times a week.

If you have recently developed pain in the centre of your chest that seems to be unrelated to mealtimes, you should seek immediate medical help because the heart condition angina may sometimes be mistaken for the pain of severe heartburn.

QUESTION

How easy is the diagnosis?

The close relationship to eating normally clinches the diagnosis. Heartburn in older people for the first time can be indistinguishable from angina and doctors may order heart checks.

If you vomit blood or have difficulty in swallowing your doctor will arrange for endoscopy of the gullet in case the symptoms are caused by a growth in the gullet.