Everything you need to know
Acid Reflux
Acid reflux feels like a mild burning sensation in your chest. People will often feel it after meals or when lying down. If you’re looking to understand how to treat acid reflux, then first you need to understand what causes acid reflux to become triggered.
These can be due to a weak lower oesophageal sphincter, a hiatus hernia or problems with the emptying of your oesophagus or your stomach.
Some of the things that are most often seen to irritate acid reflux include:
- Eating large meals or eating late at night
- Eating big portions of fatty or fried foods
- Drinking certain beverages such as alcohol, coffee, or fizzy drinks
Sometimes, an effective treatment of acid reflux is as simple as making changes to your eating habits, avoiding specific foods, or living life a little differently.
- Dietary changes – when it comes to dietary changes, there are different triggers for everyone. However, when you suffer from persistent symptoms, we often suggest reducing or avoiding:
- Chocolate
- Coffee
- Fried food
- Fatty foods
- Spicy food
- Fizzy drinks
Certain foods trigger reflux more than others, but it’s only when you avoid eating them that you can identify which ones encourage heartburn symptoms.
- Lifestyle changes – in terms of lifestyle changes, it’s important to try:
- Stopping smoking
- Eating smaller portions
- Getting to a healthy weight
Gastro-Oesophagal Reflux Disease (GORD)
Gastroesophageal Reflux Disease (GORD, also referred to as GERD) is a more serious form of acid reflux. This is when your stomach acid and bile flow chronically upwards into your gullet, causing damage to your body over time.
GORD is usually caused when the muscle at the bottom of the oesophagus becomes weakened. Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus. However, when people have GORD, as this ring of muscle has become weaker, stomach acid is no longer contained within the stomach.
If you’re concerned you may have GORD, then look out for:
- Difficulty swallowing
- Heartburn
- Frequent acid reflux (where acid from the digestive tract comes up through the upper abdomen and into the mouth)
- Bad breath
- Belching
- Feeling sick or vomiting
- Pain when swallowing
- Sore throat and a hoarse voice
- A chronic cough which may get worse at night
- Tooth decay and gum disease
The reason why GORD happens isn’t always obvious, but certain factors can increase the risk of this condition developing. Risk factors include:
- Hiatus hernia: This is when part of your stomach pushes up through your diaphragm (the layer of muscle between your chest and stomach). This is commonly associated with GORD.
- Being overweight: this places increased pressure on your stomach, and over time can weaken the muscles at the base of your gullet.
- Smoking and drinking too much alcohol or coffee.
- Gastroparesis: this is when food sits in the stomach longer than it should and regurgitates up into the oesophagus.
- Certain medicines: some medicines can cause GORD or make symptoms worse.
- Stress can worsen symptoms.
Before
Your GP can often diagnose you with acid reflux based on your symptoms, but if they’re not sure, if your symptoms are persistent, or if you are dependent on prescription medications, ask your GP to refer you to our hospital for assessment.
You may need to be assessed if:
- Your GP can’t diagnose you definitively
- Your symptoms are persistent, severe or unusual
- Prescription medications aren’t helping
- You might need surgery
- You show signs of a more severe condition, such as difficulty swallowing or unexplained weight loss
If you have, or think you might have GORD, and would like some expert advice, book an appointment with one of our consultant reflux specialists. They may recommend some tests to progress your diagnosis and will create a management plan for you to follow.
GORD is a difficult illness to live with. Some people, especially those that have been experiencing symptoms for a long time, can face complications, such as:
- Oesophageal ulcers: this is when stomach acid constantly leaks into the oesophagus and ends up damaging the lining. For long-term sufferers, this can mean ulcers form, which can cause difficulty in swallowing and chest pain, and lead to longer term damage.
- Scarred oesophagus: GORD causes damage to the ring of muscles that separates the gullet from the stomach, as well as to the gullet itself. Over time, this can cause the tissues to become scarred and the tube to become narrower causing difficulty in swallowing.
- Weakening of the oesphageal muscle so the oesophagus becomes less efficient at propelling food downwards.
- Barrett’s oesophagus: this means that the cells in your gullet have started to change. Over a long period of time, if left untreated this can develop into cancer in a small number of people.
- Oesophageal cancer: this is when the cells in your gullet grow in an uncontrolled way. If you notice your GORD symptoms are getting worse, find it difficult to swallow or have unexplained weight loss, see a doctor and seek an assessment.
During
Examination
Some of the tests to diagnose GORD that your consultant might recommend include:
- Endoscopy – this provides direct visualisation of your oesophagus and stomach, allows biopsies to be taken and also provides a good overall assessment of your oesophageal health.
- Barium tests – those are used to help visualise parts of the gastrointestinal tract (gut) such as the oesophagus (gullet), stomach and small intestines. The gut doesn’t show up well on ordinary x-rays. However, if you drink a white ‘chalky’ liquid that contains a chemical called barium sulphate, the outlines of the gut show up clearly on x-rays. This is because x-rays don’t pass through barium. These tests can help assess your swallowing ability and help identify any problems in your gullet.
- Manometry – this helps doctors see how well the muscle of your oesophagus is working. Manometry can help rule out other potential causes of your symptoms and is useful in the lead up to surgery.This test involves passing a thin tube up your nose and down into your oesophagus. The tube contains sensors that can detect the pressure in your oesophagus.
- pH monitoring – this test involves a doctor passing a thin tube through your nose. This thin catheter will measure your oesophageal acid level (known as pH) for the next 24 – 96 hours.
- Blood tests
If the tests show that you indeed have GORD, your consultant might recommend lifestyle changes and prescription medications. The medication your doctor recommends will be based on the severity of your case. Over-the-counter medications will usually only help if you have a mild transient case of acid reflux. However, if your symptoms don’t improve, don’t ignore them as you may find the problem only gets worse. Take over-the-counter medicines to start with, preferably alongside dietary and lifestyle changes, and if you don’t notice any improvement, you might be a candidate for surgery.
If surgery looks like the best option to stop your symptoms, the team here at St John & St Elizabeth Hospital has been offering advanced surgery for GORD for over 20 years, and will support you every step of the way.
During
All the procedures are performed laparoscopically (keyhole) and are designed to relieve your symptoms, prevent further damage, as well as allow you to come off medication.
Some of the procedures we offer include:
Fundoplication
Fundoplication involves wrapping the top of your stomach around your lower oesophageal sphincter. This helps to re-create the benefit of the original muscle that has weakened over time.
LINX system
Made from medical grade Titanium, the LINX system is a small flexible magnetic band of interlinked beads. These beads are designed to help boost the ring of muscles at the base of your oesophagus so that stomach acid isn’t able to flow back up your gullet
RefluxStop
A recent innovation, RefluxStop can be implanted laparoscopically to treat GORD. We are amongst the first in the UK to offer this procedure.
The procedure works by placing a non-active implant on the upper part of the stomach during keyhole surgery. The benefits of this procedure include a reduction in bloating; and little or no dysphagia (difficulty swallowing).
Weight loss surgery
Sometimes a variation of the gastric bypass is the best option to treat troublesome reflux in patients with complex or recurrent disease. In patients who are obese, this option does address the weight-related issues while also providing a remedy to the reflux.
After
The surgery will take between 1- 2 hours and patients will require a 24 to 48 hours stay in hospital, with them often returning to work the following week. The surgery performed is keyhole in 99.7% of cases.
LINX procedure: A clinical study looked at the extent to which the Linx System had helped patients five years after it had been implanted. The results showed that the GORD symptoms had improved significantly, and that 85% of patients were able to stop daily PPI medication. Reassuringly, these patients also said their quality of life had improved.
How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
If you’re… insured
St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.