Gastro-oesophageal reflux

What is ‘reflux’?
Gastro-oesophageal reflux (GORD) is the passage of stomach contents (food, stomach secretions and gas) into the oesophagus.  Patients may be unaware of reflux (silent reflux) or it may be experienced by patients as a range of symptoms including heartburn, burning pain in the stomach or behind the sternum, discomfort, acid or bitter taste in the mouth and all types of ‘indigestion’.  There are many contributing causes leading to reflux including weakness or abnormal relaxation of the valve at the lower end of the oesophagus (lower oesophageal sphincter) and hiatus hernia that occurs when part of the stomach protrudes through the diaphragm into the chest cavity.

How do I know if I have reflux?
The symptoms of reflux (heartburn, regurgitation and indigestion) may be characteristic and a diagnosis can often be made on this basis alone.  If your symptoms get better with treatment for reflux then this may confirm the diagnosis.  Testing is often not required unless there are concerning features such as vomiting, difficulty or pain with swallowing, food getting stuck or unexplained weight loss.  The most common test used to investigate or diagnose reflux is gastroscopy that allows close, direct examination of the stomach and oesophagus and the taking of biopsies.  Occasionally further specialised testing is required.

Is reflux serious?
Reflux is usually not serious and is simply an inconvenience causing discomfort or other mild symptoms.  Almost everyone experiences symptoms of reflux from time to time, often after overindulging.  Some people have more significant symptoms or complications from reflux and may require medical treatment.

In a minority of people with reflux there may be damage to the oesophagus from exposure to stomach contents causing inflammation, ulceration and scarring.  This is called oesophagitis and may vary in severity from very minor to severe.  In severe cases there can be scarring of the oesophagus resulting in narrowing which can lead to food getting stuck.

In some patients with longstanding reflux there can be an adaptive change to the cells lining the distal oesophagus called “Barrett’s oesophagus”.  People with Barrett’s oesophagus are at an increased risk of developing cancer (although the size of the risk is small) and in this case regular checks of the oesophagus with a gastroscopy are advisable.

How is reflux treated?
Often, simple lifestyle and dietary changes are all that is needed to manage reflux.  Large meals, fatty foods, coffee, alcohol, smoking and lying down with a full stomach after eating can all precipitate or aggravate reflux.  Some people will be able to identify particular foods that cause reflux and can simply avoid that type of food.  Reflux is often worse when people gain weight and losing weight can make a big difference.

Unfortunately, many people continue to have symptoms despite making lifestyle and dietary changes.  For these people and those with oesophagitis or other complications of reflux treatment with medications may be required.  Fortunately most of the medications used for treatment of reflux are both very effective and very safe.  Often these medications can be used just when you get symptoms but some people may find that they require long-term, daily treatment.

For a very small proportion of people the symptoms or complications of reflux can be severe and refractory to medical treatment.  For these people there is a surgical procedure called fundoplication that may help.