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What is Heartburn?
This is called gastro-oesophageal reflux disease (GORD or sometimes GERD) and it occurs when the acidic contents of the stomach flow backwards into the gullet which is called the oesophagus. This in turn causes inflammation of the lower oesophagus (oesophagitis).
What causes GORD?
GORD occurs when there is a failure of the valve (sphincter) at the lower end of your oesophagus (gullet). This valve should prevent fluid from the stomach passing back up your oesophagus, but in patients with GORD this is not the case and fluid from the stomach can pass freely into the oesophagus. Although not the cause, patients with GORD frequently also have a hiatus hernia. This occurs when the upper part of the stomach and valve in the lower part of the oesophagus sit in the chest cavity, rather than the abdominal cavity.
What are the symptoms of GORD?
This includes symptoms of heartburn, regurgitation of semi-digested food, difficulty swallowing and pain on swallowing.
In addition, you may also experience welling up of a foul tasting fluid into the back of your mouth; you might also notice fluid welling up when you bend over to tie your shoes or to lift something up.
Rarely, GORD may be associated with chest conditions such as asthma and may also lead to problems with tooth decay.
How is GORD diagnosed?
Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD. These include:
Gastroscopy (otherwise known as an ‘OGD’) is a thin, flexible telescope that is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. When the oesophagus can be seen to be inflamed, the term oesophagitis is used.
Oesophageal manometry and pH testing: You will also be asked to undergo some tests of your oesophagus to make sure that the muscles within the oesophagus work properly and strongly when you swallow. You will also be asked to undergo a test where a fine catheter tube is placed down your nose for a 24 hour period; this catheter tube measures the acid (pH level) in your lower oesophagus and allows us to confirm that you have an abnormal degree of acid reflux.
Other tests such as heart tracings, chest X-rays or X-ray tests where you are asked to swallow a special dye may be done to rule out other conditions if the symptoms are not typical.
How is GORD treated?
Lifestyle and simple medicines.
The majority of patients who have gastro-oesophageal reflux treat their condition with simple over the counter medicines, for example Rennies, and other medications that can be brought from the chemist that reduce the acidity in the stomach.
If these simple measures do not work then patients are commonly prescribed tablets that reduce the acid levels in the stomach. These drugs are collectively known as Proton Pump Inhibitors (PPIs, for example: Lansoprazole, Omeprazole, Esomeprazole, Pantoprazole and Rabeprazole). These drugs are highly effective at relieving the symptoms of gastro-oesophageal reflux; they do not do anything to the sphincter at the lower end of the oesophagus.
Sometimes patients notice an improvement in their symptoms if they lose weight or by giving up alcohol and smoking. We therefore generally advise people, who have severe reflux disease, to follow these measures and also to avoid eating large meals late at night and drinking large amounts of caffeine containing drinks and losing weight.
Surgical operations for reflux disease aim to prevent acid reflux by reinforcing the valve mechanism at the lower end of the oesophagus so that the fluid cannot reflux into the oesophagus from the stomach. The sphincter mechanism itself cannot be directly repaired. Instead it is reinforced by buttressing the valve mechanism with the upper stomach.
Surgical treatment for acid reflux disease has been around for many years but has become more popular in recent times as key hole methods (laparoscopic) for carrying out the surgery have been developed and it is also related to the increased number of patients who suffer with GORD.
Surgery can potentially benefit the majority of patients who have troublesome acid reflux disease. However, it is important that you are fully aware of the different options for treating your reflux disease before going through an operation.
It is critical that a precise diagnosis of gastro-oesophageal reflux disease is made prior to surgery. It is most important to be certain that reflux is causing your symptoms. There are many other conditions of the oesophagus and stomach that can cause symptoms which may be interpreted as reflux. These other conditions are not helped by surgery and may be made worse. Therefore, your surgeon will help you carefully decide whether surgery is likely to help your symptoms.
The majority of patients who wish to explore the possibility of surgical treatment are those who have severe reflux symptoms that are inadequately relieved by taking medication. Some patients have the desire not to stay on long-term medication, or have had side effects from the PPI medications they have been prescribed.