Acid reflux, or heartburn, is a painful condition that can cause an uncomfortable burning pain in your chest, hiccupping or hoarseness. It is very common, affecting up to a quarter of all UK adults.
What causes acid reflux?
Acid reflux is caused by stomach acid travelling up into the oesophagus or gullet (also called the gastrointestinal tract). It affects most people at some point in their lives, but if it becomes a persistent, ongoing problem, it is referred to as gastroesophageal reflux disease (GERD) and may require treatment.
Adults produce around 1.5 litres of gastric acid every day. It is actually hydrochloric acid, a powerful chemical that is used to break down food inside your stomach. Your stomach is specially designed to withstand this highly concentrated acid, and there is a muscular valve called the oesophageal sphincter, which is designed to prevent acid from flowing back up from the stomach to the oesophagus. This valve opens when you eat to allow the food to pass into your stomach, but it should be closed for the rest of the time.
However, sometimes the mechanism doesn’t work properly and acid can be pushed back up into the oesophagus. This causes the characteristic burning sensation of acid reflux. If the acid is there in large quantities or for a prolonged period it can cause inflammation and ulcers. So, rather than the problem being too much stomach acid, acid reflux is actually caused by the acid being in a part of your body that is not designed to withstand it.
Lifestyle factors that increase the risk of acid reflux
Certain lifestyle choices are known to increase the risk of acid reflux. These include eating certain types of food such as fried food, drinking too much alcohol, or smoking. Other factors can also play a part including being overweight, lack of exercise, eating large meals before bed and certain types of medication. You can also experience reflux by bending over or stooping forwards or when you are lying down. Pregnant women are particularly prone to the problem because of the baby pushing upwards onto the stomach.
Consequence of acid reflux
If acid reflux becomes chronic, you may have a condition called gastroesophageal disease (GERD). As digestive experts, we normally advise patients who are experiencing heartburn at least twice a week that they may have the condition. It can also cause swallowing problems, nausea, burping, vomiting, chest pain and feeling like you have a lump in your throat. Evidence suggests that problems in the gut microbiome (caused by an imbalance in the good and bad bacteria) may contribute to GERD or vice versa.
In some cases, acid reflux may be due to a hiatal hernia, which is caused by a small section of the stomach pushing up into your chest. This may be the result of weakened muscle tissue around the diaphragm and is most common in people over 50.
How can I prevent acid reflux?
Because acid reflux can be linked to diet and obesity, it may be helpful to shift to a more healthy, balanced diet and lose weight. Being overweight makes people more likely to develop a hiatal hernia, but the excess weight also puts pressure on the stomach and can force gastric juices upwards.
Eating more fibre can help to reduce acid reflux as it speeds up stomach emptying and supports good bacteria in the gut. Gentle exercise such as walking or cycling helps your body to move food out of the stomach which reduces pressure on the oesophageal sphincter. You will also benefit from reducing alcohol consumption, quitting smoking and improving your sleep.
Are there treatments for acid reflux?
There are a number of treatments for acid reflux depending on how severe it is and what is causing the problem. It is important not to leave a chronic condition untreated as severe damage to the oesophagus can occur. The most straightforward treatment is antacid medication which works by neutralising stomach acid. For more severe cases you may need prescribed medication to inhibit the production of gastric juices.
Proton pump inhibitors (PPIs) provide long-lasting reduction of stomach acid, while Histamine H2 receptor agonists reduce acid secretions by 70% over 24 hours. Surgery is normally only offered if GERD fails to respond to lifestyle changes and medication or in the most severe cases of valve dysfunction.
If you are experiencing acid reflux, talk to an acid reflux specialist in London about the steps you can take to relieve symptoms, as well as diagnostic testing for GERD.
