Heartburn and Reflux

Gastro-oesophageal reflux disease or GORD is a medical term for what most people describe as heartburn or reflux.  Heartburn is typically the sensation of a burning pain in the middle of the chest that can occur at various times, most typically soon after eating or when lying down or stooping.  Other patients can experience what we call volume reflux.  This is the sensation of large amounts of liquid appearing in the mouth, often not associated with much in the way of chest or abdominal discomfort.  This most commonly occurs at night time and will occasionally wake the patient from their sleep with a choking or coughing sensation.

Why Do We Get Reflux?

There are a number of normal mechanisms in place to ensure that we do not suffer from excessive reflux.  Everybody gets a little bit of reflux from time to time but excessive reflux can cause damage to the bottom of the gullet, or oesophagus, and in a small percentage of cases, if untreated, can increase your risk of developing oesophageal cancer.  The most important mechanism for ensuring that we do not suffer excessive reflux is having part of the gullet or oesophagus below the diaphragm.  When we breathe, we suck air into our chest with negative pressure.  The same negative pressure tends to suck stomach contents up into the gullet.  By having part of the gullet below the diaphragm, this is exposed to positive pressure which helps to keep the gullet closed and minimise reflux.  If the opening in the diaphragm through which the gullet travels stretches, then part of the stomach can move up into the chest.  This is called a hiatus hernia and increases your chances of developing reflux.

Measures to Relieve Symptoms

Mild reflux can be improved by simple measures such as eating smaller meals, reducing alcohol and coffee intake, and in particular stopping smoking.  Other measures include avoiding eating for a few hours prior to going to bed or ensuring that your last meal prior to going to bed is a milky meal.  Other measures that can be taken include propping up the head of the bed and sleeping on several pillows.

Most people with reflux symptom have their symptoms well controlled by medication.  A small number of people do not have adequate control with medication or may not wish to take medication in the longer term and therefore could benefit from surgery.  Patients with volume reflux generally do not respond well to medical treatment and benefit most from surgery.

Surgical Options

Patients who are overweight can benefit from losing weight.  In particular, patients who would be classified as being morbidly obese, for example, their BMI is greater than 30, should consider weight loss surgery as opposed to anti-reflux surgery.

Prior to anti-reflux surgery, all patients should have an endoscopy where the lining of the oesophagus can be assessed and biopsies taken.  In addition, other tests such as 24 hour pH monitoring and a barium swallow are usually performed prior to surgery.  This protocol would be discussed with any patient who is contemplating surgery.

For more information about anti-reflux surgery, click here