What Is Reflux – and Should I See a Doctor?

Most of us have suffered from reflux at one time or another – maybe after a heavy meal, a big night out, or during pregnancy. For many, symptoms come and go, but some people have frequent symptoms that can greatly affect their quality of life. Here to explain what reflux is, what’s normal, and what you can do about it is Beijing United Family Hospital (BJU) Gastroenterologist Dr. Neil Galletly.

What is acid reflux?

Reflux can mean different things to different people. When people come to see me for a consultation about their reflux, they may mean a dull burning pain behind the chest bone or an acid taste in the back of the throat that can come on after a heavy meal or in bed at night. Others may mean belching or burping more frequently, or experiencing frequent nausea after eating. And others may mean a sensation of food becoming stuck when they eat and sometimes having to wash food down or even regurgitate it out to get relief. The one thing that they have in common is that the symptoms are often made worse by food (either immediately or an hour or two afterward) and the symptoms are generally felt above the diaphragm (i.e. in the chest or throat). 

Very infrequent reflux is probably nothing to worry about. But, if it becomes more frequent, if you are experiencing symptoms more than once a week, or if symptoms are impacting your ability to swallow food, it would be sensible to speak to your Family Medicine doctor or to see a gastroenterologist. The causes of reflux symptoms are usually benign and easily treatable – but more serious diseases such as ulcers or even cancer can also cause reflux symptoms or swallowing difficulties. By seeing a specialist, serious diseases can be quickly excluded and, if necessary, appropriate treatment can be started. 

Acidity, heartburn, reflux, hiatus hernia, indigestion, GERD – what do I have?

Patients – and many doctors – often get confused over the many different terms that people use when talking about reflux symptoms. To help you understand reflux and reflux symptoms, I am first going to talk briefly about the anatomy and function of the upper gastrointestinal (GI) tract – the esophagus (gullet or food-pipe) and the stomach. 

Once we swallow food (after chewing carefully!) it enters the esophagus. The esophagus is a long hollow tube stretching from the back of the throat (pharynx) down through the chest to the top of the stomach. The wall of the esophagus is made up of muscles that contract to push food and drink down the esophagus and into the stomach. 

The stomach itself is a muscular, hollow, bean-shaped sac about the size of a fist situated at the top of the abdomen. It is the first stop in the digestive tract before food and drink pass onwards into the intestines. The cells of the stomach lining secrete acidic gastric juices, which mix with ingested food.

At the junction between the esophagus and the stomach, there is a ring of muscle called a sphincter, which acts as a valve or barrier between the stomach and the esophagus. The sphincter relaxes and opens when we swallow to allow food or drink to pass from the esophagus into the stomach. The rest of the time it is closed to prevent acidic stomach contents from rising up out of the stomach and entering the bottom of the esophagus. 

Thanks for the anatomy lesson. Now, what about my symptoms?

Now that we know a little bit about the anatomy and the function of the upper GI tract, I’m going to talk about the common symptoms that people with reflux or other problems affecting the esophagus might experience. 

Heartburn and chest pain

Heartburn is used to describe pain or discomfort felt deep behind the breastbone (sternum). It is often burning in nature and can feel as if it is rising in the chest. It is almost always felt in the center of the chest rather than on the right or the left. Heartburn can often be worse at night-time or when bending over. It is usually caused by acidic stomach contents irritating the sensitive lining of the esophagus (i.e. acid reflux or gastroesophageal reflux disease (GERD)). Heartburn is usually helped temporarily by taking Gaviscon, Pepto-Bismol, Tums, or other antacids. It is very important to remember that there are other causes of chest pain and that only very rarely is heartburn caused by angina or even a heart attack.

Acid brash 

Acid brash is a sensation of an acidic taste in the back of the throat or the mouth. People sometimes compare it to the horrible taste you may have experienced after vomiting. It is usually caused by stomach acid traveling all the way up the esophagus into the back of the throat. It is commonly caused by acid reflux and GERD.

Food becoming stuck when you swallow (dysphagia) 

Dysphagia is an unpleasant symptom where food (or very occasionally drink) becomes stuck when you try to swallow it. This may be felt in the throat or lower down behind the breastbone (sternum). Foods like bread or poorly chewed pieces of meat are common culprits. It may be possible to wash the food down with water but sometimes it is necessary to regurgitate the food back up again to clear the blockage. This can be quite embarrassing, especially in social situations. It may even lead to a fear of eating out. Dysphagia may be caused by acid reflux if it causes narrowing of the esophagus due to excess esophageal inflammation or scarring. It is very important to exclude other causes of narrowing such as cancer of the esophagus. Dysphagia and swallowing difficulties can also be caused if the muscles in the wall of the esophagus do not contract and relax in a coordinated way to push food down into the stomach. Finally, in people with allergic conditions such as hay fever, asthma, eczema, and food allergies, it may be caused by allergic inflammation in the wall of the esophagus (eosinophilic esophagitis). Dysphagia can be a serious symptom and prompt investigation is important to treat the underlying condition as early as possible.

Belching and Bloating 

These common symptoms can be caused by almost any condition affecting the stomach and esophagus.

OK, I understand what my symptoms mean. Tell me more about the disease

Acid reflux or GERD occurs when acidic stomach contents reflux back through the sphincter into the esophagus. Unlike the stomach, with its protective layer of mucus, the lining of the esophagus is very sensitive to acid. Acid can cause pain (heartburn) and can cause inflammation of the lining of the esophagus (reflux esophagitis). If the acid reaches the back of the throat, this can cause acid brash, a persistent cough, or a hoarse voice. 

Can acid reflux cause any long-term problems?

If acid reflux occurs for a number of years, the persistent irritation and inflammation of the lining of the esophagus can cause scarring (which can lead to narrowing of the esophagus, causing difficulty swallowing). It can also cause changes in the cells of the bottom of the gullet (Barrett’s esophagus), which can over time progress into precancerous or even cancerous changes. People with frequent and poorly controlled acid reflux symptoms have an increased risk of developing esophageal cancer.

Can I make any diet or lifestyle changes to help my reflux?

Acid reflux may be the result of a leaky valve between the stomach and esophagus due to inappropriate relaxation of the sphincter muscle. Certain food and drink such as chocolate, alcohol, or caffeine can promote inappropriate relaxation of the sphincter. When we are upright during the day, gravity helps keep stomach contents in the stomach (unless we bend over to tie our shoelaces or when gardening). However, at nighttime when we are lying flat, gravity is out of the equation and acidic stomach contents can more easily enter the esophagus. People often experience worse reflux symptoms at nighttime. This is why doctors advise patients with reflux to prop the head of the bed up at night and to avoid going to bed with a full stomach. Spicy and citrus foods do not cause acid reflux but may make heartburn worse by irritating the sensitive inflamed lining of the esophagus further. 

What about medication or surgery?

Acid reflux can be treated effectively with medication. Pepto-Bismol, Gaviscon, and simple antacids such as Tums or Rennies will often provide temporary relief of symptoms. They are appropriate for infrequent reflux symptoms. Medicines that reduce the amount of acid the stomach produces are often used on a daily basis to treat more frequent symptoms. If there is less acid in the stomach, then there is less acid that can reflux into the esophagus and cause irritation and inflammation. These medicines include esomeprazole (Nexium), lansoprazole (Prevacid), and ranitidine (Zantac). If you stop taking these medicines, it is quite possible that your symptoms will come back as the acid levels in your stomach build up again. People who take these medicines to reduce stomach acid are still able to digest food perfectly well. Most people do not suffer any side effects with these medicines, although long-term esomeprazole and lansoprazole use may increase the risk of developing osteoporosis (thinning of the bones). Surgery (often keyhole surgery) can be performed to tighten up the junction between the stomach and the esophagus and reduce the reflux of acid into the esophagus.

Drugs for acid reflux are normally very effective. If you have been diagnosed with acid reflux but acid-reducing medicines do not help your symptoms, it would be sensible to go back to see your doctor or see a specialist to check the diagnosis is correct. Occasionally bile – which is alkaline – can reflux into the esophagus. Bile is also an irritant to the sensitive esophagus lining – but will not be reduced by taking acid-reducing medicines. Additionally, the nerve endings in the esophagus can sometimes become overly sensitive, resulting in pain and heartburn from only very small amounts of acid.

What happens if I ignore my reflux symptoms? 

As we discussed at the beginning of the article, most causes of reflux symptoms are benign and easily treatable – but, as I have discussed, more serious conditions such as Barrett’s esophagus or even cancer can cause these symptoms. If you have only very infrequent reflux symptoms that settle with simple antacids, then there is probably nothing to worry about. If they become more frequent, and certainly if you are experiencing indigestion more than once a week or if food feels as if it gets stuck, then it would be sensible to speak to your Family Medicine doctor or to see a gastroenterology specialist. By seeing a specialist, serious diseases can be quickly excluded and, if necessary, appropriate treatment can be started to settle your troublesome symptoms.

Dr. Neil Galletly is BJU’s new Gastroenterologist! To make an appointment with him, please call the BJU Service Center at 4008-919191. 

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