Most of us have experienced some sort of reflux in our lives, also described as heartburn. You might experience it when you’ve eaten certain foods, for example fatty foods. Fatty foods relax your lower oesophageal sphincter (LES) and take longer to digest, so because they sit in your stomach for longer, your body responds by making more acid. Pregnant women may experience reflux during pregnancy, as a result of hormonal changes and/or the baby pressing against the stomach. Spicy foods are also usually top of the list! But what causes reflux? 

Reflux is caused by acid escaping the stomach and entering the oesophagus (food pipe). Acid is normally trapped in the stomach by a ring of muscle (lower oesophageal sphincter). The LES allows food to pass through to the stomach when you swallow but should close immediately afterwards. If it doesn’t close completely or opens too often, this leads to reflux or heartburn.

When reflux is a problem

Although everyone has likely experienced reflux in our lives, this is not supposed to happen frequently in healthy people. It only occurs when the pressure inside the stomach becomes greater than the pressure keeping the LES closed. There are four main causes of reflux disease: 

• Hiatus hernia
• Weak LES (valve)
• Oesophageal sensitivity
• Gastroparesis

The term reflux itself is actually used to describe a group of symptoms that are caused when acid or other gastric content leaves the stomach and moves up the oesophagus. Many patients labelled as having reflux disease have other conditions. Some symptoms that people with reflux can experience: 

Heartburn – used to describe the pain felt in the lower chest that feels like it is ‘burning’. 

Regurgitation – this allows us to group a number of symptoms to describe the sensation of fluid running back up the oesophagus, sometimes all the way up to the throat or mouth. 

Epigastric pain – often difficult for a patient to describe, this refers to pain at the point where the breastbone meets the abdomen. 

Chest pain – this pain is often associated with a feeling of food being ‘stuck’, tightness of the chest or pain in the jaw, back or left arm. 

There are other symptoms of reflux in addition to these, such as cough, asthma/breathlessness, belching/gas trapping or a bitter taste in the back of the mouth or the throat. Click here to read more about reflux symptoms. 

 

How do I know if I need reflux treatment? Reflux testing. 

Before undergoing reflux testing, the majority of people experiencing reflux symptoms will first undergo a trial of antacid or acid suppression medication first, to identify if they have any potential underlying disorder or medical condition. They will usually also have had an endoscopic examination of the oesophagus and stomach (gastroscopy) to look for ulcers, inflammation and other conditions.  If no underlying medical condition is identified and the patient continues to have persisting symptoms of reflux despite adequate treatment, then they are a candidate for reflux testing. 

The aim of reflux testing is to determine the relationship between reflux and symptoms, as well as the severity of the oesophageal acid exposure. Acid can be measured at the lower and upper ends of the oesophagus over a 24 hour period, or even for as long as 4 days. Find out more about reflux testing options here. 

 

Reflux Treatment Options

If you’ve read this far, you have probably already tried the various reflux medications that are available such as antacids, acid suppression tablets or even gastric motility agents. But if none of those are working, then there are other reflux treatment options available. 

Anti-reflux procedures work by repairing the mechanical causes of the reflux. The larger the procedure the more effective that it will be, but the larger the procedure, the more important it is that accurate tests are performed initially in order to avoid overtreatment or unwanted side-effects. 

Endoscopic Surgical Therapies – incisionless procedures that are performed from within the oesophagus and stomach under an anaesthetic. 

Stretta Procedure – this involves introducing radiofrequency energy to the lower oesophagus to “tighten it”. The Stretta procedure has no direct effect on the LES muscles but does reduce reflux symptoms in people who no longer want to take antacid medications. Click here for more information. 

RAP (Endoscopic Resection and Plication) – this procedure tightens the junction of the oesophagus by “bunching up” some of the upper stomach to act as an extra cushion below the lower oesophageal valve. This is ideal for people without significant hiatal hernia where the reflux is caused by a weak or inappropriately relaxing LES. 

Laparoscopic Surgical Procedures – there are various surgical procedures that have a lot in common. General anaesthetic, 1-2 nights in the hospital, mostly 5mm incisions and the ability to correct hiatal hernia (the greatest driver of reflux in most people with reflux associated with oesophagitis or Barrett’s oesophagus). 

If you would like to know more about reflux treatment options click here. 

If you are suffering from chronic reflux and would like to discuss testing or treatment options, please contact our practice on (02) 9553 1120 to make an appointment or contact us online.