Gastro-oesophageal reflux

What is gastro-oesophageal reflux?

This is the irritation of the oesophagus, caused by stomach acid. The trouble is caused by a faulty oesophageal sphincter, the muscular ring at the lower end of the oesophagus, near the diaphragm. If this sphincter does not work properly, stomach acid flows into the oesophagus, causing a burning sensation. This is known as heartburn. In severe cases the irritation of the lower oesophagus is called oesophagitis. Gastro-oesophageal reflux is the most common cause of indigestion in Ireland.

What causes it?

  • Certain foods can relax the muscular ring at the lower end of the oesophagus, responsible for acid reflux. Such foods include citrus fruit, tomatoes, garlic, chocolate, tea, coffee, alcohol, peppermints.
  • Dishes high in fat and oil.
  • Excess weight can cause extra pressure on the sphincter.
  • Certain medications, like aspirin.
  • Stress, because this strains the nerves controlling the muscular ring.
  • Smoking which stimulates stomach acid.

What are the symptoms of gastro-oesophageal reflux?

  • A painful burning sensation in the upper chest.
  • Sour and burning taste of reflux when it reaches the mouth.
  • Hoarse voice from irritated larynx.
  • Difficulty breathing.
  • Excessive belching.
  • Chronic coughing.
  • Wheezing and other asthma-like symptoms in adulthood.

How is it diagnosed?

  • The doctor will ask the sufferer about their symptoms.
  • An endoscopy to views the oesophagus may be required. This will be done in hospital on an outpatient basis.
  • A pH study of the oesophagus may be required, over 24 hours, indicating how often and how long the reflux episodes last.
  • The doctor may require a recording of the heart's electrical activity (ECG or electrocardiograph), to rule out heart problems.
  • A gastroscopy may be considered to rule out hiatus hernias, peptic ulcers and other conditions whose symptoms mimic the symptoms of gastro-oesophageal reflux.

How is it treated?

Generally antacids are recommended. These are drugs which neutralise the hydrochloric acid secreted in the digestive juices in the stomach. If symptoms persist, prescription medication may be necessary to reduce the amount of acid formed within the stomach. Occasionally surgery is recommended in very severe cases, where the oesophageal sphincter is reinstated, preventing reflux and heartburn.

How can I prevent gastro-oesophageal reflux?

The following changes in lifestyle can reduce the risk of developing reflux:

  • Reduce caffeine and other trigger foods in the diet.
  • Avoid large, fatty meals before bedtime.
  • Avoid eating and drinking at the same meals as the larger the stomach’s volume of contents the more likely there will be splashing of acid into the oesophagus.
  • Avoid smoking.
  • Reduce alcohol consumption.
  • Lose weight if you are overweight.

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