Oesophageal Reflux

Oesophageal reflux is a medical condition characterised by the reflux of stomach acid and other contents into the oesophagus. It is sometimes referred to as acid reflux or gastro-oesophageal reflux (GORD). This condition is quite common, with up to 20% of the population experiencing at least mild symptoms. It can cause significant discomfort as well as a range of complications if it is not appropriately managed.

Symptoms of Oesophageal Reflux

The most common symptom associated with oesophageal reflux is heartburn. This is a burning sensation in the chest behind the breastbone and is quite distinctive. Other symptoms may include:

Regurgitation of food
Pain and discomfort in the chest
Difficulty swallowing
Frequent burping
Bad breath
Bloating
Bloodstained vomit

Causes of Oesophageal Reflux

Oesophageal reflux can be caused by a variety of factors. The most common cause is a weak or damaged valve in the lower oesophagus, called the lower oesophageal sphincter (LOS). This valve normally opens to allow food and liquid down into the stomach, and then closes to prevent stomach contents refluxing back up into the oesophagus. If this valve is not working correctly, stomach contents can reflux back up and cause the characteristic symptoms.

Other causes of oesophageal reflux include certain medications, large meals, smoking, obesity, and abnormal pressure on the stomach (for example during pregnancy). Some medical conditions can also lead to oesophageal reflux.

Complications of Oesophageal Reflux

Oesophageal reflux can lead to a range of complications if left untreated. These can include:

Esophagitis – inflammation of the oesophagus, which can cause pain and discomfort
Ulceration – erosion and ulcers can occur in the oesophagus, usually caused by prolonged exposure to stomach acid. This can be painful and can lead to bleeding
Stricture – scarring of the oesophagus as a result of repeated inflammation and irritation can lead to narrowing of the oesophagus and difficulty swallowing
Barret's oesophagus – a serious complication in which the lining of the oesophagus becomes abnormal and is associated with an increased risk of cancer
Laryngo-pharyngeal reflux – stomach acid and other contents may also irritate the voice box and throat

Treatment and Management of Oesophageal Reflux

Treatment of oesophageal reflux depends on the severity and cause of the condition. Milder cases can often be managed with lifestyle modifications, such as avoiding large meals, not smoking, and managing weight. There are also a range of over the counter medications that can be taken to manage the symptoms.

For more severe cases, prescription medications may be needed. These may include antacids, H2 blockers (antihistamines), and proton pump inhibitors (PPIs), which block the production of stomach acid. Surgery may also be recommended in certain cases, such as for patients with a malfunctioning LOS.