Some of us can eat what we like. Tangy oranges, a glass of wine, raw onion on a crunchy salad, baked beans, a pint of cider, fresh tomatoes, one too many beers followed by a hot and spicy curry…….
Some of us can’t……..
We can’t bend over, let out a tiny belch, lie flat at night-time. But burping seems to help, except it makes it worse. We drink milk, but then the acid soon comes back. Sounds familiar?
The gullet (food pipe, oesophagus) leads the way down to the stomach. At the bottom of the gullet, on the way into the stomach, is a one-way valve type thing. This is a great invention that allows food to go down, and then you can stand on your head without the food coming back up. Great!
The stomach produces natural hydrochloric acid which aids digestion (but is also used to clean concrete!) It has a pH of around 1-2 which those of you who have ever been sick will recognise as being quite nasty on its way out.
This all works fine until the valve system goes wrong, and for acid reflux sufferers, the acid can travel back up the gullet, sometimes making it up as far as the back of the throat. It can burn and be very unpleasant.
Common symptoms are a burning sensation, worse on burping, travelling up the gullet from the stomach.
This is known by doctors as Gastro-oesophageal reflux disease (GORD) or GERD (gastro-esophageal reflux disease) if you happen to live across the pond!
Sometimes these symptoms are not quite as typical, and sufferers can feel odd pains in the chest, neck, shoulder, back, or even an irritating cough.
Mild reflux is simply painful and annoying……
Persistent or bad reflux can cause damage to the gullet (oesophagitis), and if you have it for a long time it can cause scarring.
Milk and dairy products can neutralise the acid and give temporary relief. There are medicines (antacids and alginates) available from your pharmacist which can also neutralise the acid, and line the stomach against more acid. But for some, the burning gets so bad that we need to use tablets to reduce acid production and allow the lining of the gullet and stomach to recover.
There are two types of tablet medicine that we use……..
The H2 receptor antagonists – H2RAs – (Zantac / Ranitidine, or Tagamet / Cimetidine) have been around for years and can be very effective. They have been superseded somewhat by the Proton Pump Inhibitors – PPIs – (Losec / Omeprazole, Nexium / Esomeprazole, Zoton / Lansoprazole, Protium / Pantoprazole) which are extremely effective.
What’s in a name?……
NHS GPs are encouraged to prescribe generically and cost-effectively, however some people prefer to have their tablets given to them by trade-name, or to choose which tablet they use.
If lifestyle measures such as keeping a healthy weight, no smoking, cutting down on alcohol and avoiding fatty and irritating foods don’t keep the acid at bay, then neutralising agents or tablets can be very effective. Where some medicines (such as blood pressure tablets for example), need to be taken regularly every day to be fully effective, anti-acid medication can be taken whenever you feel that nasty burn beginning.
Some drugs are notably bad for making reflux worse……
These include non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Neurofen), naproxen and indomethacin used in the treatment of headaches, painful periods or musculoskeletal pain, but also much more innocuous drugs such as calcichew for osteoporosis and arthritis or even drugs used in the treatment of erectile dysfunction in men, such as Viagra and Cialis.
If you suffer with what you feel is acid reflux and are under the age of 55 with no alarming symptoms (such as unintentional weight loss, difficulty swallowing, vomiting or even vomiting blood), then it can be safe to try these medications and see how they work. If they are not completely effective or if you are over 55 with new symptoms, or if you have any of the above worrying symptoms, then you would need to see your GP to be considered for an endoscopy (telescope test where the hospital doctor peeps down the gullet into the stomach to check for ulcers / cancers / causes of the reflux.)
There is a little bacteria that can live in the stomach, Helicobacter Pylori……
This can live with us quite happily and in most people cause no problems. However in some people it can cause symptoms of indigestion and sometimes even ulcers in the stomach. There is a simple test that you can do to test for this bug should you be experiencing unusual indigestion symptoms that are not responding to treatment. If you have symptoms of acid and test positive for Helicobacter then you will need a double dose of antibiotics plus a PPI that can get rid of the bug and cure the indigestion.
Any sufferers that do not respond to treatment, do not have identifiable Helicobacter or have any alarming symptoms, should see their doctor to make sure there is nothing more than simple acid reflux.
For more information click here.