Acid reflux disease, also called gastro-oesophageal reflux disease is a clinical condition where acid in the stomach regurgitates into the lower part of the oesophagus causing burning sensation in the chest. It is a fairly common condition that affects millions of people around the world. In this article we shall take a brief look at how acid reflux disease occurs and how it is treated.
The underlying reason for acid reflux developing is reduced tone of the lower oesophageal sphincter. Normally, this sphincter relaxes when food or liquids are ingested, allowing them to enter the stomach. Once the food has passed into the stomach, the lower oesophageal sphincter tightens and prevents food from coming back up into the oesophagus. In acid reflux disease, the acid and food in the stomach can pass back up into the lower part of the oesophagus as the lower oesophageal sphincter is a rather lax and fails to close properly. In other words, the primary reason for acid reflux disease is failure of the lower oesophageal sphincter to close properly. See http://www.webmd.com/heartburn-gerd/guide/what-is-acid-reflux-disease
In addition to this, slow emptying of the stomach and a hiatus hernia (herniation of the stomach through the diaphragm into the chest cavity) are also associated with acid reflux disease.
Causes of acid reflux disease
There are a number of factors that play a role in the development of acid reflux disease. Some of them are listed below –
Obesity has been associated with higher incidence of reflux disease.
Certain foods such as alcohol, spices, coffee and chocolate can cause acid reflux.
Medications such as nitrates and calcium channel blockers have been associated with a higher incidence of reflux.
Symptoms and signs
Patients usually complain of a burning sensation within the chest, a feeling of food regurgitating into the throat and even difficulty swallowing. Sometimes, if acid reflux is severe, patients can also develop a cough and chest pain which can mimic a heart attack.
As such, there are no specific findings on clinical examination and a diagnosis is usually made from history alone.
Once a clinical diagnosis of acid reflux is made, there are few diagnostic tests that can be conducted to confirm the diagnosis. These include –
Gastro-oesophageal endoscopy – Here a camera is passed into the food pipe all the way down to the stomach to assess the degree of contraction and relaxation of the lower oesophageal sphincter.
24-hour pH monitoring – This is a test where a pH monitoring probe is inserted into the lower part of the oesophagus to assess the drop in pH over a 24-hour period. This is one of the best tests available to make a diagnosis of acid flux disease.
Oesophageal manometry – This helps assess the tone of the lower oesophageal sphincter.
Simple lifestyle changes such as weight loss, decreased alcohol intake, alteration in dietary habits and stopping smoking can significantly reduce acid reflux. Medications such as proton pump inhibitors (Omeprazole, Lansoprazole) block acid production completely and help relieve symptoms.
In cases where the above measures are unhelpful, surgical treatment such as Nissen’s fundoplication is helpful in treating acid flux disease.
If left untreated, acid reflux can cause a change in the cellular structure of the lining of the lower end of the oesophagus. The condition is called Barrett’s oesophagus and the new cells that are formed can develop into cancer over time. Barrett’s oesophagus requires regular monitoring and treatment before cancer develops.
Acid reflux disease is a common condition. Risk factor modification and simple treatments can help manage the condition. Complications may occur if it is left untreated and surgical options are available should simple measures be ineffective.