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Acid reflux
Acid reflux refers to acidic stomach contents rising into the oesophagus, which occurs occasionally in almost everyone. Acid reflux causes the stomach contents to rise into the oesophagus repeatedly, causing heartburn or inflammation of the oesophagus.
Acid reflux in brief
- Acid reflux causes the contents of an acidic stomach to repeatedly rise into the oesophagus, causing heartburn and possibly inflammation of the oesophagus.
- Dietary and lifestyle changes, such as quitting smoking and avoiding substances that exacerbate heartburn, can significantly alleviate the symptoms of acid reflux.
- Acid reflux and heartburn can be the sum of many factors, and even stress can cause heartburn.
Symptoms of acid reflux
Acid reflux means that the acidic contents of the stomach rise into the oesophagus. Almost all people experience this occasionally, often briefly and without symptoms. Acid reflux causes the stomach contents to rise into the oesophagus repeatedly, causing heartburn or inflammation of the oesophagus.
Symptoms of acid reflux:
- Heartburn Burning or stinging sensation in the upper abdomen or behind the sternum.
- Stomach contents rising into the mouth. Feeling that the stomach contents are rising up into the mouth along the oesophagus. If the stomach contents rise into the mouth, tooth enamel may be damaged.
- Hoarseness of voice and sore throat. Reflux can cause hoarseness of voice and a sore throat as a result of irritation.
- Swallowing pain and difficulties. Rarer symptoms that require more in-depth examination.
Acid reflux also often aggravates asthma symptoms and may predispose you to recurrent respiratory and sinus infections.
What causes acid reflux?
The lower oesophageal sphincter is a combination of several anatomical structures. It is an important part of the protection against acid reflux. If the pressure in the lower sphincter is reduced, the acidic stomach contents often rise into the oesophagus.
Acid reflux is caused by, for example:
- Diaphragmatic hernia, which exposes the lower sphincter to a pressure drop and, thus, to acid reflux. Diaphragmatic hernia refers to a wider-than-usual oesophageal opening in the diaphragmatic muscle where the function of the sphincter is impaired.
- Alcohol and smoking
- Certain foods such as fats, chocolate and citrus juice can make heartburn worse.
- Overweight entails a significant predisposition to acid reflux as high body fat in the torso increases pressure in the stomach.
- Eating habits, such as taking a nap after a meal and eating a lot before bedtime, can predispose to reflux.
- Other factors, such as certain medicines, overexertion and mental stress, can make heartburn worse.
Diagnosing acid reflux
We recommend seeking medical consultation if you are suffering from recurring heartburn or alarming symptoms, such as chest pain, pain when swallowing, food blocking the oesophagus, bleeding or weight loss. The diagnosis of acid reflux is based on the patient's symptoms, possible results of testing medicinal treatment, endoscopy and, if necessary, oesophageal pH test.
The first step in the diagnosis of reflux disease is an appointment with a doctor, where either a general practitioner or a gastroenterologist conducts an interview and a clinical examination. This stage is a key part of the diagnostics, as it helps to assess the severity of symptoms and possible causes, laying the foundation for further investigations and a treatment plan.
The drug treatment trial includes a two-week course of acid blockers. If the symptoms improve within two weeks, this indicates acid reflux.
Gastroscopy is recommended if heartburn is prolonged or if alarming symptoms occur. The gastroscopy is performed by a gastroenterology surgeon or gastroenterologist and the situation of the oesophagus, stomach and duodenum is examined. Oesophageal, gastric and duodenal ulcers and tumours can also be detected in endoscopy. The gastroscopy usually takes 5–10 minutes.
Usually, routine biopsies are taken during the endoscopy from the lining of the duodenum to rule out coeliac disease and from the stomach lining to detect, for example, Helicobacter pylori. In addition, diaphragmatic hernia and possible oesophagitis can be diagnosed both visually and by biopsies.
The lower part of the oesophagus may have what is known as Barret's mucosa, where the mucosa of the lower part of the oesophagus has become intestinal-type mucosa. This is a benign change, meaning that the right kind of cell tissue is in the wrong place, but the situation requires monitoring and biopsy every three years or so.
Treatment of acid reflux
Treatment of acid reflux is intended to prevent acidic stomach contents from rising into the oesophagus through changes in diet and lifestyle. Repeated rise of acidic stomach contents, if untreated, may damage the lining of the lower oesophagus and cause oesophagitis. Prolonged acid reflux may also cause permanent oesophageal mucosal cell changes.
There are several ways to treat acid reflux:
- Avoid food and substances that aggravate heartburn.
- Avoid heavy meals in the evenings and naps after meals.
- Night-time heartburn can be reduced by raising the head of the bed by placing wooden blocks under the legs or by placing a pillow under the mattress.
- Losing weight in overweight patients is a key part of treatment.
- Take into account the stress and overexertion that causes heartburn when modifying your lifestyle.
- For mild and temporary heartburn, medicines obtained from pharmacies without a prescription are sufficient.
Medication prescribed on the basis of an assessment made by a physician with an active substance that blocks the production of gastric acid is needed to control more difficult symptoms. This type of medication can often alleviate heartburn in a couple of days. As prescribed by your doctor, heartburn medicine can be used regularly, for a few weeks when the symptoms get worse, or only when necessary, depending on the symptoms.
Surgical treatment of acid reflux
Surgery is considered if the acid reflux is severe and there is a constant need for medication. In addition, asthma exacerbation associated with acid reflux is a sufficient reason to consider surgery.
The need for surgical treatment is assessed by a specialist in abdominal surgery with experience in the treatment of acid reflux, who will review the benefits and risks of surgery with the patient. Old age and severe underlying diseases increase the risks associated with surgery, in which case heartburn is usually treated with medicine. Excessive overweight reduces the chances of performing surgery.
The operation involves correcting the diaphragmatic hernia and constructing the upper part of the stomach into a back valve around the lower part of the oesophagus to prevent acidic stomach contents from entering the oesophagus. The operation prevents burping, at least partially, and therefore some of the patients may experience flatulence after the procedure.
The surgery usually yields good results, but over the years, some valves stretch and the heartburn may return.
Gastrointestinal problems
Abdominal pain
The causes of stomach pain and treatment options should be investigated when the pain starts to interfere with everyday life.
Inflammatory bowel disease (IBD)
The most typical symptom of inflammatory bowel diseases is diarrhoea. If the diarrhoea persists, blood may be present in the stool.
Irritable bowel syndrome (IBS)
A functional gastrointestinal disorder that causes abdominal pain, bloating and changes in bowel movements.
Lactose intolerance
The inability to digest lactose due to a deficiency of the enzyme lactase, resulting in gastrointestinal symptoms.
Frequently asked questions about acid reflux
Acid reflux means that the acidic contents of the stomach rise into the oesophagus. Almost all people experience this occasionally, often briefly and without symptoms. Acid reflux causes the stomach contents to rise into the oesophagus repeatedly, causing heartburn or inflammation of the oesophagus.
Acid reflux is often caused by a decrease in lower oesophageal occlusive pressure, which can be caused by, for example, diaphragmatic hernia, smoking, alcohol, coffee, certain foods, obesity, overexertion or stress.
The diagnosis of acid reflux is based on the patient's symptoms, possible results of testing medicinal treatment, endoscopy and, if necessary, oesophageal pH test.
Oesophageal pH measurement, or daily recording, is used in acid reflux testing. A thin catheter with electrodes for measuring acidity (pH) is inserted into the oesophagus through the nose. During the measurement, the aim is to live as normal a daily life as possible. The recording reveals the amount, duration and timing of acid refluxes.
Reflux is calmed by dietary and lifestyle changes, such as avoiding foods that exacerbate heartburn, losing excess weight and managing stress. Over-the-counter medicines from a pharmacy can be used for mild heartburn, and more severe symptoms require medication prescribed by a doctor.
We recommend seeking medical advice if you are suffering from recurring heartburn or alarming symptoms, such as chest pain, pain when swallowing, food blocking the oesophagus, bleeding or weight loss.
