What is Reflux Disease?
Reflux is one of the commoner acid-related disorders.Your
stomach naturally produces acid to help sterilise and digest your food. However,
sometimes the acid has unwanted effects on the lining of the gullet (oesophagus),
stomach or duodenum causing an acid-related disorder.
Normal amounts of acid will cause discomfort or pain if these parts of the digestive
system are weakened or damaged. Infection, older age, alcohol and certain drugs
can all weaken the lining of the digestive system. Your stomach may also produce
more acid than you need. This can happen if you are under stress or if you smoke.
The major symptoms of reflux disease are:
- heartburn - a burning sensation felt in
the central chest area. It most often occurs while swallowing and when lying down
or bending.
- regurgitation - an acidic or bitter tasting
fluid, or even food, comes up into the mouth.
In the past, these problems were thought to be caused by a
hiatus hernia. A hiatus hernia occurs when the upper part of the stomach
pushes through the diaphragm into the chest. In fact, hiatus hernias are very common
and are frequently found in people who have no symptoms whatsoever.
We also know that reflux can occur in people who do not have a hiatus hernia.
It is now known that the muscles around the junction between the
oesophagus and the stomach form a valve (called the lower
oesophageal sphincter or
LOS for short). This valve normally prevents stomach acid coming up the wrong
way (refluxing). Reflux occurs if the LOS valve has grown weak or if the stomach
contents are put under too much pressure.
That is why reflux symptoms often occur in late pregnancy or in people who have
a large amount of abdominal fat.
In reflux it is the acidic fluid passing from the stomach that causes the pain of
heartburn. In some cases the acidic fluid can cause inflammation of the lining of
your oesophagus and this is known as oesophagitis.
Heartburn and reflux oesophagitis can be treated with drugs that lower the amount
of acid in the stomach.
Reflux symptoms may resolve if precipitating causes can be identified and remedied.
For example, this might involve losing some weight, cutting down on fatty foods
or eating and drinking smaller quantities at a time.
Sometimes the muscles of the LOS or other parts of the digestive system are not
working properly. If it is thought that these disorders of gut movement are an important
cause of reflux, it may be appropriate to use drugs which can correct the muscle
function and so prevent reflux. These days, surgery is seldom used to treat reflux
because the acid-reducing treatments are so effective.