Reflux refers to the movement of material from the stomach up into the oesophagus through
a muscle that connects the two. That muscle is called the lower oesophageal sphincter.
Usually it remains tight but when it becomes loose, the stomach contents will migrate back
upwards. Usually that’s acid contents moving up but
sometimes it can be non-acid including food or including air from time to time.
It’s usually occurring because of an incompetence or ineffectual contraction of that sphincter
but some individuals will have a delay in emptying of the stomach so food sits around
in the stomach for longer and as a consequence is more likely to come back up.
You may come across the term hiatus hernia which refers to the stomach sitting slightly
higher up in the chest wall or sorry, in the chest cavity, and that then increases the
likelihood of reflux again through an interference of functioning of the sphincter muscle.
Some individuals have what is referred to as a hiatus hernia which refers to movement
of the stomach up into the chest area. That also renders the sphincter muscle competent
or ineffective hence predisposing to reflux.
People who complain of acid reflux will suffer a variety of symptoms. In the short-term,
they may complain of a burning sensation behind their breastbone. They may complain of a belching
feeling bringing up air or regurgitation of food. They may have an acidic taste in the
mouth. They may experience a feeling of sickness or nausea. They can also experience what we
call atypical symptoms or unusual symptoms such as a cough, particularly at night when
acid is coming back up and then spills up into the lung causing spasm or coughing.
If symptoms have gone on for a while, it may have resulted in a complication of acid reflux
and the classic one is a formation of a stricture or narrowing of the lower end of the oesophagus
in which case they may complain of difficulty swallowing food, it may get stuck, or they
may complain of pain when they swallow.
Acid reflux is treated in a variety of different ways usually split up into three. There are
lifestyle measures that individuals can engage in themselves such as adjusting their diet
and eating patterns, avoiding eating late at night, avoiding large meals, chewing their
food properly and slowly, washing it down.
There are certain foods that might precipitate symptoms so things like caffeine and alcohol,
fatty foods, sometimes spicy foods. These are all known to precipitate symptoms. Drinking
carbonated or fizzy drinks can also aggravate symptoms. There’s a whole range of lifestyle
measures.
The second tier is usually is then the introduction of medication usually to reduce the amount
of acid being produced in the stomach. Classic drugs in that category include drugs like
omeprazole, which are referred to as proton pump inhibitors. These can be combined with other
drugs that stimulate the contraction of the stomach to empty so the combination of the
two reduces the amount of acid available to reflux back up.
When all those measures have failed then surgery is often an option in a in a minority of patients
- probably about 5 or 10% at most.
Recently, there have been some advances in surgical treatments in particular in the management
of reflux problems. The classic treatment over the years has been what is referred to
as a Nissen fundoplication and that involves wrapping the upper part of the stomach in
an axis usually around 270 degrees which then enhances the sphincter muscle and thus reduces
the amount of acid reflux coming back up. But more recently, we've seen the emergence
of a device called a LINX device which is a magnet which is attached around the outer
part of the oesophagus. It's done surgically under a keyhole technique under full anaesthetic
and done by a surgeon. What it basically does is attach itself as a magnet that is made
to measure on the outside of the oesophagus so that when food goes down through the oesophagus
it pushes open the magnet and goes into the stomach and then when the food is resting
in the stomach the magnet opposes itself an acts as a sphincter. That device is called
a LINX device. It's becoming increasingly obvious that that is beneficial when selected
in the right individual.