Reflux is very common – almost everybody experiences it at some time or another.
Also known as gastro-oesophageal reflux disease (GORD), symptoms include a burning sensation in the chest, nausea, regurgitation and sometimes discomfort in the upper abdomen.
Mr Sayed Hassen is an Upper GI Surgeon in Melbourne who deals with the worst cases of reflux.
“One way to experience reflux is to have a very big meal, a few glasses of wine or beer, and then try to have a sleep. When you lie down the acid from the stomach comes up to reach the gullet – causing reflux,” said Dr Hassen.
“There are some substances that are well known to induce reflux due to their chemical makeup which relaxes the sphincter between the stomach and the gullet, normally keeping the acid from rising: cabbage, onions, alcohol, nicotine to name a few,” he said.
Dr Hassen said the common nature of reflux means is it more likely for people to misinterpret what it is they are actually experiencing – this is why is important to see a medical specialist for reflux symptoms.
“There is a link between reflux and what is generally known as functional disorders. This includes things like abdominal aches and pains, bloating and other symptoms that may not be related to reflux. People can use the term indigestion to mean a variety of things including reflux, heartburn, upper or lower abdominal pain, however these could be due to other causes such as allergies, intolerances or a broader gut problem such as irritable bowel syndrome.
“Sometimes these symptoms can trigger reflux which is why people can think their reflux is due to a certain allergy when in fact they are experiencing a secondary symptom. Feeling bloated after a meal is an example of this. That is why gut symptoms need to be identified at their source before treatment for reflux can begin,” he said.
Symptoms can be fairly well controlled using some simple actions such as not eating a big meal at night; cutting down on alcoholic drinks, especially red wine; no smoking; and losing some weight.
If that fails or symptoms persist, then simple medication is of value. Over the counter antacids from pharmacies such as Gaviscon or Zantac are a good step, or for more significant symptoms a proton pump inhibitor (PPI) like Nexium or Pariet might be better suited. While a GP is the best place to get advice on what is best suited to your symptoms, a pharmacist can also help you choose short-term relief.
If people are experiencing what they suspect is indigestion, a GP can help them with determining a place to start with relief. If symptoms persist beyond this initial treatment, Dr Hassen said it is wise to request a gastroscopy and referral to a gastroenterologist or upper GI surgeon for further investigation.
Long term implications
“People come at different stages [of illness]. Sometimes if people come in the early stages, or they are quite young, we can use treatment that incorporates lifestyle changes and medication. If they come with a mechanical problem like a large hiatus hernia they can get quite bad reflux, and generally people with these conditions will not be able to control their reflux with a change of lifestyle or medication alone,” he said.
But people need to be aware of a few things when it comes to treatment for reflux, said Dr Hassen.
“Firstly, some of those drugs have side effects; long term use of PPIs in can have the potential of causing osteoporosis and the potential for broken bones. This is something I am mindful of with my patients, women in particular as they are more prone to osteoporosis.
“People should not be put on significant prescription medication without having had a gastroscopy at least once, to make sure there is no other reason for their reflux. This looks for things like the presentation of cancer or even precursors for cancer.
“Secondly, reflux in the long term can lead to cancer. I do not wish to frighten people and say that reflux always leads to cancer, as that is incorrect, but in the last twenty years or so there has been a steady increase in the number of mostly overweight individuals who experience reflux also developing cancer of the lower oesophagus.
“I have seen patients complain for months before they eventually get referred to a specialist, and that’s a concern. So, I would urge patients to say to their GP, ‘this is clearly not responding and needs referral’,” said Dr Hassen.
There is always a small potential for these symptoms to worsen and give way to cancer, which must not be missed.
“Surgery is not the way to go for everybody – far from it. You only get an operation if other things don’t work. Surgery is not always a way out of your symptoms, and sometimes even after surgery some symptoms will remain.
“It’s a matter of doing all the medical things plus the medication. If you use medication alone, it probably won’t work by itself in all cases. We would normally trial a patient on a medication for at least six months before even contemplating surgery,” said Dr Hassen.
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