Reflux
Definition
Gastro-oesophageal reflux is the reflux of stomach contents into the oesophagus. Oesophagitis is inflammation of the oesophagus.
Epidemiology
It's pretty common, and often gets worse as you get older. Most people will experience heart burn at some point in their lives after a meal, and about 10% get it every day.
Pathophysiology
Basically, the stuff in the stomach leaks back up the oesophagus, sometimes reaching as far as the back of the throat. Short term this can cause a bit of pain, but long term it can inflame the oesophagus, causing oesophagitis, and if not dealt with, can lead to Barrett's oesophagus (which is more serious).
Risk Factors
- Smoking
- Pregnancy
- Heavy drinkers
- Obesity
- Being older than 35
Clinical Features
- Heartburn (pain in chest)
- Stomach contents regurgitating into mouth
- Feeling sick
- Acid taste in mouth
- Belching
- Feeling of bloating
- Nocturnal cough
Investigations
Normally, none, unless PPIs don't sort it out.
Otherwise, you might have an endoscopy to look for inflammation, and a biopsy to check for Barrett's.
Management
- STOP SMOKING! Not a surprise there. Smoking makes stomach acid worse, and relaxes the sphincter at the bottom of the oesophagus.
- Avoid trigger foods - some people find food such as chocolate, peppermint, tomatoes, spicy stuff, hot drinks, coffee, and alcoholic drinks make it worse. Also eating big meals can make it worse.
- Proton pump inhibitors - half the population is on lanzoprazole. These drugs make the acid in the stomach less acid, and can thus cure the burning problem.
Prognosis
You will be fine, unless you get oesophageal carcinoma.
Approximately 10% of those with reflux have Barrett's, and of those, about 0.5% of sufferers get cancer each year. For this reason, its recommended that those with reflux get an investigative check up every five years.