Acid reflux – what are the signs, symptoms, causes and treatments of Gastro-oesophageal reflux disease (GORD)?

Acid Reflux
Acid Reflux

Gastro-oesophageal reflux disease (GORD) (also known as acid reflux)  is a common condition where acid from the stomach leaks out of the stomach and up into the oesophagus (gullet).

he oesophagus is a long tube of muscle that runs from the mouth to the stomach.

Common symptoms of GORD include:

  • heartburn – burning chest pain or discomfort that occurs after eating
  • acid reflux – you may have an unpleasant taste in the mouth, caused by stomach acid coming back up into your mouth
  • pain when swallowing (odynophagia)
  • difficulty swallowing (dysphagia)

GORD occurs only occasionally for some people, but if the symptoms persist it’s usually regarded as a condition that needs treatment.

Read more about the symptoms of GORD.

What causes GORD?

It’s thought that GORD is caused by a combination of factors, but the most common is the failure of the lower oesophageal sphincter (LOS) – a ring of muscle towards the bottom of the oesophagus.

This acts like a valve, opening to let food fall into the stomach, then closing to prevent acid leaking out of the stomach.

In GORD, this sphincter doesn’t close properly, allowing acid to leak up out of the stomach.

Known risk factors for GORD include:


  • being overweight or obese
  • being pregnant
  • eating a high-fat diet

Read more about the causes of GORD.

Diagnosing GORD

Your GP should be able to diagnose and treat GORD by asking you about your symptoms.

Further testing is usually only required if you have pain or difficulty swallowing, or if your symptoms don’t improve despite taking medication.

Testing usually involves using an instrument called an endoscope, which is a long, thin, flexible tube with a light and camera at one end. It will be gently lowered down your throat so that any acid damage to the oesophagus can be seen.

Endoscopy is usually used if the diagnosis of GORD is in doubt, to check for any other possible causes of your symptoms, such as functional dyspepsia (an irritable stomach or gullet) or irritable bowel syndrome (IBS).

Read more about diagnosing GORD.

Treating GORD

A step-by-step approach is usually used for treating GORD. This means that simple treatments, such as changing your diet, will be tried first.

If this proves ineffective in controlling your symptoms, medication – such as antacids, proton-pump inhibitors (PPIs) or H2-receptor antagonists (H2RAs) – may be recommended.

Antacids neutralise the effects of stomach acid, and PPIs and H2RAs reduce the amount of acid that the stomach produces.

Surgery may be required in cases where medication fails to control the symptoms of GORD.

Read more about the treatment of GORD.

Complications

A common complication of GORD is that the stomach acid can irritate and inflame the lining of the oesophagus. This is known as oesophagitis.

In severe cases of oesophagitis, ulcers (open sores) can form, which can cause pain and make swallowing difficult, particularly if the gullet becomes narrowed (stricture).

Cancer of the oesophagus, known as oesophageal cancer, is a rarer and more serious complication of GORD.

Read more about the complications of GORD.

Outlook

Most people initially respond well to treatment with medication, but symptoms can often return quite quickly (within days or weeks).

People with recurring GORD may need to take medication on a long-term basis.

 

[Original article on NHS Choices website]

Achalasia – what you need to know but were afraid to ask!

Achalasia is a disorder of the gullet (oesophagus) where it loses the ability to move food along. The valve at the end of the gullet also fails to open and allow food to pass into your stomach.

Achalasia
Achalasia

As a result, food gets stuck in your gullet and is often brought back up.

A ring of muscle called the lower oesophageal (cardiac) sphincter keeps the opening from the gullet to the stomach shut tight to prevent acid reflux (acidic stomach content moving back up into the gullet).

Normally, this muscle relaxes when you swallow to allow the food to pass into your stomach. In achalasia, this muscle does not relax properly and the end of your gullet becomes blocked with food.

Achalasia is an uncommon condition that affects about 6,000 people in Britain. It is sometimes known as cardiospasm.

What are the symptoms?

Symptoms of achalasia may start at any time of life and usually come on gradually.

Most people with achalasia have dysphagia, a condition where they find it difficult and sometimes painful to swallow food. This tends to get worse over a couple of years.


It may cause you to bring back up undigested food shortly after meals and some of the vomited food may have been held up in your gullet for some time.

Bringing up undigested food can lead to choking and coughing fits, chest pain and heartburn.

Occasionally, vomit may dribble out of your mouth and stain the pillow during the night. If it trickles down your windpipe, it can cause repeated chest infections and even pneumonia.

You may experience gradual but significant weight loss.

However, in some people achalasia causes no symptoms and is only discovered when a chest X-ray or other investigation is performed for another reason.

What is the cause?

Achalasia is caused by damage to and loss of the nerves in the gullet wall. The reason for this is unknown, although a viral infection earlier in life may be partly responsible.

Achalasia may also be associated with having an autoimmune condition, where the immune system attacks healthy cells, tissue and organs. One recent study found people with achalasia are significantly more likely to have an autoimmune condition such as Sjogren’s syndrome, lupus or uveitis.

Although achalasia can occur at any age, it is more common in middle-aged or older adults.

There is no evidence to suggest that achalasia is an inherited illness. Women with achalasia can have a normal pregnancy and there’s no reason why their children will not develop normally.

How is it diagnosed?

If your GP thinks you have achalasia, you will be referred to hospital to have some diagnostic tests performed.

Barium swallow

A barium swallow involves drinking a white liquid containing the chemical barium, which allows the gullet to be seen and videoed on an X-ray.

In achalasia, the exit at the lower end of your gullet never opens properly, which causes a delay in barium passing into your stomach.

An ordinary chest X-ray may show a wide gullet.

Endoscopy

A flexible instrument called an endoscope is passed down your throat to allow the doctor to look directly at the lining of your gullet and stomach. Trapped food will be visible.

The endoscope can be passed through the tight muscle at the bottom of your gullet and into your stomach to check there is no other disorder of the stomach.

Read more about having an endoscopy.

Manometry

Manometry measures pressure waves in your gullet. A small plastic tube is passed into your gullet through your mouth or nose and the pressure at different points in your gullet is measured.

In achalasia, there are usually weak or absent contractions of the gullet and sustained high pressure in the muscle at the lower end of the gullet. The high pressure means the muscle does not relax in response to swallowing, causing symptoms of achalasia.

How is it treated?

The aim of treatment is to open the lower oesophageal sphincter muscle so food can pass into the stomach easily. The underlying disease cannot be cured but there are various ways to relieve symptoms which can improve swallowing and eating.

Dilatation (stretching the muscle)

A balloon (about 3-4cm in diameter) is used to stretch and disrupt the muscle fibres of the sphincter muscle at the lower end of your gullet.

This usually improves swallowing but may need to be performed several times or repeated after one or more years. Balloon dilatation does carry the risk of oesophageal rupture which may require emergency surgery.

Surgery

Under general anaesthetic the gullet is accessed through the abdomen (tummy) or, rarely, the chest. The muscle fibres of the lower oesophageal sphincter that fail to relax are divided. This usually leads to a permanent improvement in swallowing.

The operation is now performed by keyhole surgery (laparoscopy) and only requires an overnight stay in hospital.

Recovering from treatment

There are a few things you can do after dilatation or surgery to reduce symptoms:

  • chew your food well
  • take your time eating
  • drink plenty of fluids with your meals
  • always eat food sitting upright
  • use several pillows or raise the head of your bed so that you sleep fairly upright, which prevents stomach acid rising into your gullet through the weakened valve and causing heartburn

If heartburn develops after treatment, consult your GP as medication may be needed to reduce the acid reflux. Sometimes your surgeon may suggest you take this routinely to prevent problems after surgery. Read about treatments for acid reflux.

You should also see your GP if you still have swallowing difficulties or are continuing to lose weight.

It’s normal for chest pain to persist for a while after treatment – drinking cold water often gives relief.

Cancer risk

If the gullet contains a large amount of food that does not pass into the stomach in the normal way, the risk of cancer of the oesophagus (gullet) is slightly increased.

The increased risk is likely to be most significant in long-term untreated achalasia. It’s therefore important to get appropriate treatment for achalasia straight away, even if your symptoms are not bothering you.

According to Cancer Research UK, compared with the general population:

  • men with achalasia have an eight to 16 times higher risk of oesophageal cancer
  • women with achalasia have a 20 times higher risk of one particular type of oesophageal cancer (adenocarcinoma)

However, cancer of the oesophagus is very uncommon and although your risk is slightly increased, it remains highly unlikely.

Abdominal pain – what are the signs, symptoms, cause and treatments of a stomach ache

A stomach ache is a term often used to refer to cramps or a dull ache in the tummy (abdomen). It’s usually short-lived and is often not serious.

Stomach ache and abdominal pain - your guide
Stomach ache and abdominal pain – your guide

Severe abdominal pain is a greater cause for concern. If it starts suddenly and unexpectedly, it should be regarded as a medical emergency, especially if the pain is concentrated in a particular area.

Call your GP as soon as possible or go to your nearest hospital accident and emergency (A&E) department if this is the case.

If you feel pain in the area around your ribs, read about chest pain for information and advice.

Stomach cramps with bloating

Stomach cramps with bloating are often caused by trapped wind. This is a very common problem that can be embarrassing, but is easily dealt with. Your chemist will be able to recommend a product which can be bought over the counter to treat the problem.

Sudden stomach cramps with diarrhoea

If your stomach cramps have started recently and you also have diarrhoea, the cause may be a tummy bug (gastroenteritis). This means you have a viral or bacterial infection of the stomach and bowel, which should get better without treatment after a few days.

Gastroenteritis may be caused by coming into close contact with someone who’s infected, or by eating contaminated food (food poisoning).

If you have repeated bouts of stomach cramps and diarrhoea, you may have a long-term condition, such as irritable bowel syndrome.

Sudden severe abdominal pain

If you have sudden agonising pain in a particular area of your tummy, call your GP immediately or go to your nearest A&E department. It may be a sign of a serious problem that could rapidly get worse without treatment.

Serious causes of sudden severe abdominal pain include:

appendicitis – the swelling of the appendix (a finger-like pouch connected to the large intestine), which causes agonising pain in the lower right-hand side of your abdomen, and means your appendix will need to be removed
a bleeding or perforated stomach ulcer – a bleeding, open sore in the lining of your stomach or duodenum (the first part of the small intestine)
acute cholecystitis – inflammation of the gallbladder, which is often caused by gallstones; in many cases, your gallbladder will need to be removed
kidney stones – small stones may be passed out in your urine, but larger stones may block the kidney tubes, and you’ll need to go to hospital to have them broken up
diverticulitis – inflammation of the small pouches in the bowel that sometimes requires treatment with antibiotics in hospital

If your GP suspects you have one of these conditions, they may refer you to hospital immediately.

Sudden and severe pain in your abdomen can also sometimes be caused by an infection of the stomach and bowel (gastroenteritis). It may also be caused by a pulled muscle in your abdomen or by an injury.

Long-term or recurring abdominal pain

See your GP if you or your child have persistent or repeated abdominal pain. The cause is often not serious and can be managed.

Possible causes in adults include:

irritable bowel syndrome (IBS) – a common condition that causes bouts of stomach cramps, bloating, diarrhoea or constipation; the pain is often relieved when you go to the toilet
inflammatory bowel disease (IBD) – long-term conditions that involve inflammation of the gut, including Crohn’s disease and ulcerative colitis
a urinary tract infection that keeps returning – in these cases, you will usually also experience a burning sensation when you urinate
constipation
period pain – painful muscle cramps in women that are linked to the menstrual cycle
other stomach-related problems – such as a stomach ulcer, heartburn and acid reflux, or gastritis (inflammation of the stomach lining)

Possible causes in children include:

constipation
a urinary tract infection that keeps returning
heartburn and acid reflux
abdominal migraines – recurrent episodes of abdominal pain with no identifiable cause

 

[Original article on NHS Choices website]

How does your gut feel? Expert digestive health tips

Watch our video featuring nutritionist, Ella Allred for helpful tips and advice on how we can keep our digestive systems healthy for everyday life.

Digesting our food adequately is vital for the absorption of vitamins and minerals which are required for all processes in the body. Improving digestion and repairing the lining of the gut (which can become damaged) is also key for increasing a feeling of energy and vitality.

Nutritionist Ella Allred shares her professional advice with us on the effects that a bad diet, stress, and other elements may have on our bodies. These symptoms can include bloating, slow metabolism, pain and stiffness, increased allergic reactions and other symptoms. She also shares remedies to help us avoid digestive discomfort.

Here are some steps to take to help your digestive system –

1. Feed it properly – Your digestive system is like a piece of fine machinery. Many different parts work together to process food. In order to get the maximum benefit, make sure the type of food you put into it is the best quality. We want the best digestive system so use the best fuel! To improve digestive health and maintain it, it is important to eat a balanced and varied diet.

·

Diets for weight loss
Diets for weight loss

Think vegetables! – Vegetables are packed full of nutrients to help your digestive system function properly. Focus on eating plenty of dark-green leafy vegetables such as broccoli, spinach and cabbage.


· Dried fruit, such as dates, figs, and prunes are good sources of dietary fibre. Fibre helps your digestive system function properly.

· Beans and legumes – if you don’t have time to cook dried beans, buy canned but make sure you rinse them thoroughly before cooking. Lentils and split peas are less gas-forming than other legumes.

· Ground flaxseeds are a gentle laxative.

2. Address any food allergies/sensitivities. Food sensitivities are behind many digestive disorders. Some people have an adverse reaction to certain foods which can place a stress on the digestive system. If you think this could be something you are suffering from, try keeping a food diary and match this with any symptoms. You could also consider an elimination diet whereby you remove certain foods from you diet for a while to see if symptoms improve. A food allergy test is also available.

3. Get enough water – Insufficient water intake is a primary cause of constipation. Carry a large bottle of water around with you and sip throughout the day.

4. Increase good gut bacteria – Not all bacteria is bad! There are over 400 different kinds of bacteria and yeasts in the digestive system. Of these, the bacteria Lactobacillus acidophillus and Bifidobacterium bifidum are considered good live bacteria because they can help to maintain intestinal health. Consider a good quality live bacteria supplement and eat yoghurt which contains live bacteria.

5. Practice Mindful Eating – Eat slowly and savour every bite.

6. Chew Chew Chew! – Digestion begins in the mouth so thoroughly chew each and every bite of food. Take smaller bites and put your knife and fork down between bites.

Bloating: The cause and prevention


How to prevent bloating
How to prevent bloating
It can be a topic that is seldom discussed, uncomfortable and embarrassing, so what are the most common causes of bloating and what can you do to prevent it

In this video, Sian, a 33 year old business owner and busy mother of two finds herself, like many of us, suffering from severe bloating as a result of her diet and busy lifestyle.

Sian documents her experiences in a week long video diary which shows how something as simple as a protein shake and not taking time to sit down and eat her meals can trigger bloating, as well as other lifestyle factors that she wasn’t even aware of.

To help people like Sian, consultant gastroenterologist at University College London, Dr Laurence Lovat, shares his professional and expert advice. He classifies and explains the differences between the three types of bloating, which foods to eat for a happier digestive system, as well as revealing other factors such as how fast you eat, that you may not know can also lead to bloating.

For all this and more watch our informative video.