Reflux & Hiatal Hernias

What is reflux, heartburn and acid reflux?

“Reflux” or “Gastro oesophageal reflux disease” is a very common disorder usually causing “indigestion” or “heartburn” (or heart burn). It is a chronic disease that occurs when the lower oesophageal sphincter does not close properly and stomach contents refluxes into the oesophagus.

Normally, the oesophagus (gullet) carries food from the mouth to the stomach. The lower oesophageal sphincter is a ring of muscle at the bottom of the oesophagus that acts like a valve between the oesophagus and stomach. This valve is designed to prevent stomach content “refluxing” back up into the oesophagus. When refluxed stomach acid contacts the lining of the oesophagus, it causes a burning sensation in the chest or throat called “heartburn”.

Causes of Reflux and Heartburn

• Hiatus Hernia
• Alcohol use
• Overweight / Obesity
• Pregnancy
• Smoking
• Certain foods can further exacerbate reflux:
  
  • alcohol
  • caffeine
  • chocolate
  • fatty foods
  • bananas
  • tomato
  • spicy foods
  • cucumbers
  • peppermint / spearmint

Complications of Reflux

Persistent reflux can lead to inflammation and ulceration of the oesophagus leading to pain or swallowing issues (stricture formation). Sometimes a change in the lining of the oesophagus can also occur which is known as “Barretts” oesophageal disease. This carries an increased risk for oesophageal cancer and needs specialist review and monitoring.

Improving reflux through lifestyle and dietary modifications

You will find that modifications in diet and lifestyle can help to alleviate the symptoms of reflux along with medical therapy (anti-reflux medications).

• Dietary modifications:
  
  • Avoiding foods that trigger or worsen reflux (list above)
  • Eating smaller portioned meals, chew through food well and avoid eating 2-3 hrs prior to bedtime
• Lifestyle modifications:
  
  • Avoid smoking
  • Attempt weight loss to help with reduce pressure to the hiatus
  • Sleep elevated with an extra pillow – allow gravity to help keep stomach acid out of oesophagus when sleeping

In patients with persisting symptoms, surgery may be indicated.