Let’s talk about heartburn with Dr Alice Fitzgibbon

Let’s talk about heartburn with Dr Alice Fitzgibbon

This month’s column is about a problem many people will experience at some point in their lives – acid reflux.

For some people, heartburn (caused by acid reflux) is an occasional problem, and for others it can happen longer term. So what exactly is happening when we experience heartburn? Our stomachs are full of acid. Stomach acid is needed to help break down the food we eat so it can be digested properly, and our bodies can take the nutrients we need from it. In acid reflux, the acid from the stomach comes back up into the oesophagus (the gullet). Sometimes it can come back up as far as the throat, or even into the mouth.

Heartburn is felt as a burning pain just behind the breastbone. Other symptoms of acid reflux can include bad breath, a sour taste in the mouth, voice hoarseness, a persistent throaty cough or the sensation of something stuck in the throat. Sometimes, you might never have heartburn but you might have any of these other symptoms – this is called silent reflux. The symptoms of reflux are generally worse after eating (especially large meals), when lying flat or when bending over. This is why some people have particularly bad symptoms at night time.

Acid reflux can happen for no obvious reason. It is known that for some people the following may trigger acid reflux or make it worse:hear

  • Certain foods (especially spicy food, tomatoes, onions, chocolate, coffee)
  • Alcohol
  • Being a smoker
  • Being overweight
  • Stress
  • Taking Non-Steroidal Anti-Inflammatory (NSAID) medications like ibuprofen
  • Pregnancy

Also having a condition called a hiatus hernia can make you more likely to suffer with acid reflux. Having a hiatus hernia means that the top part of the stomach can move up into the chest cavity. This makes it more difficult for the acid to stay in the stomach, so it may escape upwards.

If you have heartburn, tackling any triggers you know cause your symptoms is the best way to help yourself. As we know, losing weight, reducing alcohol consumption and stopping smoking will have many overall health benefits, as well as helping acid reflux symptoms. Taking smaller meals, avoiding food triggers and not eating 3-4 hours before going to bed may also help. Sleeping with the head of the bed raised, or with an extra pillow, might also help gravity keep that stomach acid where it is supposed to be.

Sometimes, despite all of these measures, heartburn can still cause problems. You can buy over the counter medication to help. There are many different type of antacids – they work by acting on the stomach acid to neutralise it; this often quickly relieves symptoms. Antacids are best taken with, or soon after, meals.

If, despite trying lifestyle measures, and over the counter medications, you are still struggling with heartburn, it may be time to see your GP. Sometimes, we prescribe another type of medication called a Proton Pump Inhibitor (PPI) which acts on the stomach lining to stop so much acid being produced in the first place. Common PPI medications are omeprazole and lansoprazole. These medications may be used as a course or longer term. They may have long term side effects if used for years at a time – this should be discussed with your GP if needed.

Simple heartburn is a not a worrying condition. Severe heartburn, heartburn that persists despite medications, heartburn associated with swallowing difficulty, vomiting, weight loss or abdominal pain may need further investigations to find out if there is an underlying cause for it. Often the best test for this is a camera test called an endoscopy which your GP can refer you for. Don’t ignore heartburn with other symptoms – visit your GP who can help you get to the bottom of it.

Found out more about acid reflux and heartburn from the NHS at https://www.nhs.uk/conditions/heartburn-and-acid-reflux/

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