Gastroesophageal reflux (GER) occurs when the lower oesophageal sphincter, a ring of muscle at the junction between the oesophagus and the stomach, does not close properly. This allows stomach acid to flow back (reflux) into the oesophagus, causing irritation and inflammation. The primary symptom of GER is heartburn, which can feel like a burning pain in the chest, behind the breastbone. Other symptoms may include:
- Regurgitation of food or liquid into the mouth
- Bitter taste in the mouth
- Difficulty swallowing
- Nausea
Why Does Gastroesophageal Reflux Happen?
GER can be caused by a variety of factors:
- Weakness or relaxation of the lower oesophageal sphincter:
- Hiatal hernia: A condition where the upper part of the stomach pushes up through the diaphragm, causing the sphincter to weaken.
- Overeating or eating large meals: Can increase pressure on the stomach, forcing acid back up.
- Obesity: Excess weight can put pressure on the stomach, leading to reflux.
- Certain foods and beverages: Spicy foods, fatty foods, chocolate, coffee, alcohol, and citrus can relax the lower oesophageal sphincter and increase acid production.
- Smoking: Can weaken the sphincter and slow the clearance of acid from the oesophagus.
- Other contributing factors:
- Medications: Certain drugs, such as NSAIDs, calcium channel blockers, and sedatives, can relax the sphincter or increase acid production.
- Pregnancy: Hormonal changes and increased pressure from the growing uterus can cause reflux during pregnancy.
When Does Gastroesophageal Reflux Occur?
GER can occur at any time, but symptoms are often more noticeable:
- After meals: Especially when lying down, bending over, or exercising
- At night: When lying flat, which allows acid to flow more easily into the oesophagus due to gravity
- During pregnancy: Many women experience heartburn during pregnancy due to hormonal changes and physical pressure on the stomach
How to Treat Gastroesophageal Reflux
Treatment for GER focuses on reducing acid production, alleviating symptoms, and preventing complications:
- Lifestyle changes:
- Dietary adjustments: Avoiding trigger foods (spicy, fatty, acidic) and beverages (alcohol, caffeine) can help reduce symptoms.
- Meal timing: Eating smaller, more frequent meals can prevent overeating and reduce the pressure on the stomach.
- Weight management: Losing excess weight can decrease the pressure on the stomach and reduce reflux.
- Avoiding lying down after meals: Waiting at least 2–3 hours before lying down can prevent acid from flowing back into the oesophagus.
- Elevation of the head: Sleeping with the head raised can help keep acid down during the night.
- Medications:
- Antacids: These provide quick relief by neutralising stomach acid.
- H2-receptor antagonists: These drugs reduce acid production in the stomach (e.g., ranitidine, famotidine).
- Proton pump inhibitors (PPIs): These are more effective at reducing acid production and are often prescribed for longer-term relief (e.g., omeprazole, lansoprazole). PPIs are taken daily for up to 8 weeks, depending on the severity of the symptoms.
- Medical procedures:
- Endoscopic treatments: Techniques such as radiofrequency ablation can help tighten the lower oesophageal sphincter.
- Fundoplication surgery: In severe cases, this procedure involves wrapping the upper part of the stomach around the lower oesophagus to strengthen the sphincter and prevent reflux.
- Long-term management:
- Regular follow-ups: Monitoring by a healthcare provider can help assess the effectiveness of treatment and adjust medications if needed.
- Avoiding lifestyle triggers: Continuing to make dietary and lifestyle changes can help prevent the recurrence of symptoms.
By making these adjustments and adhering to prescribed treatments, many people with GER can effectively manage their symptoms and reduce the risk of complications.
Other Resources:
