Gastric Reflux

What Is Gastric Reflux?

Gastric reflux, also known as gastro-oesophageal reflux disease (GORD), is a chronic condition characterised by the frequent backward flow of stomach acid into the oesophagus. The oesophagus is the tube that connects the throat to the stomach. Normally, a ring of muscle called the lower oesophageal sphincter (LES) prevents stomach acid from flowing back into the oesophagus. However, in individuals with GORD, the LES becomes weak or relaxes inappropriately, allowing stomach acid to enter the oesophagus.

Impact of Gastric Reflux On Anatomy and Health

• Oesophageal Damage: The repeated exposure of the oesophagus to stomach acid can lead to irritation and inflammation. Over time, this can cause damage to the lining of the oesophagus, a condition known as erosive oesophagitis.
• Heartburn: Heartburn is a common symptom of GORD. It is characterised by a burning sensation in the chest or throat, which can be uncomfortable and may worsen after meals or when lying down.
• Regurgitation: People with GORD may experience the regurgitation of sour or bitter-tasting fluid in the mouth. This can be unpleasant and may lead to bad breath.
• Difficulty Swallowing: In severe cases of GORD, the narrowing of the oesophagus due to scarring and inflammation can make it difficult to swallow. This condition is known as dysphagia.
• Respiratory Issues: Gastric reflux can also affect the respiratory system. Stomach acid can be aspirated into the lungs, leading to coughing, wheezing, and pneumonia.
• Tooth Erosion: The acid that reaches the mouth during regurgitation can erode tooth enamel, leading to dental problems.
• Barrett's Oesophagus: In some individuals with long-standing GORD, changes in the lining of the oesophagus can occur, increasing the risk of oesophageal cancer.

Cause and Risk Factors for Gastric Reflux

Several factors can increase the risk of developing gastric reflux, including:

• Obesity: Excess body weight can pressure the stomach and weaken the LES, making it more likely for stomach acid to flow into the oesophagus.
• Dietary Factors: Consuming large meals, spicy or fatty foods, citrus fruits, and caffeine can trigger GORD symptoms in some individuals.
• Lifestyle Habits: Smoking, alcohol consumption, and lying down after eating can contribute to gastric reflux.
• Pregnancy: Pregnant women may experience GORD due to hormonal changes and the pressure exerted by the growing uterus on the stomach.
• Hiatal Hernia: A hiatal hernia occurs when a portion of the stomach protrudes into the chest cavity through the diaphragm, and it can increase the risk of GORD.
• Age: Older adults are more prone to GORD, as the LES may weaken with age.
• Certain Medications: Some medications, such as antihistamines, calcium channel blockers, and sedatives, can relax the LES and contribute to GORD.
• Genetics: Some individuals may have a genetic predisposition to developing GORD.

Symptoms of Gastric Reflux

The symptoms of GORD can vary in severity from person to person. Common symptoms include:

• Heartburn: A burning sensation in the chest or throat, often after eating or when lying down. It's a hallmark symptom of GORD.
• Regurgitation: The sensation of stomach contents, including acid or partially digested food, flowing back into the throat or mouth.
• Dysphagia: Difficulty swallowing, often due to the narrowing of the oesophagus from inflammation and scarring.
• Chest Pain: Some individuals with GORD experience chest pain that can mimic heart attack symptoms. It's important to seek medical attention if you're unsure about the cause of chest pain.
• Chronic Cough: A persistent dry cough, often worse at night, can be a symptom of GORD, as stomach acid can irritate the throat.
• Hoarseness or Sore Throat: GORD can irritate the throat and vocal cords, leading to hoarseness or a chronic sore throat.
• Asthma or Wheezing: Aspiration of stomach acid into the lungs can trigger asthma symptoms or wheezing in individuals with asthma.
• Dental Problems: The acid that reaches the mouth during regurgitation can erode tooth enamel, leading to dental issues.
• Laryngitis: Inflammation of the voice box (laryngitis) can result from stomach acid irritating the area.
• Bad Breath: Persistent bad breath, known as halitosis, can be a symptom of gastric reflux.

Stages or Levels of Gastric Reflux

• Occasional or Mild GORD: Individuals may experience occasional heartburn or mild reflux symptoms at this stage. These symptoms occur infrequently and may be manageable with over-the-counter antacids or lifestyle modifications like dietary changes and avoiding trigger foods.
• Frequent GORD: In this stage, symptoms become more frequent, occurring twice weekly. Frequent heartburn, regurgitation, and discomfort become noticeable and may interfere with daily activities. Over-the-counter medications like antacids or H2-receptor antagonists (H2 blockers) may be used to manage symptoms.
• Moderate GORD: GORD symptoms are more persistent and severe at this level. Heartburn, regurgitation, and other symptoms may occur daily or several times a week. Lifestyle changes and over-the-counter medications may relieve some, but a healthcare professional may prescribe stronger medications like proton pump inhibitors (PPIs).
• Severe GORD: Severe GORD is characterised by frequent and intense symptoms that significantly impact an individual's quality of life. Symptoms may include severe heartburn, regurgitation, difficulty swallowing (dysphagia), and respiratory symptoms like coughing and wheezing. PPIs or other medications are often prescribed at higher doses, and long-term management is necessary.

Diagnosis of Gastric Reflux

• Medical History and Symptoms: The initial step in diagnosing GORD is thoroughly discussing your medical history and symptoms with a healthcare professional. Typical symptoms, such as heartburn, regurgitation, and chest pain, will be assessed.
• Physical Examination: A physical examination may be conducted to check for signs associated with GORD, such as esophagitis, throat irritation, or respiratory issues.
• Endoscopy: An upper endoscopy involves inserting a thin, flexible tube with a camera (endoscope) down the throat to inspect the oesophagus and stomach visually. This procedure can identify inflammation, oesophageal damage, or complications like Barrett's oesophagus.
• pH Monitoring: pH monitoring measures the level of acidity in the oesophagus over 24 hours. It helps determine if acid reflux episodes are occurring and their frequency.
• Oesophageal Manometry: This test measures the strength and coordination of the muscles in the oesophagus and LES. It can identify issues with muscle function that contribute to GORD.

Treatment of Gastric Reflux

Treatment for GORD aims to alleviate symptoms, heal oesophageal damage, and prevent complications. Here are common treatment options:

• Lifestyle Modifications:
• Dietary Changes: Avoiding trigger foods (e.g., spicy, fatty, citrus), eating smaller meals, and avoiding late-night eating can help reduce symptoms.
• Elevating the Head of the Bed: Sleeping with the head of the bed elevated can prevent acid reflux during the night.
• Weight Management: Losing excess weight can reduce abdominal pressure and improve symptoms.
• Medications:
• Antacids: Over-the-counter antacids can provide short-term relief from heartburn.
• H2 Blockers: Histamine-2 receptor blockers can reduce stomach acid production.
• Proton Pump Inhibitors (PPIs): PPIs are powerful medications that block acid production and can provide long-term relief.
• Prokinetics: These medications improve oesophageal motility and help prevent reflux.
• Foaming Agents: These medications create a foam barrier to prevent reflux.
• Surgery: In severe cases or when medication and lifestyle changes are ineffective, surgical options like fundoplication (wrapping the top of the stomach around the LES) may be considered.

Complications of Untreated Gastric Reflux

If GORD is left untreated or poorly managed, it can lead to complications. These complications can be considered stages of disease progression:

• Esophagitis: Chronic exposure to stomach acid can lead to inflammation and irritation of the oesophagus, a condition known as erosive esophagitis.
• Strictures: Repeated injury to the oesophagus can cause narrowing or strictures, making it difficult to swallow.
• Barrett's Oesophagus: Over time, some individuals with chronic GORD may develop Barrett's oesophagus, a condition in which the normal lining of the oesophagus is replaced by abnormal tissue. Barrett's oesophagus is a risk factor for oesophageal cancer.
• Respiratory Complications: Aspiration of stomach contents into the lungs can lead to respiratory issues, including chronic cough, bronchitis, and pneumonia.
• Oesophageal Cancer: In rare cases, long-term untreated GORD can increase the risk of developing oesophageal cancer, particularly in individuals with Barrett's oesophagus.

Seek medical attention and follow a tailored treatment plan for GORD symptoms. Effective management can help control symptoms, heal oesophageal damage, and reduce the risk of complications. Regular follow-up with a healthcare provider is essential to monitor progress and adjust treatment.