Heartburn (or acid reflux as it is known) can be very uncomfortable but, arguably, occasional symptoms are normal. If you over eat or drink excess alcohol on a night out, then the burning symptoms might be expected. However, symptoms on a daily basis that start to affect your day-to-day activities are certainly not normal and need attention. Symptoms vary between patients and can include burning in the middle of the chest, foul acidic taste in the mouth or night time cough as the acid comes up the gullet and spills over into the lungs. Often associated with heart burn is what we call “volume regurgitation” – this is where the stomach contents can come up into the mouth when bending forward or lying down. Both of these symptoms need attention. The problem is that long term acid in the gullet can cause damage, which left unchecked, can cause a change in the lining of the gullet to what we call “Barrett’s oesophagus”, so called after Norman Barrett who discovered the problem in 1950. Patients with this issue have a thirty times increased risk of life threatening cancer of the gullet. The cause of the acid reflux or volume regurgitation is usually a “hiatus hernia” where part of the stomach has pushed up through the diaphragm through a natural hole into the chest.
After recognition of the problem, attendance at your GP is crucial. The first thing to try is lifestyle modifications which may include measures such as stopping smoking, avoiding trigger foods or alcohol. If these don’t make a significant difference then medication is the next step. Different varieties exist but the most common is called Omeprazole which switches off the stomach acid. Starting at low dose is advisable and sufficient for most people, but doses may need to be increased as symptoms dictate.
If you do not wish to take long term medication or if the medication fails to control the symptoms then you may need to be referred for a surgical opinion. You will need investigations which may include a camera investigation (a “gastroscopy”), an x-ray investigation while you drink (a “barium swallow”) and a 24 hour acid check via a small probe placed down the nose into the gullet. If all of these investigations confirm acid reflux, hiatus hernia or Barrett’s oesophagus then surgery may be recommended.