About Acid Reflux

By Phil Hariram

1. Acid reflux is common and increasing in the developed world. A Gollop Poll in USA reported that 44% had symptoms on a monthly basis. GERD is higher in whites and the obese. There is also a higher prevalence in people aged 60-70 years. It is rare in blacks. It is also lower in Eastern countries. In India it is 7.5%, Malaysia 3% and China 0.8%. It is suggested that this incidence will increase as these countries introduce Western diet higher in fats.

2. Lifestyle change is an important aspect of treatment of acid reflux. Some patients show marked improvement after losing only a small amount of weight.

Obesity increases abdominal pressure and affects the lower esophageal sphincter (LES). Large meals distend the stomach and adds pressure on the LES. Certain foods affect the sphincter. Avoid or consume in moderation, food such as fats, coffee and alcohol.

3. Antacids neutralize acids in the stomach. This reaction raises the pH and is likely to relieve heartburn or other symptoms of reflux. Trials, however, show that antacids will not heal esophagitis.

The antacids commonly used are magnesium hydroxide, magnesium trisilicate and aluminium hydroxide.

4. Acid Suppressant drugs should be used if lifestyle changes and antacids are ineffective. The first group introduced are the H2-receptor antagonists such as ranitidine. Side effects from this groups of drugs are rare.

The newer proton pump inhibitors like omeprazole and lansaprazole are more effective than H2-receptor antagonists. They are safe and long term use has shown no ill effects. They are so effective that most GERD patients that were unresponsive to ranitidine were effectively treated with omeprazole.

5. A complication of GERD is bleeding from esophigitis. This can lead to anaemia especially in children. Stricture is a distressing complication. It can cause pain and difficulty on swallowing. Barrett's esophagus, experts think, develop after damage to the mucosal lining by acid reflux.

6. Most infants reflux, and conservative measures such as thickened feeds help. Reflux generally subside before the end of the first year. In the past Barrett's esophagus was thought to be confined to adults but with the introduction of smaller fibreoptic endoscopes, more biopsies are done and Barrett's esophagus are being diagnosed in children.

7. Surgery for acid reflux is very uncommon since the advent of effective acid suppressant medical treatment. Today stricures are not common and there are only a rare few that do not respond to omeprazole as acid reflux treatment.

The commonest procedure is Nissen Fundoplication. Today laparoscopic fundoplication is popular.

8. Smoking makes acid reflux symptoms worse, especially in children. Nicotine relaxes the lower esophageal sphincter allowing acidic stomach contents to reflux up into the esophagus. In addition deposited nicotine in the back of the throat when swallowed is corrosive to the esophageal lining. Stop smoking if you have acid reflux.

9. Raising the head of the bed is an effective acid reflux treatment. It is useful for nocturnal acid reflux symptoms and reduces sensitization that results in problems during the day. Tests have shown that adding additional pillows is ineffective.

10. Do not ignore your symptoms. Lifestyle changes may be all that is necessary to control your symptoms but if, in addition to over the counter medications ,your symptoms persist see your family doctor. If you have GERD, complications can be severe and the symptoms very distressing.