It’s not just down to overindulgence – more an occupational hazard of being human. Acid reflux is remarkably common – one in three adults get it, and one in six suffer at least twice a week. But simple measures could end the misery of indigestion.
If food starts sticking as you swallow it, or you get severe pain on swallowing, see your doctor urgently. Peppermint, alcohol, spicy foods, tomato and onions may worsen reflux or indigestion – cut one out at a time and see if it helps
How reflux occurs
When you eat, food passes down your gullet into your stomach. Here, powerful acid starts digesting it, before it’s passed on first to the small and then the large intestine. Muscles in your gullet work together to squeeze food down, and there’s a valve made of muscle between the gullet and oesophagus. This is found at the level of your diaphragm – the horizontal sheet below the lungs that separates your chest cavity from your stomach. The valve relaxes to let food through and should then tighten enough to stop food (and acid) coming back up. It should, but it doesn’t always – and that’s where the trouble starts, at least as far as reflux is concerned.
The lining of the stomach is specially designed to withstand the powerful acid it contains. The lining of the gullet isn’t, because it shouldn’t have any acid in it. If the one-way valve between the gullet and the top of the stomach leaks, acid can reflux back into the gullet. The result is often burning pain behind the breastbone, known as heartburn. Acid can rise up into the back of your throat, leading to a bitter taste and sometimes a persistent sore throat.
What are the causes?
One cause of acid reflux is a hiatus hernia, where the top of the stomach slides or rolls through the diaphragm into your chest cavity. But anything that puts excess pressure on your stomach cavity can force food backwards – this includes big meals, being overweight, constipation, tight belts or dresses. If you lie flat or hunch forwards, acid doesn’t have to travel against gravity and is more likely to reflux. That’s why heartburn is common at night.
Indigestion or ‘dyspepsia’ refers to a whole variety of upper digestive tract problems. Symptoms include pain in the top of your stomach; feeling (or being) sick; bloating; feeling full quickly on eating; and wind, as well as acid reflux. Most people with indigestion don’t have a stomach ulcer, but can have inflammation of the lining of the stomach or duodenum (the first part of the small bowel).
What treatments are possible?
Most treatments for acid reflux also work for other kinds of indigestion. Antacid tablets or liquids act quickly to relieve symptoms by neutralising acid, but don’t work for long. For more severe or persistent symptoms, you’ll probably need a course of tablets called PPIs (there are several, all with names ending in ‘-prazole’). Your doctor will often prescribe a month’s course of tablets to settle inflammation, then suggest you stop them to see if your symptoms recur. You can buy these from your pharmacist too.
Avoiding heavy meals, especially late at night, may relieve your symptoms. For reflux, try raising the head of your bed by 4-6 inches (with a brick under the legs of the bed). Anti-inflammatory medicines like naproxen, ibuprofen or aspirin commonly cause reflux or indigestion. So can bisphosphonates (used for osteoporosis), a heart medicine called nifedipine and many others. If in doubt, speak to your pharmacist.
Reflux and indigestion are rarely serious, but your doctor will sometimes recommend an endoscopy, where a small tube is passed into your stomach to examine it. ‘Red flag’ symptom include being off your food or losing weight for no reason; vomiting or pooing blood; becoming anaemic; or severe symptoms that don’t respond to treatment.
Although uncommon, Barrett’s oesophagus is a complication of reflux where the cells lining the lower end of the gullet become damaged and there’s a small but real risk of cancer. You’ll be offered regular endoscopy to check up on it.
