Heartburn is chest pain, often likened to a burning feeling, that occurs just behind your sternum (breast bone) usually after eating. It is one of the most common symptoms of acid reflux, a condition where stomach acid leaks into your oesophagus.
Whilst the majority of people just get the occasional bout after a heavy meal or lying down straight after eating, others will experience heartburn and other acid reflux symptoms regularly, significantly impacting their lives. In these cases, it is caused by a chronic condition known as GORD (gastro-oesophageal reflux disease).
It may be easy to ignore your symptoms, as they are often harmless or will go away on their own. However, recurrent acid reflux and GORD can have more long-term impacts on your health. That is why it is important to get your symptoms checked with your usual healthcare provider. Keep reading to find out more about what causes long-term acid reflux and some of its complications.
Acid reflux is the name of the condition that predominantly causes heartburn. It occurs when a valve at the entrance to your stomach, known as the LES (lower esophageal sphincter) is not functioning properly. In normal digestion, the LES closes as soon as food has finished passing through. However, in some cases, the valve does not close all the way or it opens back up too often. This allows stomach acid to leak (or reflux) into your oesophagus and cause a burning sensation in your throat and behind your breastbone, as well as regurgitation, a bitter or sour taste in your throat and mouth, and bad breath (all caused by the stomach acid). You may also experience symptoms often referred to as ‘indigestion’ which includes bloating, flatulence, burping, nausea and hiccups.
If you get symptoms of acid reflux more than twice a week, it’s likely you have a long-term condition. This is known as GORD (gastro-oesophageal reflux disease) or GERD (gastroesophageal reflux disease) depending on where you’re from. It is a chronic condition where there is recurrent reflux of stomach contents, a combination of acid, bile and pepsin (a digestive enzyme). Over time, this reflux causes the LES to weaken and therefore allows symptoms to occur more frequently.
Symptoms of GORD, in comparison to acute acid reflux, are more persistent and severe. It can cause chest pain, a dry cough, wheezing, a sore throat, hoarseness, trouble swallowing, asthma as well as tooth decay.
Your diet and eating habits can be a significant risk factor for acid reflux. Certain foods and beverages such as acidic foods, spicy foods, fatty foods, carbonated drinks, onions, garlic, chocolate and many others are more common causes of acid reflux. In addition, eating heavy meals then lying down or snacking before bed make it easier for stomach acid to travel up your oesophagus.
Acid reflux is also a complication of being overweight. This is because there is excess pressure on your abdomen. The extra body fat squeezes your stomach so more stomach acid travels upwards. Pregnant women also experience acid reflux more frequently because of certain hormonal changes and how the baby, as it grows, presses on your stomach.
The abdominal pressure caused by excess weight from being overweight or from pregnancy can also cause a condition known as a hiatus or hiatal hernia, a leading cause of acid reflux. This is where the stomach bulges up into your chest through an opening in your diaphragm. It’s not known exactly why this condition happens, but it is more typical in women, people who are overweight, and anyone over the age of 50.
Stress, genetics, whether you smoke and certain conditions (such as gastroparesis) have also all been linked to weakening of the LES valve and can all cause GORD symptoms.
Long-term acid reflux can cause complications. It can cause open sores in the oesophagus (oesophageal ulcers) as well as inflammation of the oesophagus (oesophagitis) or in the voice box, also known as your larynx (reflux laryngitis). Additionally, it can lead to tightening and narrowing of your oesophagus, a condition known as oesophageal stricture. These conditions are incredibly uncomfortable and can result in difficulty swallowing or blood loss.
GORD has also been linked to several other long-term conditions, including sleep deprivation and more serious gastrointestinal conditions.
Lower sleep quality is a side effect of long-term acid reflux, but many people who have GORD or acid reflux do not realise the connection. However, studies have shown that 60% of those who experience recurrent heartburn report that their sleep is affected, and more than 30% find it impacts their daytime functioning. This is because acid reflux symptoms can flare-up when you lay down, which is believed to be caused by several factors:
Naturally, this can cause people with GORD to have difficulty falling and staying asleep, as well as an overall reduced sleep quality. Research also suggests that GORD is linked to obstructive sleep apnoea (OSA), a sleep disorder where your airways are blocked and your breathing pauses whilst you sleep. The exact nature of the relationship is still uncertain, where GORD causes OSA or vice versa, but they definitely co-occur and can substantially impact your sleep quality.
An estimated 1 in 10 people in the UK with recurrent heartburn are believed to have Barrett’s oesophagus, a condition that causes abnormal oesophagus lining. Our oesophagus lining is similar to our skin in that it is multi-layered to protect it from injury or stomach acid. However, recurrent reflux gradually damages this lining. As the lining heals itself, the cells can be replaced by ones that resemble those in the stomach or the intestine. This is a process called metaplasia and causes the abnormal oesophagus lining present in those with Barrett’s oesophagus.
It is typically diagnosed by an endoscopy, which involves a tiny camera being passed down your oesophagus so a gastroenterologist can see what’s causing your symptoms. They may also take a biopsy, a small sample of cells, to rule out any other more serious causes.
In very rare cases of Barrett’s Oesophagus, cells in the lower oesophagus can become precancerous or abnormal - this is known as dysplasia. It means those who have Barrett’s need regular check-ups to monitor the cells in their oesophagus. The risk of cancer developing in Barrett’s patients is rare, with a prevalence of about 1 in 1000, which makes up less than 1% of oesophageal cancer cases. Oseophageal cancer is a lot more common in those who smoke or drink heavily, as both habits cause chronic irritation and inflammation in the upper part of the oesophagus.
If you have Barrett’s, you should not worry as any abnormal cell changes are rare. However, it's still important to have these regular check-ups to monitor your condition so that you can catch any abornamilities early.
Chronic acid reflux symptoms can impact people’s lives significantly. Fortunately, acid reflux and GORD symptoms can be lessened with lifestyle changes such as diet adjustments, weight loss and quitting smoking as well as over-the-counter medications like antacids. On prescription, the most effective treatment of GORD is a group of medicines known as PPIs (proton pump inhibitors). These medications work by reducing stomach acid, such as Esomeprazole (Nexium), Lansoprazole and Omeprazole. These are clinically proven to be the best course of treatment for long-term acid-reflux, as opposed to other prescription medications like H2 blockers (famotidine or cimetidine), and are available to buy here at euroClinix.
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