Reflux and Heartburn.
A burning discomfort behind the breastbone caused by stomach acid rising into the oesophagus. For many people, reflux is manageable with lifestyle changes and medication. For others, surgery offers a lasting solution.
Stomach acid rising where it should not.
Heartburn and reflux occur when the valve at the lower end of the oesophagus loses effectiveness, allowing stomach acid and contents to travel upwards. This valve, the lower oesophageal sphincter, normally relaxes to allow food into the stomach and closes to prevent backflow. When it does not function correctly, acid causes the characteristic burning sensation.
The condition is also known as gastro-oesophageal reflux disease (GORD) and ranges in severity from an occasional nuisance to a condition that significantly affects quality of life and, over time, may cause changes to the lining of the oesophagus.
Factors that contribute to reflux include:
- Weakening or dysfunction of the lower oesophageal sphincter
- Hiatus hernia, where part of the stomach pushes above the diaphragm
- Excess weight placing pressure on the abdomen
- Pregnancy
- Certain foods, including fatty or fried foods, chocolate, caffeine, alcohol and citrus
- Eating large meals or lying down soon after eating
- Smoking
Recognising reflux and GORD.
Heartburn is the most common symptom, but reflux can present in several ways.
- Burning sensation behind the breastbone (heartburn)
- Regurgitation of food or sour liquid into the mouth
- Bitter or sour taste in the mouth
- Chest pain
- Difficulty swallowing
- Chronic cough or throat clearing
- Oesophageal ulcers (sores in the lining of the food pipe)
- Aspiration pneumonia (in severe cases)
If you experience chest pain, persistent difficulty swallowing, or unintentional weight loss, seek medical assessment promptly.
How reflux is investigated.
Diagnosis is confirmed through targeted investigations chosen to answer specific clinical questions.
Gastroscopy
A camera is passed through the mouth into the upper gut to assess the oesophagus, stomach and duodenum. It can identify inflammation, ulcers, Barrett's oesophagus (a change in the lining of the food pipe caused by long-term reflux) and hiatus hernia.
Oesophageal manometry
Measures how well the muscles of the oesophagus are working, including the function of the lower oesophageal sphincter. Important before any anti-reflux surgery.
24-hour pH study
Monitors acid levels in the oesophagus over a full day and night. Confirms whether reflux is occurring, how frequently, and whether episodes correlate with symptoms.
Imaging
Chest X-ray or barium swallow may be used to assess anatomy and the position of a hiatus hernia.
Managing reflux: from lifestyle to surgery.
Treatment is tailored to the severity of your symptoms and the underlying cause. Not everyone with reflux requires surgery.
Lifestyle changes
Stopping smoking, maintaining a healthy weight, avoiding trigger foods (fatty or fried foods, chocolate, caffeine, alcohol, citrus, tomatoes), eating appropriate portion sizes, not lying down directly after meals and elevating the head of the bed at night.
Medication
Antacids neutralise gastric acid. H2-receptor blockers reduce acid production. Proton pump inhibitors (PPIs) are highly effective at suppressing acid. Prokinetic agents can help gastric emptying. Medication may manage symptoms without addressing the underlying cause.
Anti-reflux surgery (fundoplication)
Fundoplication strengthens the lower oesophageal sphincter by wrapping the upper part of the stomach around the junction with the oesophagus. Performed laparoscopically, it is the definitive surgical treatment for reflux not adequately controlled by medication, or when a hiatus hernia is contributing.
Anti-reflux surgery and hiatus hernia repair are performed within the Upper GI & Surgical Care pathway. The type of repair is guided by your symptoms, motility testing and anatomy. Before surgery, you complete the Meridian Foundation Program, our structured preparation phase covering health, nutrition, understanding and readiness.