Acid reflux, dyspepsia and dysphagia

Acid reflux occurs when stomach acid escapes back up into the oesophagus (food pipe). While the lining of the stomach is able to tolerate acid, the tender tissues of the lining of the oesophagus are not. This results in the symptoms of heartburn (burning pain behind the breastbone) and/or dyspepsia (indigestion). Dyspepsia is the pain in the middle of the upper abdomen that people often refer to as indigestion. Dyspepsia can be associated with a feeling of fullness or heaviness far sooner than you would normally expect from the size of meal you are eating, and nausea after eating. In mild cases, dyspepsia causes discomfort and belching, and in severe cases it can lead to regurgitating food into your oesophagus or vomiting.

It is estimated that as many as one in five people experience heartburn at least once a week, while one in ten people experience discomfort on a daily basis. This is mostly due to the high-fat diet and widespread obesity in western societies and is made worse by eating too much, too fast and opting for high-fat meals.

These symptoms are common but they should be investigated to make sure they are not a sign of something more serious. Acid reflux can also cause inflammation of the oesophagus (oesophagitis) that can, in some cases, lead to difficulties in swallowing (dysphagia). Stomach cancer is not common but the sudden onset of dyspepsia can be a sign of this disease, especially if you are over 55 and display other symptoms such as weight loss, vomiting, bloody stools or vomit, and increasing difficulties with swallowing. Dyspepsia may also be the first sign of a peptic ulcer in the stomach or the upper part of the small intestine.

 

What is GORD or GERD?

Occasional heartburn is common and nothing to worry about, but persistent heartburn is likely to be due to gastro-oesophageal reflux disease (GORD), which is caused by acid leaking out of the top of the stomach and into the oesophagus on a regular basis. It is due to weakness of the sphincter at the bottom of the oesophagus and is said to be made worse by smoking, eating large meals, and obesity.

GORD (known as GERD in the USA because they spell oesophagus 'esophagus') can also cause a sour or acidic taste at the back of the mouth, as stomach acid rises up the oesophagus, as well as difficulty in swallowing (see dysphagia below). Less commonly, GORD can cause an irritating persistent cough and wheezing, as well as sore throats and laryngitis. Persistent, untreated GORD can cause tooth decay, as acid from the stomach attacks the enamel of the teeth.

GORD is most common in the over-40 age group. People can sometimes mistake the painful sensations in the chest for heart problems, causing undue worry and distress, so it is always best to have heartburn symptoms checked out. Diagnosing and treating GORD is important, as longstanding acid irritation of the oesophagus can be linked to pre-malignant damage to the oesophagus (Barrett's oesophagus) or the development of strictures, causing dysphagia.

 

What is dysphagia?

Dysphagia means having difficulty swallowing, like something is stuck in the oesophagus as you swallow food or liquids. Dysphagia occurs in around a third of all people with GORD, which in this context is due to stomach acid scarring the lining of the oesophagus.

Dysphagia may occur in around a third of all people with GORD. If it occurs only very occasionally it is rarely serious. However, if you suddenly experience significant problems swallowing or infrequent dysphagia gets worse, prompt investigation is required. It may be that you have developed a stricture (a narrowing) in the oesophagus. This is often due to a benign cause but it can also be due to oesophageal cancer.

 

Investigating dyspepsia, GORD, or dysphagia

Any new or recurrent symptoms need to be investigated. At The Physicians' Clinic we employ several different approaches, but these usually involve blood tests and scans and many patients require an endoscopic procedure. Gastroscopy [Link to procedure] is straightforward and is performed as a day case with no overnight stay required. It provides extremely accurate information about the cause of your symptoms.

 

Treatment options for acid reflux

The most appropriate treatment depends on the exact cause of the symptoms. Many cases may require no specific treatment, but respond to lifestyle/dietary changes. Peptic ulcers are often caused by Helicobacter pylori infection and this can be treated effectively with a course of antibiotics and other drugs. Acid-lowering medications (such as proton pump inhibitors) can be effective in treating the symptoms of GORD as they reduce the damaging effects of acid on the oesophagus. More interventional approaches, including endoscopic treatment, or even surgery, can be necessary, but this is relatively rare.

The specialists at The Physicians' Clinic can discuss your symptoms with you and will be able to recommend timely and appropriate investigations and any treatment that might be necessary.