Heartburn after a hefty portion of fish and chips or a triple-chili Thai dish is something most of us have experienced as a one-off. But for individuals with gastro-oesophageal reflux disease, heartburn can be an everyday thing - along with belching, involuntary regurgitation and sleepless nights.
When does reflux become cause for concern?
“When reflux persists daily for more than three months and is not responding to, or only partly responding to a prescribed antacid, that worries us,” said Upper GI Surgeon Dr Craig Taylor of Sydney’s OClinic.
“Chronic (ongoing) reflux can gradually cause damage and inflammation to the lining of the oesophagus, which can give rise to some serious issues: pain on swallowing or difficulty swallowing, or anaemia from chronic blood loss, where a small blood volume is lost over a long time. The third worry is cancerous change in the cells of the oesophagus.”
“There are four specific diagnostic tools for reflux,” Taylor said. “Depending on patient history, we don’t necessarily use all four.” The first is an upper endoscopy; a long flexible tube with a tiny camera goes down through the mouth, examining the oesophagus, stomach and the first component of the small intestine.
“The second is a barium swallow, an X-ray that outlines the oesophagus with oral contrast, and the third, a pH manometry; a probe is inserted nose-down into the oesophagus, giving a snapshot of what’s going on there over 24-hours.
“The fourth is a nuclear medicine test, a reflux isotope scan, for diagnosing less typical [cases]. It involves drinking fluid [containing] harmless radioactivity; a camera measures where that fluid goes, seeing if reflux is starting to cause aspiration, that is, breathing the fluid into the lungs.”
Patients are first told to avoid diet and lifestyle habits that exacerbate symptoms: smoking, alcohol, caffeine, spicy and fatty foods. “We also want them to avoid eating late at night because we don’t want to stimulate acid production before bed,” Taylor said. “Lying down can exacerbate reflux because there’s no longer gravity to prevent acid draining down away from the oesophagus.”
Propping up the bedhead can be helpful, he said.
Medication is the next line of treatment, the goal being “to reduce acid production and the amount of fluid in the stomach, with medication that turns off the stomach’s acid pump.”
When to resort to surgery
Failure to control reflux through medication makes a patient a suitable surgery candidate, Taylor said. “Or if there’s symptom-resolution with medication, but the patient doesn’t want to be medicated for long, for instance someone who is young,” surgery might be the best option.
“Fundoplication surgery involves making the valve at bottom of oesophagus work better,” Taylor explained. Performed via laparoscopy (keyhole surgery) under general anaesthetic, the one-hour surgery requires an overnight hospital stay.
“Improvement or resolution of symptoms occurs in almost 100 per cent of patients. There can be side effects of swallowing difficulties, bloating and [trapped gas], but newer techniques have reduced the risk of these.”
When to see your doctor
If you’re experiencing ongoing reflux, “insist on a referral for an anti-reflux surgeon from your GP. This doesn’t necessarily mean you’ll need surgery,” Taylor stressed. “It just means you’ll have access to the full range of treatment options, including medication, and that the surgeon can determine if and when surgery is necessary.”
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