Acid reflux means that the acidic contents of the stomach rise to the oesophagus. Almost all people experience this occasionally, often briefly and without symptoms. In acid reflux, the stomach contents rising to the oesophagus repeatedly cause heartburn or inflammation of the oesophagus.
About 20% of people suffer from heartburn every week and about 10% every day.
This is a very common condition that often results in people using over-the-counter pharmacy products or seeking a medical consultation.
Symptoms of acid reflux
Heartburn is the most common symptom of acid reflux. It produces a burning or stinging sensation or pain in the upper abdomen or under the sternum. Acid reflux can also make the contents of the stomach rise to the oesophagus, throat or mouth. Some people experience hoarseness and a sore throat.
Difficulty or pain when swallowing is a less common symptom and requires more thorough examination.
Acid reflux often aggravates asthma symptoms and may predispose you to recurrent respiratory and sinus infections. If the stomach content rises to the mouth, tooth enamel may be damaged.
What causes acid reflux?
The lower oesophageal sphincter is a combination of several anatomical structures. It is an important part of the protection against acid reflux. If the pressure in the lower sphincter is reduced, the acidic stomach content often rises to the oesophagus.
Diaphragmatic hernia exposes the lower sphincter to a pressure drop and, thus, to acid reflux. Diaphragmatic hernia refers to a condition where the “channel” of the oesophagus through the diaphragm muscle is looser than usual.
Smoking, alcohol, coffee and certain foods, such as fatty food, chocolate and citrus juice, can cause heartburn. After a heavy meal, the stomach contents rise to the oesophagus more easily, especially in a lying position. Taking a nap after eating and having heavy meals before going to bed may predispose you to acid reflux.
Learn more: Quitting smoking (in Finnish)
Overweight also entails a significant predisposition to acid reflux as high body fat in the torso increases pressure in the stomach.
Some medications, such as painkillers, as well as stress and overexertion can aggravate heartburn.
How is acid reflux diagnosed?
We recommend seeking a medical consultation if you are suffering from recurring heartburn or alarming symptoms, such as chest pain, pain when swallowing, food blocking the oesophagus, bleeding or weight loss.
An interview with a general practitioner or a specialist in internal medicine and a clinical examination are key parts of the diagnostics. The diagnosis of acid reflux is based on the patient's symptoms, possible results of testing medicinal treatment, endoscopy and, if necessary, oesophageal pH test.
Testing medicinal treatment is part of the diagnostics: a two-week course of acid blockers is given, and if the symptoms improve, a diagnosis of acid reflux is likely.
Gastroscopy is recommended as a further examination of prolonged heartburn, especially if there are alarming symptoms. The procedure is performed by a surgeon specialising in gastroenterology or internal medicine.
Gastroscopy takes 5–10 minutes and shows the state of the oesophagus, stomach and duodenum. Usually, routine biopsies are taken from the lining of the duodenum to rule out coeliac disease and from the stomach lining to detect, for example, Helicobacter pylori. In addition, diaphragmatic hernia and possible oesophagitis can be diagnosed both visually and by biopsies. Oesophageal, gastric and duodenal ulcers and tumours can also be detected in endoscopy.
Barrett's mucosa can be found in the lower parts of the oesophagus, which is a benign condition but requires endoscopic monitoring and biopsies every three years or so.
What helps with heartburn and acid reflux?
Treatment of acid reflux is intended to prevent acidic stomach contents from rising to the oesophagus through changes in diet and lifestyle.
- Avoid food and substances that aggravate heartburn.
- Avoid heavy meals in the evenings and naps after meals.
- Night-time heartburn can be reduced by raising the head of the bed; place wooden blocks or a wedge-shaped item, such as a pillow, under the bed legs.
- For overweight people, weight loss is a key part of the treatment in addition to the aforementioned means.
- Stress and overexertion must also be taken into account when adjusting your lifestyle.
- For mild and temporary heartburn, medicines obtained from pharmacies without a prescription are sufficient.
- Medication prescribed on the basis of an assessment made by a physician with an active substance that blocks the production of gastric acid is needed to control more difficult symptoms. This type of medication can often alleviate heartburn in a couple of days. As prescribed by your doctor, heartburn medicine can be used regularly, for a few weeks when the symptoms get worse, or only when necessary, depending on the symptoms.
Repeated rise of acidic stomach contents, if untreated, may damage the lining of the lower oesophagus and cause oesophagitis. Prolonged acid reflux may also cause permanent oesophageal mucosal cell changes.
When does acid reflux require surgery?
Surgery is considered if the acid reflux is severe and there is a constant need for medication. In addition, asthma exacerbation associated with acid reflux is a sufficient reason to consider surgery.
The need for surgical treatment is assessed by a specialist in abdominal surgery with experience in the treatment of acid reflux, who will review the benefits and risks of surgery with the patient.
Old age and severe underlying diseases increase the risks associated with surgery, in which case heartburn is usually treated with medicine. Excessive overweight reduces the chances of performing surgery.
The operation involves correcting the diaphragmatic hernia and constructing the upper part of the stomach into a back valve around the lower part of the oesophagus to prevent acidic stomach contents from entering the oesophagus. The operation prevents burping, at least partially, and therefore some of the patients may experience flatulence after the procedure.
The surgery usually yields good results, but over the years, some valves stretch and the heartburn may return.
Remember these 7 things about acid reflux
- Heartburn is most often a chronic condition where the severity of the symptoms fluctuates.
- Most people find help in dietary and lifestyle changes, quitting smoking and losing weight.
- Mild and temporary symptoms can be alleviated with over-the-counter medicines purchased from a pharmacy.
- You should see a doctor if you have recurring heartburn problems and/or need regular medication.
- Gastroscopy may be performed to examine prolonged heartburn.
- Urgent gastroscopy is necessary if you suffer from pain when swallowing, food blocking your oesophagus, chest pain, gastrointestinal haemorrhage or weight loss.
- Medication helps most people who have heartburn problems.
- Surgical treatment is considered if the patient suffers from persistent acid reflux and needs regular medication.