Reflux Causes and Treatment

The esophagus runs from the throat to the stomach behind your chest. At its lower end, it passes through a sheet of muscle (diaphragm) which separates the chest from the abdomen. At the point where it passes through the diaphragm, there is a muscle ring which opens when you swallow food but remains closed at other times to prevent the concentrated hydrochloric acid in the stomach from coming back up (refluxing) into the esophagus when lying down or bending over.

The cells lining the inside of the stomach are acid-resistant, but those lining the esophagus are not. If acid (along with food and other digestive juices) is able to flow back up into the esophagus, the acid will attack the unprotected cells and can cause inflammation, ulceration, pain and scarring. This is known as GERD, or reflux gastroesophageal reflux disease.

Some babies are unlucky enough to have a defect or temporary weakness in the muscle ring at the bottom of the esophagus. The reflux of acid into the esophagus causes considerable pain to the infant. Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. This is usually in the form of a mixture which is given after every feed. More sophisticated treatments are available for the intractable cases. It is important that the baby is fed in an upright position and is not allowed to lie down flat after the feed.

In adults, factors such as obesity, smoking, overeating, a hiatus hernia, rapid eating, alcohol, stress and anxiety, and poor posture may cause the excessive production of acid in the stomach and/or slackness in the muscle ring. The patient experiences a burning sensation behind the breast bone, a bitter taste on the back of the tongue and burping as gas escapes easily from the stomach. It is often worse at night after a large meal when the patient is lying down, as it is then easier for the acid to flow up out of the stomach.

If the attacks of acid reflux are intermittent and mild, the lower end of the esophagus can recover between each episode, but if the attacks are regular or constant, the pain will become more severe, and significant damage may occur to the area. If ulcers form, they may erode down to a vein or artery, and severe bleeding may occur that in extreme cases may be life-threatening. The other main complication is scarring and narrowing of the lower end of the esophagus to the point where it may be difficult, or even impossible, to swallow food. Long before these advance stages, most patients have sought medical assistance for the problem.

When reflux gastroesophageal reflux disease is suspected, it will be proved by either gastroscopy, in which a flexible tube is passed down into the stomach, and through which a doctor can see exactly what is happening; or by a barium meal, in which a special fluid is swallowed, and its passage into the stomach (and sometimes its reflux back up into the esophagus) can be followed by a series of X-rays.

Treatment will involve the appropriate advice with regard to losing weight, propping up the head of the bed, having the main meal in the middle of the day, avoiding bending and heavy lifting, stopping smoking and reducing alcohol (nicotine and alcohol relax the muscle ring). Medication can be given to reduce the acid concentration in the stomach and to act as a foam that floats on the stomach acid to protect the lower end of the esophagus. Further treatment will involve the use of medication to help empty the stomach, and reduce acid production.

Only in severe, resistant cases is it necessary to resort to quite major surgery to treat the problem. The majority of patients can be controlled if they follow a doctor's advice and use the appropriate medication.

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