Print this page

Peptest

What is reflux?

Simply put, Reflux is the contents of the stomach (Acid, Pepsin & Bile) escaping through a valve at the top of the stomach and up into the oesophagus and even into the airways causing a variety of symptoms.

There are many causes including poor diet, too much alcohol, use of certain pain killing drugs, stress and general lifestyle.

Diagram

Gastroesophageal Reflux Disease (GORD)

Gastroesophageal reflux disease is one of the most prevalent chronic diseases in the world with an estimated 4 million people in the UK suffering from daily reflux episodes. It is characterised by the symptoms of heartburn and regurgitation.

GORD is caused by reflux of the gastric contents into the oesophagus. In most sufferers this is due to a relaxation of the lower oesophageal sphincter (LOS) that opens to allow food and liquids to pass into the stomach, and closes to prevent food and stomach acid from flowing back into the oesophagus. This relaxation of the LOS happens a few times each day in people without GORD. It's not known why it happens more frequently in GORD sufferers. The oesophagus lining isn't the same as that of the stomach and isn't able to cope with pepsin, acid and other stomach enzymes and hence it is easily injured. It is this reflux of pepsin and acid into the oesophagus that produces the symptoms and potential damage to the oesophagus.


LaryngoPharyngeal Reflux LPR (Airway Reflux)

During gastroesophageal reflux, the contents of the stomach may reflux all the way up the oesophagus, beyond the upper oesophageal sphincter (a ring of muscle at the top of the oesophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), contact of delicate laryngeal and respiratory tissues with corrosive gastric juice produces symptoms such as hoarseness, voice disorders, chronic coughing and throat clearing. Around 35% of the US population exhibit LPR symptoms while 50% of all voice disorder or chronic cough patients will be diagnosed with LPR.

What are the symptoms?

Gastroesophageal Reflux Disease or GORD is known for causing heartburn but when it reaches the throat and beyond (Airway Reflux or Laryngopharyngeal Reflux (LPR) it can cause a variety of symptoms.

Cause of LPR

The cause of LPR is poorly understood. It is thought that an abnormality of the upper or laryngeal sphincter (UOS) of the oesophagus malfunctions, allowing a small amount of stomach secretions to touch the larynx and pharynx. The reflux has devastating effects because the larynx and pharynx have no defence mechanisms to these substances. It is known that refluxing as little as two times per week can have significant effects on the voice. The long-term consequences of LPR include severe degradation of the voice, and even larynx cancer.

 

 

Supine and Upright reflux

Based upon pH-monitoring data, most patients with airway reflux (LPR) are upright (daytime) refluxers; however when an LPR patient has supine (nocturnal) reflux, tissue damage tends to be more severe. When it comes to initiation, nighttime reflux is far more injurious than daytime reflux. For many LPR patients, regardless of dose of acid-suppressive medications, late-night eating must be curtailed before effective treatment can begin.

How dangerous is Reflux?

Without early diagnosis and treatment reflux can in time lead to damage to the oesophagus (erosive oesophagitis) and to a pre-cancerous condition called Barrett’s Oesophagus. In certain cases it may also be linked to cancer of the Larynx.

Lower quality of life

In addition to the health risks, GORD symptoms can impact a person’s health and happiness.

A majority of GORD patients report that their quality of life has been compromised because of problems with food, drink, and sleep, as well as social and physical limitations. Quality of life for GORD patients is similar to heart-attack patients, and in some cases, even lower than those for cancer and diabetes.

 

 

Treatments


Diagram

 

Medication

There are a number of over the counter remedies that alleviate the minor symptoms of acid reflux but for more chronic sufferers, a GP can prescribe three types of medication for reflux.

Antacids

Antacids are drugs that neutralize stomach acid. They provide immediate, short term relief but are not generally effective in preventing chronic reflux. Common antacids include: Gaviscon®, Tums®, Alka-Seltzer®, and Rennie®.

Gaviscon Advance

Gaviscon Advance forms a physical ‘raft’ over the stomach contents which helps prevent gastric contents (including pepsin and acid) coming back up into the oesophagus. As such it is effective at treating the classic symptoms of reflux.

H2 Blockers

H2 (histamine) inhibitors act on the stomach's acid producing cells. H2 blockers prevent histamine from stimulating the cells, reducing the amount of acid each cell produces. H2 blockers have limited effectiveness as they only work for 8-12 hours, so do not prevent acid production and reflux throughout the day. Common H2 blockers include: Tagamet®, Zantac®, Pepcid® and Axid®.

Proton Pump Inhibitors

The most commonly prescribed medications for reflux are Proton Pump Inhibitors (PPIs) which work by blocking the site of acid production in the stomach cells – the proton pump. Proton Pump Inhibitors are more effective at suppressing acid secretion and work over a longer period than H2 blockers. It is also important to note that each of these drugs requires lifetime therapy; symptoms will return shortly after a patient discontinues their use.

Recent press coverage has suggested that whilst PPIs may be effective, they are not as safe as originally assumed and that long-term use may be associated with a variety of potentially serious adverse effects.

Surgery

Nissen Fundoplication. The procedure involves a section of stomach being wrapped around the oesophagus to mimic the function of the Lower Oesophageal Sphincter (LOS). As a result of the complexity of the procedure and unreliable results, it tends to be offered only to those with debilitating symptoms of acid reflux. 

New Linx™ Reflux Surgery

A new, exciting development in the surgical treatment for GERD/GORD. The Linx™ System is a small, flexible band of interlinked titanium beads with magnetic cores which is wrapped around the weak LOS to reinforce the sphincter, preventing reflux immediately with no change to stomach anatomy.

Both procedures are performed laparoscopically through the abdominal wall.

Based upon pH-monitoring data, most patients with airway reflux (LPR) are upright (daytime) refluxers; however when an LPR patient has supine (nocturnal) reflux, tissue damage tends to be more severe. When it comes to initiation, nighttime reflux is far more injurious than daytime reflux. For many LPR patients, regardless of dose of acid-suppressive medications, late-night eating must be curtailed before effective treatment can begin.

 

Lifestyle and Reflux

Many people successfully manage their Reflux symptoms with changes in diet and lifestyle. Once you have a positive diagnosis of reflux we would advise that you try some of the suggestions listed below to improve your symptoms:

  • Try to eat your last meal of the day at least 3 hours before retiring to bed.
  • Try eating smaller portions at regular intervals rather than fewer larger meals.
  • Eat slowly.
  • Wear loose-fitting clothes.
  • Avoid foods and drinks that are known to trigger heartburn symptoms, these include: onions, peppermint, chocolate, caffeinated drinks, citrus fruits and juices, tomatoes and high-fat foods.
  • Keep a symptom diary and record when your symptoms appear and what specific meals and activities this relates to.
  • Maintain a healthy weight.
  • Stop smoking.
  • Avoid alcohol.
  • Take regular gentle exercise such as walking. Exercise can trigger Reflux symptoms if this is a problem wait at least two hours after a meal before exercising.
  • Drink plenty of water. Some people recommend alkaline water which is said to denature Pepsin.
  • Raise the head of your bed so that your head and chest are higher than your feet.
  • Sleep on your left side, reflux happens less often in this position.