Gastroesophageal Reflux

Gastroesophageal reflux causes a burning sensation in the lower part of the oesophagus (the duct that transports food from the mouth to the stomach). Reflux occurs when gastric fluids (gastric acid and digestive enzymes) go back up in the oesophagus.

The role of the muscle (sphincter) that separates the oesophagus from the stomach is to keep the stomach's fluids from going back up the oesophagus. When this sphincter becomes relaxed, gastric secretions are able to go back up the oesophagus. While the stomach has a mucosal barrier designed to resist acid secretion, the oesophageal mucosa is more fragile and becomes easily irritated by contact with these secretions.

What are the symptoms of gastroesophageal reflux?

Symptoms may include:

• heartburn
• pain or discomfort in the stomach or the chest
• nausea
• cough
• hoarse voice.

What causes gastroesophageal reflux?

Certain medical conditions, such as pregnancy or hiatus hernia, make it easier for reflux to occur because they induce additional pressure on the stomach. Other elements can also cause or increase reflux such as stress or anxiety, as well as taking drugs that delay stomach emptying or that decrease the tonus of the lower oesophageal sphincter. Thus, they induce the return of food to the oesophagus. Also, other drugs may promote or aggravate reflux by irritating the oesophagus, such as anti-inflammatory drugs (eg.: ibuprofen). Talk to your pharmacist or doctor if you take drugs or herbal products.

Certain foods of lifestyle habits may also cause or worsen gastroesophageal reflux. Foods to avoid: alcohol and soft drinks; caffeine (chocolate, tea, coffee,etc.); mint; high-fat or spicy foods; citrus fruit (orange, grapefruit, etc.) and tomato juice. Lifestyle habits to modify: Stop smoking; Try to eat and drink more slowly; Eat smaller and well-balanced meals; Raise the head of your bed by 15 to 20 cm; Avoid very tight clothing; Do not lie down within 3 hours after a meal; Do not eat very cold or very hot foods; Avoid strenuous workouts of efforts after a meal; Try to lose those extra pounds; Try to reduce your stress level and to promote relaxation.

How is gastroesophageal reflux treated?

There different drugs used to treat reflux problems:

1. Antacids, which temporarily neutralize gastric acidity.
2. Drugs that speed up digestion, making food and gastric acids reach the intestine more rapidly.
3. Drugs that reduce acid production in the stomach.

Antacids and certain other drugs are available without a prescription, but other more potent drugs require medical supervision.

Each treatment should be tailored to the patient's needs, especially since there are numerous causes of reflux and people often react differently to medication. To maximize your treatment's efficacy, drugs should be taken in a specific manner and at specific times, even those available without a prescription. Do not hesitate to seek advice from your pharmacist: he is the most knowledgeable health professional when it comes to medication.

It is best to consult a doctor if:

• your symptoms impair your daily activities or occur more than two times a week;
• lifestyle modifications do not improve your symptoms;
• OTC drugs taken regularly for a maximum of 2 weeks did not relieve your symptoms.

You should seek medical attention immediately if:

• persistent or severe digestive problem, particularly first occurring after the age of 50;
• unexplained weight loss;
• chest pain spreading to the back, neck, jaw, shoulder, left arm (signs of a heart problem);
• pain or difficulty swallowing;
• choking or shortness of breath;
• persistent pain after meals and during the evening;
• severe or prolonged vomiting;
• black stools or vomiting blood;
• no more relief of pain when taking a drug that used to bring relief.

For more information:

Canadian Digestive Health Foundation

www.cdhf.ca