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Heartburn, Reflux and Indigestion

What is heartburn?

Heartburn, reflux and indigestion are common symptoms that are associated with gastro-oesophageal reflux, which occurs when acid is regurgitated from the stomach to the oesophagus. Heartburn is the most common of these symptoms and it is usually described as a burning sensation or pain behind the chest bone and many people experience heartburn after eating. Other symptoms associated with reflux include flatulence (breaking wind), chest pain and belching and in some cases, symptoms including a dry cough, sore throat and wheezing may also be experienced.

What causes reflux?

The stomach is naturally acidic to prevent infection and there is mechanism (a small, circular muscle) in place to prevent acid from being regurgitated from the stomach and reflux occurs when this mechanism fails to work. If the muscle does not contract as it should, acid can reflux to the oesophagus and this contributes to inflammation of the oesophagus, known as oesophagitis.

Investigations for reflux

In most cases no tests are required to diagnose reflux because the symptoms are usually sufficient for doctors to reach an accurate diagnosis. However, in cases where the diagnosis is uncertain, tests may be required. Tests to evaluate reflux, pH and the function of the muscles in the oesophagus include a gastroscopy, pH test and oesophageal manometry. If a patient experiences symptoms such as sudden weight loss, difficulty swallowing or a loss of appetite, urgent tests may be ordered.

How is reflux treated?

In addition to medical treatments, lifestyle changes can also be highly beneficial; these may include a change in diet, changes in eating habits (for example avoiding eating late at night and cutting down on caffeine) and cutting down or quitting drinking and smoking. Medication, including antacids, is usually given to neutralise acids, but in more serious cases when medication is not sufficient, anti-reflux surgery may be required.

Swallowing problems

There are many possible reasons why you may experience difficulty with swallowing but in most cases the cause is benign. However, some swallowing problems are also symptomatic of oesophageal cancer and for this reason it is always important to investigate if you have problems with swallowing. Many cases of swallowing difficulties are associated with benign processes, which include:

  • spasms in the oesophagus or sphincter
  • problems with the sphincter at the end of the oesophagus
  • narrowing in the oesophagus (this is known as benign oesophageal stricture)

If you do experience problems with swallowing tests will be carried out to determine the cause. The most common test used in this scenario is a gastroscopy but other tests, including a barium X-ray and oesophageal motility tests may also be carried out.