GERD/Acidity
Management of acid reflux and heartburn that persist, recur frequently or affect daily life
What is GERD/Acidity?
A ring of muscle sits where the food pipe joins the stomach and is meant to stay shut except when something is passing through it. When that ring slackens, or when part of the stomach has slid upwards through the gap in the diaphragm, the contents of the stomach can travel back the wrong way.
The stomach lining is built to sit in acid all day. The lining of the food pipe is not, so the same fluid that is harmless in one place inflames the other. That single fact explains the pattern: worse lying flat, worse after a large or late meal, worse with anything that loosens the ring further.
It is a mechanical fault with a chemical consequence. Medication answers the chemistry and leaves the mechanics untouched, and that is the reason most people settle quickly on tablets and start over within weeks of stopping them.
What you might notice
- Burning behind the breastbone
- Food or drink that sticks on the way down
- Undigested food coming back up
- Gnawing pain in the upper abdomen
- Feeling full after a few mouthfuls
How it is diagnosed
For most people the story is enough to act on, and a few weeks of treatment is started on that basis. How well it answers is itself part of the diagnosis.
A direct look at the lining is added when the trouble has run for months, when solids have started to catch on the way down, or when there is weight loss or a low haemoglobin. It shows how inflamed the lower food pipe is, how far the join has been pulled up into the chest, and whether the lining down there has changed to a more intestinal type, which carries its own schedule of rechecks.
Before any operation, the pressure along the food pipe is measured and acid is recorded over a day. That confirms the acid and the trouble arrive together, and that the muscle can still push a swallow along.
Recovery
On medication the lining heals over four to eight weeks, and comfort usually returns well before that. The dose is then stepped down to the lowest that holds.
After an operation the first fortnight is spent on soft food, because the repair is swollen and swallowing feels tight. That tightness eases as the swelling goes. Wind is harder to bring up for the first few months, so fizzy drinks and large meals are uncomfortable, and most people eat smaller amounts more often at first.
Office work is usually possible after a week or so with keyhole ports, and heavy lifting is left for six weeks so the repair is not strained while it knits.
If it is left untreated
Mild, occasional trouble that answers to a change in meal timing can be left alone and reviewed. Plenty of people manage it that way for years.
Sustained exposure is different. Repeated acid injury inflames the lower food pipe, and healing inflammation scars, so the passage narrows and food begins to hold up. Acid reaching the throat at night can also inflame the voice box and set off wheeze.
The change that matters most is quiet. In some people the lining at the lower end swaps to a type that tolerates acid better, and that new lining carries a small but real risk of turning cancerous over decades. It causes nothing on its own, and it is found only by looking.
Questions about GERD/Acidity
Do I have to stay on acid tablets for life?
Not necessarily. Many people take a full-strength course for eight weeks, then step down to the lowest dose that holds them, or to taking one only when needed. What decides it is what the lining looked like at endoscopy and how quickly things return when you stop. If severe oesophagitis was seen, long-term treatment is usually advised, because the aim is to keep the lining healed and not simply to keep you comfortable.
How do I know whether I need surgery?
Surgery is considered when reflux is proven on endoscopy or on a pH study and returns every time a full dose of medication is stopped, or when a large hiatus hernia means the valve cannot work whatever the acid is doing. It is also an option for someone who does not want to take tablets for the next forty years. Before it is booked, manometry checks that the food pipe still pushes properly, since a wrap added to a weak food pipe causes trouble swallowing.
Will changing what I eat be enough?
For a lot of people it helps a great deal. The measures with the best support are losing weight if you are carrying extra, leaving three hours between the last meal and bed, and raising the head end of the bed instead of adding pillows. Cutting out specific foods works only if you have noticed that particular food setting it off. None of this heals an inflamed lining on its own, so it usually sits alongside treatment instead of replacing it.
Other gastroenterology treatments
Diagnosis and treatment of inflammation of the stomach lining
Day CareTreatment of ulcers in the stomach or upper small intestine and their underlying causes
Day CareTalk to a care coordinator about GERD/Acidity
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one