Acid Reflux | Heartburn

What is Heartburn/Acid Reflux?

Acid reflux, also known as heartburn or just reflux, occurs when stomach acid travels up the oesophagus towards the mouth. This results in a burning sensation in the chest and a variety of other symptoms. If heartburn occurs regularly, it may be classed as gastroesophageal reflux disease (GORD or GERD). GORD is very common with an estimated 10-15% of Australians suffering from the condition.

Symptoms of Reflux

The major identifying symptoms for acid reflux are: 

• The uncomfortable burning sensation radiating up the chest toward the throat causing chest pain.
• Regurgitation - acid from the stomach can cause a sour/bitter taste in the mouth.

Severe cases of reflux are often mistaken for a heart attack or vice versa, as chest pain can occur in the oesophagus behind the heart. For this reason, it is important that if you are experiencing severe chest pain that you seek emergency medical advice to rule out heart problems.

Minor identifying symptoms for heartburn can be:

• Bad breath
• Nausea
• Hoarseness - particularly after lying down
• A persistent cough that worsens around morning and meals

Long term Gastroesophageal reflux disease (GERD) is associated with severe complications. While the stomach is built to tolerate acid, the oesophagus is not. As such, the problems are often related to the stomach acid damaging the lining of the oesophagus. This type of damage can lead to:

• Barrett’s oesophagus - a change in the oesophagus cells due to damage
• Oesophagitis - the inflammation of the oesophagus
• Oesophageal ulcers - painful wounds in the oesophagus

What Causes Heartburn?

Heartburn can result from a variety of factors. In the body, there is a muscle that opens and closes the space between the stomach and oesophagus, called the oesophageal sphincter. The failure of this muscle in the body allows for stomach acid to escape the stomach up into the oesophagus. This is the major reason for symptoms of acid reflux.

Lifestyle

Dietary choices are one of the most common triggers for heartburn. These include:

• Drinks containing caffeine
• Large meals overfilling the stomach
• Alcohol
• Fatty foods
• Spicy foods
• Carbonated drinks (soft drinks)
• Highly acidic foods such as citrus fruits and tomatoes.

Other lifestyle factors that can cause reflux include smoking, stress, and being overweight or obese.

Medical conditions

Conditions that delay gastric emptying or the condition known as hiatus hernia, where the stomach pushes up into the chest, are well-known causes of GORD symptoms.

Medications

Regularly taking medicines that affect the stomach and acidity such as anti-inflammatory drugs and effervescent tablets can result in GORD.

Pregnancy GORD

During the first trimester, the stomach takes longer to empty in order to absorb more nutrients which can result in pregnancy-related GORD. Also as the baby grows in the third trimester, it can push up the stomach, also resulting in acid reflux.

Acid Reflux Treatments

There are many different treatment options for oesophageal reflux disease (GORD). The first option that people should try to manage and prevent their heartburn is lifestyle changes. Only after these changes are made should people try medication for reflux.

Lifestyle Changes for Heartburn Relief

Here is a list of changes that can be made to improve reflux and quality of life:

• Avoid foods that give you reflux - these vary for each person, it’s best to make a list!
• Sleep on your left side - this moves stomach acid away from the oesophagus
• Reduce or quit smoking
• Attempt to lose weight if you are overweight or obese
• Reduce drink triggers - alcohol, soft drink, and coffee are all known triggers for reflux
• Eat smaller meals - change large meals to smaller more frequent meals
• Avoid food close to sleeping - don’t eat 3-4 hours before sleeping to reduce the amount of acid in the stomach overnight

Some of these changes are difficult to make all in one go so it is recommended that you keep a record of what triggers your heartburn and focus on avoiding these triggers first before tackling more difficult changes like weight loss. 

Antacids

Antacids are a substance that neutralises stomach acid. These treatments come in liquids or chewable tablets which coat the affected areas in the oesophagus, neutralising the acid as it moves toward the stomach. They generally work instantly to improve the burning sensation associated with the condition.

These medicines often also contain other ingredients that sit on top of the stomach acid to create a barrier to the acid entering the oesophagus.

These medicines are generally fairly well tolerated by most people but can cause the urge to burp, constipation or diarrhoea (depending on formulation).

Heartburn Tablets

The first tablet treatment for acid reflux is best suited to those who experience reflux once or twice weekly on average. They belong to the medicine class known as H2 receptor blockers. These drugs work by temporarily stopping one way the stomach produces acid, lowing the overall amount of stomach acid. They are taken once or twice daily and provide some relief within one hour.

The side effects of these treatments are closely related to heartburn symptoms and can be nausea, constipation, and diarrhoea. 

Begin Assessment

The second tablet treatment for acid reflux is best suited to those who experience reflux regularly more than twice a week. They belong to a class of drugs known as proton pump inhibitors or PPIs. PPIs work by stopping a mechanism that pumps acid into the stomach. This reduction of excess stomach acids results in reduced heartburn.

They are generally taken once daily and provide some relief within one hour but the full effects of these medicines can take up to a few days of continuous use.

The side effects of these treatments are closely related to heartburn symptoms and can be headaches, nausea, constipation, and diarrhoea.

Written by Clinical Pharmacist Tyson Wilkman