Gastro-oesophageal Reflux: Heartburn Explained

Gastro-oesophageal reflux

Gastro-oesophageal reflux is the medical name for what most of us refer to as heartburn, although it can also cause other symptoms besides the burning pain in the centre of your chest.

It is the most common cause of indigestion and will affect most people at some stage in their lives. Usually the symptoms are relatively trivial, but they are often long standing and can become quite disabling. The most common symptom produced by gastro-oesophageal reflux is the burning sensation that can radiate into the throat. It often comes and goes and can be brought on by certain foods, by stooping or by lying flat in bed at night.

Sometimes gastro-oesophageal reflux is associated with difficulty swallowing or painful swallowing. Occasionally gastro-oesophageal reflux can cause regurgitation of food into the mouth and a feeling of nausea. Usually, a change in lifestyle is all that is required to ease symptoms, but there are a number of useful antacid treatments available from the chemist, and, for more severe cases, there are a number of highly effective drugs now available on prescription.

It is important to point out at the outset that, in the vast majority of cases, gastro-oesophageal reflux is not serious and does not mean you have or are likely to develop another illness such as cancer. However, it is important to distinguish heartburn from another common cause of central chest pain, namely angina, especially in men or women over 50.

Angina pain is usually brought on by exertion, such as brisk walking uphill and is quickly relieved by rest, unlike reflux, so it is usually not difficult to tell one from the other. If you have pain that you think might be angina, you should consult your doctor without delay.

What are the causes?

The glands in the stomach produce a cocktail of hydrochloric acid and pepsin (an enzyme) to aid in the initial breakdown and subsequent digestion of food. In addition, this, cocktail acts as an initial step destroying any bacteria that are present in food. The stomach protects itself, from the dangerous effects of the acid/pepsin mixture with a lining of special mucus. When the mixture leaves the stomach on its way into the intestine (the first part of which is called the duodenum), the acid is neutralised by alkaline juice from the pancreas.

The oesophagus is rather sensitive to acid, but in normal circumstances this is not important because the junction between the stomach and oesophagus held tightly closed by a valve (the gastro-oesophageal valve), thus preventing any of the stomach contents from passing back up the oesophagus. Occasionally however, the gastro-oesophageal valve is not completely tight and so allows acid and pepsin back up into the oesophagus, causing the symptoms outlined previously.