Gastroesophageal reflux disease
If you have repeated indigestion or acid reflux, you may be at risk of developing gastroesophageal reflux disease (GERD). This is a general term, used to describe acid reflux, either with or without inflammation of the gullet (esophagus). In it, the corrosive acid our stomach produces to break down food moves up to the esophagus (the food pipe), where the lining is much more sensitive and so can get damaged over time.
If you have GERD you typically experience heartburn, where you may feel a gnawing or burning pain in your central chest that moves up to the throat after eating. While you may have suffered indigestion before, symptoms with GERD may be much more easily triggered, more severe, and last longer after eating or drinking. It can also be the case that the usual treatments you have used before and which worked well may no longer be effective.
Regular acid reflux is more common in smokers, pregnant women, heavy drinkers, the overweight or obese and people aged between 35 and 65 years old.
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How is it diagnosed?
Many cases of GERD are diagnosed from the history and do not require any specialized tests. If these are required then it is diagnosed on endoscopy (or gastroscopy), a test where a small flexible camera tube is passed down your throat to view the esophagus and stomach, and possibly into the small bowel. You’re awake throughout but are given medication to help you relax. It is a very common procedure that is usually well-tolerated by most people who have it done.
Tissue samples or biopsies may be taken at the time, and tested for bacteria (a germ) called H. pylori, which can increase acid production. The team will also look for any damage to the lining or stomach ulcers.
Your doctor may organize an endoscopy or refer you to a specialist team who then arrange it.
What puts me at risk of GERD?
GERD has the same risk factors as for acid reflux and heartburn, including obesity, pregnancy, alcohol, smoking, spicy or oily foods, large meals, and caffeinated or fizzy drinks, or if you have a hiatus hernia.
GERD has a tendency to run in families, so if this is the case for you, you should take care to address any diet or lifestyle factors that can prevent it, and seek help early if symptoms develop.
Certain drugs may affect the proper functioning of the esophagus to neutralize stomach acid, such as tricyclic antidepressants like amitriptyline, or antipsychotics. Other drugs can increase acid production, like ibuprofen, naproxen, aspirin, or steroid tablets, if taken for more than a short time.
Neurological conditions such as diabetic neuropathy from uncontrolled diabetes mellitus, Parkinson’s disease, or a skin condition called systemic sclerosis can put you at risk.
Pharmacist recommended products
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Healthwords Pharmacist top tips
We have shortlisted a range of treatments that you can try in the short term.
Gaviscon Liquid is a good first option, as it can provide quick relief and does not interact with most medicines. As an antacid, it works to neutralize acidity, which soothes the upper gastric area quickly, and it forms a protective coating to prevent further acid reflux throughout the day. Gaviscon Advance tablets can also be helpful.
Low-dose proton pump inhibitors are available to buy, such as esomeprazole as in Nexium 24HR, or H2-receptor antagonists, such as Pepcid. These work in a different way to reduce the amount of acid produced – they don’t have an immediate effect but once working, they provide longer-lasting relief. Nexium 24HR can provide up to 24 hours relief plus protection for the gut lining. Gaviscon Advance or other alginate antacids can be used alongside these acid suppression medications.
If there is no improvement, or the constant need to neutralize acid symptoms remains, then speak to your doctor.
When should I see my doctor?
If acid reflux treatments from your pharmacist or doctor have not helped after a couple of months, and your doctor has either ruled out or treated the bacteria H. pylori, you should book an appointment to see them again so they can review your symptoms and consider if you need further tests like an endoscopy.
You should book an urgent appointment if you have difficulty swallowing or a sensation of something blocking the windpipe. Your doctor would also want to see you urgently if you have any sign of bleeding from the gut lining, including vomiting blood or a brown substance that looks like ground coffee, if you have black stools, severe abdominal pain or if you are losing weight for no obvious reason.
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