Reflux occurs when the valve between the oesophagus and the stomach doesn’t function properly, allowing stomach fluid containing variable acid to escape into the oesophagus. This may cause discomfort, heartburn and a sense of fluid rising behind the breastbone (regurgitation).
Most reflux patients are well treated by medication. Many patients choose not to continue with long term drug treatment in light of the possible link between long term use, osteoporosis, gastric cancer and increased bone fracture rates, amongst others.
A proportion (20-30%) of patients develop breakthrough symptoms despite maximal medical therapy and are considered to have failed medical management.
- Stomach fluid regurgitation (without necessarily vomiting) often into the throat
- Sore throat
- Chest pain
- Pulmonary inhalation
- Nocturnal sleep disturbance, sitting up to sleep
- Occasional choking food jamming with swallowing
- Voice trouble
Any change in heartburn or food sticking on swallowing, or pain on swallowing should be investigated quickly. These patients are 'fast tracked' to endoscopy to exclude development of cancer.Reflux Medicine Failure
Often as the medication ‘wears out’ patients need to increase their doses, which often incompletely help.
Reflux of vomit can occur at night and sleep may be disturbed.
A chest ache can often occur, raising heart concerns. Typically, the chest ache will occur at the same time as heartburn occurred previously.
Heartburn and regurgitation may persist. There may also be difficulty or pain on swallowing and food may stick. It is important to quickly check these two problems as alternatively the cause may be cancer.Reflux Related Cough and the Throat
Airway problems can occur with reflux disease.
- Weak voice
- Throat soreness / dry throat / 'lumpy' throat
- Throat clearing / mucous throat
- Occasional inhalation of stomach contents (aspiration) particularly at night or when lying down
- Chest infections
This condition usually responds poorly to medication, even in high doses. It is frequently caused by substance other than acid (such as bile, gas or peptic juices). More frequently double dose medication and occasionally surgery may be of benefit. If medication has not helped after 6-8 weeks it should be discontinued.
Surgery is strongly indicated if there is a history of aspiration and choking as it may cause pneumonia and lung disease.Alarm symptoms such as food sticking, weight loss, anaemia or pain when swallowing require urgent investigation.
For information on cough, visit the International Society for the Study of Cough (ISSC) page: http://www.issc.info/cough.html Reflux and Singers
Singers have a special problem due to the pressure placed on the diaphragm during singing. Reflux can occur just by straining. It can cause the voice to be damaged.
Reflux and the Lung
Increasing shortness of breath and chest infections are being seen with small amounts of reflux contaminating the lung. This can be very hard to diagnose and requires extensive testing. Use of Proton Pump Inhibitor (PPI) medication for reflux is associated with more chest infections as reduced acid reflux fluid contains more bacteria.