Acid Reflux and the wide range of symptoms, and what can be done.


Hi everybody! It’s Dr Renée and I’m
back with my VLOG. This week i’m going to talk to you about acid reflux. And it
seems to me to be a massive problem which is why I’m covering it. I see
people with reflux in almost every session that I work as a GP. So what is
it? We all know that we have acid in our stomach that our body uses to digest
food, and that’s exactly where it should stay; in the stomach. But unfortunately in
acid reflux it doesn’t. It comes through the sphincter or the elastic band which
is the joint between your food pipe or oesophagus and your stomach. And it moves up into the oesophagus and there it can cause damage because it’s in the wrong
place. So depending on how often that happens to you and how much acid comes
through and also how far it travels up the oesophagus, will dictate whether or
not you have symptoms and how severe they are. If it happens more than
twice a week, by definition you have acid reflux disease or gastro oesophageal
reflux disease. Otherwise known as GORD. In America they call it GERD because they don’t spell oesophagus properly! Just so if you’re looking at this on the
internet you know the difference is: GORD and GERD are the same thing. So who gets
it? Well the stats vary dramatically, so we
don’t absolutely know, but estimates put it about one in five people so 20%.
That’s a lot of people if you think about it. And of course some people will
be coping with it treating themselves and therefore not coming forward and not
being in the stats and some people won’t have symptoms, but that doesn’t mean
there isn’t damage being done. So they aren’t coming forward either. So what are
the causes? So hiatus hernia can cause reflux and that’s where a section of the
stomach slides through that elastic band, that sphincter, into the oesophagus. Being
overweight puts lots of abdominal pressure on your stomach and that can
cause it too. Being pregnant, for the same reason, you’ve got a baby in your tummy
that’s pushing up on my stomach. And this is a really common pregnancy problem and
quite often later in the pregnancy when the baby’s getting bigger.
Lying down immediately after eating or having a really large meal can be a
problem. Or snacking before bedtime; same kind of theory, that you’re lying down
after eating and your stomach’s going to work while you’re sleeping. And then
NSAIDs, non-steroidal anti-inflammatory drugs or painkillers, that you and I
know as ibuprofen, aspirin, diclofenac, naproxen, to give you a few. These can
really irritate the stomach and in actual fact are the largest cause of
stomach bleeds in the world, so that could be a serious problem. And now, to
ruin life completely, there are seven foods and obviously they are foods that
we really like in the main! So I’m about to tell you about all the nice things
that really irritate the stomach and these seven food groups are a direct irritant to the stomach. So if you’re prone to acid reflux or gastritis then
these will make it worse. So those are: Tomatoes, spicy food, chocolate (yup chocolate). Peppermint, and I know you’re saying
‘what peppermint’s really good for the stomach?’
Well actually it’s really good for the colon but it’s not so good for the
stomach where it’s a direct irritant. Caffeine, so all of those coffees and
teas I’m afraid need to go if you’re suffering. Alcohol, without question is a
real problem, and smoking. So those are the seven food groups you need to think
about and the causes of acid reflux if you’re thinking about trying to cut
things out and make yourself better. So what are the symptoms? Well these are
really varied and some people have some of them. some have none, and some have every single one! So it’s really difficult sometimes to differentiate what’s going
on. And some of the symptoms are not obvious as you’ll see. So having
heartburn is probably the most common one when you have a burning sensation up
the middle of your chest or behind your sternum. Having difficulty swallowing or
a lump in the throat is really quite common. And talking at the throat you can
actually get a hoarse voice from reflux. So that would always mean investigating.
Having asthma like symptoms, so wheezing or coughing. But on the subject
the cough, if you’ve had an irritating little cough for months on end
nobody’s gets into the bottom of it, it may well be reflux. And some treatment
might send the cough away. Having a sore throat all of the time.
Chest pain. Tooth decay; so where the acid is coming up and eroding the back of
your teeth. Bad breath. Regurgitation. Nausea. Burping. Hiccups that you can’t get rid of. Shortness of breath. All of these things, as odd as they may sound, can be
down to acid reflux, and will need treatment. So what’s the risk of not
treating acid reflux? well oesophagitis is one of the main
risks, where the acid just eats away at your food pipe or oesophagus and actually
causes erosions (or little holes). Or you get ulcers and ulcers bleed and they
can actually be fatal if they they really do bleed. So both of those things
are quite serious obviously. Barrett’s oesophagus is a risk, and we think that
10% of people (so one in ten) who have regular acid reflux, get Barrett’s
oesophagus. And this is when the cells at the bottom of the oesophagus change into
a different type of cell type. And that’s a problem, it’s a precancerous situation,
so you can go on to get oesophageal cancer if you’ve got Barrett’s esophagus.
So that’s really serious. And then you can get strictures, which is where the
oesophagus actually gets webs of tissue connecting one side to the other. And
then you won’t be able to swallow food properly and you’ll feel the food is
sticking. So strictures are also really serious. So I guess what I’m saying is it
needs to be treated if you have it! So those symptoms I mentioned were really
vast and could always be other things. So what else could it be, If it’s not acid
reflux? Well, your GP or your doctor, should always move out any chest pain to
make sure that it’s not coming from your heart, that’s really important. They need
to make sure that any cough or shortness of breath or wheezing is not a
respiratory problem, like asthma or infection. And we also find hoarseness,
so a husky voice, in some serious oesophageal cancers. So those things have to be ruled out before we agree that it is reflux and treat it as such. So how
do you diagnose acid reflux? Well normally people will go to the chemist and
they’ll get an over-the-counter remedy like rennies or gaviscon (any of those). And
if you do get symptoms, go and get those, and it works that does more or less
confirm that you are treating acid reflux because the treatment is working.
If it’s not or it’s not controlling it completely, see your GP; really important.
Your GP will take a really detailed history, including a diet history.
They’ll weigh you, make sure you’re not overweight. They’ll have a feel of your tummy. They’ll do some tests: some blood tests, a stool sample for Helicobacter pylori (and
we’ll talk about that later). They’ll decide if they can treat you or whether you
need a referral. And then they will treat you and they’ll follow you up to see
whether or not the treatment has worked. So the management of acid reflux,
initially is self-care, then it’s trials of treatment by your GP, and if none of
that’s working it’s referral to a gastroenterologist for them to investigate further.
So let’s talk about self-care because these are the things that you can do at
home before seeing a doctor. So weight loss is really important. You need to
have a BMI between 18.5 at 25 (and you can find BMI calculators online). You need
to avoid those 7 trigger foods I told you about. As much as you like caffeine,
it’s a real irritant; go to decaf. Cut alcohol out for a while. You may be
able to get back to them later but you need to let your stomach and oesophagus
heal first. Have smaller meals, earlier meals and don’t have them within three
to four hours of going to bed. Stop smoking and manage stress and depression,
because we have found that stress and depression can also aggravate acid
reflux disease. So what will your GP do after they’ve taken their thorough
history and decided that this is probably reflux?
Well they’ll talk to you about lifestyle and self-care that I’ve just talked
about. They’ll initially give you some alginates. So that’s gaviscon and those kind of things (peptac). And what these do is; you take them after a meal and they
actually sit over the food and acid in your stomach and prevent it from rising
up into your eosophagus. They might take a stool sample for Helicobacter pylori. So you give a tiny bit of poo to your GP receptionist (they have the best job
in the world) and it sent off to the lab to see whether or not you’ve got the
bacteria Helicobacter living in your stomach. And this can be a cause of acid
reflux disease because these bacteria burrow into the stomach wall and then
they allow the acid in which causes the problem. And what your GP may do
alongside testing for Helicobacter pylori is to give you a trial for a
month of a PPI. That’s a proton pump inhibitor and you’ll
probably know them as omeprazole, lansoprazole, oesoprazole. So
these suppress the acid in the stomach and if you try them for a month if that
works all well and good. And if that has worked, then they
will work out with you a plan for the future of lifestyle changes, plus a
longer-term ppi, which gradually they will try and wean off. And in the
meantime, if your Helicobacter pylori stool sample comes back as positive,
they’ll treat that. And that will be treated with a week’s course of one PPI
and two antibiotics. But be warned, this does not always get rid of the pain. They’ll
also do a medication review just to make sure you’re not taking any tablets which
could be making the problem worse. So as we’ve mentioned already, the NSAIDs will
be looked at, but there are lots of other medications. Things like alpha blockers,
benzodiazepines, beta blockers (so common blood pressure
tablets), biphosphonates for your bones, calcium channel blockers (again blood
pressure), steroids, nitrates, theophyllines. There’s so many and
I’ll put a list of them afterwards so you can have a look to see what
you might be on that could be irritating your stomach. So what if
nothing works after that? What if you have to go back to your GP and say ‘I’m
still in pain, I’ve still got these symptoms’. So the GP should revisit everything
again and make sure there’s not an alternative diagnosis, so is it your
heart, is it your liver, is it asthma etc They might add another medication in, an
H2 receptor antagonist, something like ranitidine and see if that helps,
which again suppresses acid. But if all else fails they will actually send you
to a gastroenterologist, or directly for an endoscopy before a gastroenterologist,
to see what’s going on. It’s important to know that 50 to 70 percent of endoscopy’s
are normal. So the camera goes down and can’t find anything. And in the rest
of the cases they can find gastritis (so an irritation of the stomach wall),
they’ll find Barrett’s oesophagus which we spoke about earlier, or they’ll find
an ulcer. So what about taking PPI’s long-term? Is that a good idea? And this
is a question we get asked all the time. Well the aim should always be, to be on
the lowest possible dose of a PPI. And if possible wean off. And sometimes even
with all of the lifestyle changes it’s not possible. But in most cases if those
lifestyle changes are really adhered to then it should be possible in the longer
term. What are the risks of a long term PPI? Well there are risks and this is
important. So you’re at a higher risk of infection, so you have a lower threshold
for getting pneumonia. Small intestine bacterial overgrowth (SIBO) is more common in people taking a PPI. Infection with salmonella and
campylobacter, which causes diarrhoea and tummy upsets. And C. difficile, which is
one of the superbugs is also more common in people that take PPI’s. You could also become deficient in some essential minerals and
vitamins. So calcium, iron, magnesium and vitamin b12 for example, so that’s
important. Kidney disease has been reported, as has osteoporosis.
There’s also been some studies recently about a connection between PPI’s and
stomach cancer, and I know from the radio show that this is a cause of distress to people who feel they need them but obviously don’t want
the risk of stomach cancer. So I just wanted to unpick that a little bit. So
the study was from Hong Kong and it was 63,000 people, so it was quite a big
study. But all of these people had been treated for Helicobacter pylori and had
reflux disease. So what the study said was that those taking a PPI long
term were twice as likely to get stomach cancer within seven to eight years. Now
look at that sensibly; it’s still tiny. let’s stress that. Stomach cancer is
really very rare; about four cases per 10,000. So even if you double that,
it’s still minute. so the chances of you getting stomach cancer in your lifetime
are miniscule. And there are risk factors that put you at higher risk for it.
So we know that Helicobacter pylori is linked to an increase in stomach
cancer and all of these people had been treated for it. So the study was already
skewed in that direction. The study didn’t prove for sure that PPI was the
cause, there was an association. It wasn’t adjusted for other risks for
stomach cancer like smoking and alcohol. And all of the patients in the study
were Asian, and we know that there is a higher risk of stomach cancer in Asian
communities. So I don’t think this particular study was very relevant to
the UK. I think it’s interesting but I don’t think it should worry you in
terms of an increase in your risk; if you need a PPI you need one. So
that leads us on to the next question beautifully, which is, do I take one or
not when I’ve got acid reflux? So the answer to that is quite straightforward.
If you have complicated gastro oesophageal reflux disease; so if you have
an ulcer, Barrett’s oesophagus then yes the benefits of a PPI outweigh the
risk. If you have uncomplicated disease try and use the lowest dose possible
and stop when you can by using lifestyle changes to try and treat the underlying
problem. So that’s the guidance that I would give. I always try and look at natural remedies, as you know. So I’ve done that today and
all of these are alongside self care, I guess they are self care. So managing your
stress is really important then we know that that’s important and it does have
an impact. Wear looser clothing around your tummy so you’re not pushing up on
the stomach and putting pressure on. Raise the head of your bed so that you
sleep head higher than feet so that the acid actually goes down rather than up.
Aloe vera juice has been mentioned as a solution but it is a laxative so be
careful, because you don’t want to replace one problem with another. Ginger
and fennel tea have been mentioned as a solution, as has baking soda in water
although I think that’s pretty disgusting to drink, so I’m not sure if I
could actually do it, but it’s a suggestion. And then regular yogurts and
probiotics. So we know how important the gut microme is in almost every disease
process, so I’m sure that won’t do any harm, and they will help.
So in conclusion, these food triggers, these seven foods, are really important
and I go over that with all of my patients. And just to reiterate; tomatoes,
spicy food, peppermints, chocolates, smoking, alcohol and caffeine.
Cut those out if you have a problem. You may not have to do it for a long time.
You may have to do it for three to six months to let the stomach heal and then
you might be able to go back. You can replace the caffeine with decaffeinated,
so that’s fine, don’t think you have to get rid of coffee or tea, just go for decaffeinated! Lose weight if you can. Just a five to
ten percent weight loss may help the problem significantly. But these things
don’t work for everyone, some people really suffer. So if they’re not working
for you go and see your GP, get checked out and there are treatments and tests
that they can do and hopefully solve the problem. So that’s my VLOG today. I hope
it’s helped. I’ll put the information that I said, including the seven foods, in
the comments afterwards. Please let me know what you think, ask me any
questions and please suggest any topics for the future; this one was suggested on
the radio and that’s why I’ve done it today, and I’m more than happy to go with
what you need. Take care for now, bye!

3 Replies to “Acid Reflux and the wide range of symptoms, and what can be done.

  1. I am on ranitidine for a small hiatus hernia, is that as dangerous as the PPI tabs you were talking about?

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