Treatment of acid reflux- lifestyle

To get rid of acid reflux, often the first step is to make some lifestyle changes. 10 lifestyle changes that may help acid reflux include:

1. quit smoking
2. try to lose excess weight
3. elevate the head of your bed by a few inches
4. avoid eating late at night/close to bed time
5. avoid larger meals- trying smaller, more frequent meals instead
6. avoid certain common triggers such as uncooked onion, spices, fatty greasy foods.
7. some people report that a diet lower in carbs (carbohydrates), such as bread, pasta and sugary foods, may help their reflux symptoms
8. avoid excess caffeinated or carbonated (fizzy) drinks
9. reduce or eliminate alcohol intake
10. check any medications you are taking- some drugs can cause worsening acid reflux as a side effect.

Treatment of acid reflux- medication

All medications have the potential to cause side effects in some people. Some medications can also interact with other drugs you may be taking- so it is always important to discuss treating your acid reflux with a doctor, especially if the problem is continuing for weeks or longer.

Antacids and over-the-counter options

There are many over-the-counter medications available from pharmacies which can help to neutralise stomach acid and/or soothe the lining of the oesophagus.  These may be adequate for the management of mild acid reflux.

PPIs

“Proton Pump Inhibitors” or PPIs are medications that reduce the amount of acid your stomach makes. They are very effective, particularly if there is inflammation of the oesophagus (oesophagitis) or stomach (gastritis), caused by acid.  They can help ulcers to heal. There are many brands available- some are available without a prescription, but you will need to see a doctor for a prescription if you need to take them for more than a week or two, or if you need a higher dose.

H2 antagonists

H2 antagonists are another type of medication that reduce the amount of acid produced by the stomach- they are not quite as effective as PPIs, but sometimes may be used if a person cannot take a PPI due to side effects or other issues.

Treatment of acid reflux- surgery

For most people, lifestyle changes and medications are enough to manage the symptoms of GORD. However, sometimes surgery may be considered if these measures are nor working, or if complications are developing. A procedure called a Nissen Fundoplication may be considered. A Nissen fundoplication involves wrapping the top part of the stomach around the oesophagus, to create the effect of a sphincter. It is often a laparoscopic procedure (keyhole surgery).

Diagnosis of Acid Reflux

In most cases, a doctor can diagnose acid reflux or GORD by by asking questions about your symptoms. If the symptoms are not straightforward, getting worse, or if there are some worrying issues such as weight loss, you may need to have some further tests- this might involve blood tests, an ultrasound of the abdomen, and often a referral to a specialist to have a camera test of the oesophagus and stomach (endoscopy).

Complications of acid reflux

Sometimes people experience what they think is just acid reflux, but in fact a more serious underlying issue may be present. If you get any of the following symptoms you should seek immediate medical attention:

• Chest pain or upper tummy pain worse on exertion
• Difficulty swallowing foods or liquids
• Persistent pain on swallowing
• Persistent vomiting
• Vomiting blood or dark brown vomit
• Unexplained weight loss
• Shortness of breath
• A change in your bowel habit (diarrhoea or constipation) for more than 6 weeks
• Changes in your bowel motion (dark or black poo)
• Lump in the abdomen (tummy)
• Unexplained low iron levels or anaemia (low blood count)
• Jaundice (yellow discolouration of the skin or eyes)
• New GORD symptoms in someone aged 55 years or over
• Acid reflux/ GORD symptoms with any of the following:
  • Family history of stomach or oesophageal cancer in more than two first degree relatives
  • Barrett’s oesophagus (a condition where the cells lining the lower oesophagus change to resemble those of the stomach/intestine, which have a risk of turning cancerous over time)
  • Pernicious anaemia (a condition associated with low Vitamin B12)
  • Previous stomach ulcer surgery
  • A previous diagnosis of the following stomach conditions: dysplasia, atrophic gastritis or intestinal metaplasia

Acid reflux and related conditions

If you have certain medical conditions you are more likely to also suffer from GORD:

Asthma

Many people who have asthma also get acid reflux. It is not certain why this occurs. Many people notice that if their acid reflux is flaring up, it triggers their asthma. If you have asthma and acid reflux, you may find that carefully managing both of these conditions is the most effective way to avoid symptoms.

IBS (Irritable Bowel Syndrome)

IBS or Irritable Bowel Syndrome is a condition that affects the large intestine (gut). It commonly leads to abdominal cramps, diarrhoea, constipation and bloating. Many IBS sufferers are intolerant of “FODMAPs”, which are types of fermentable sugars in food. Acid reflux appears to be more common in people who have IBS, so sometimes it may help to tackle both issues, by seeking advice from a doctor, specialist or dietitian.

Pregnancy

As many pregnant women will notice, acid reflux is much more problematic in pregnancy, particularly in women who already had some issues before pregnancy. This may be because the sphincter muscle in the lower oesophagus becomes more relaxed and allows acid to pass upwards from stomach. Obviously, as the foetus grows, this can also create pressure on the stomach which may force acid upwards. Acid reflux can be safely treated with medication in pregnancy, but this should be done under the advice and supervision of a doctor.

Do children get acid reflux?

Acid reflux is very common in babies under the age of one, but it usually gets better over time. It often presents with small amounts of milk being vomited after feeds. While in most cases, it does not cause major issues, and does not need any medical treatment, in some instances, reflux can lead to complications- such as more significant vomiting, difficulty feeding, poor weight gain, unsettled sleep, signs of tummy pain (such as irritability, crying and arching of the back) or a recurrent cough. Of course, other conditions can cause the same symptoms, so it is very important to get advice from a GP, maternal child health nurse or paediatrician if a baby has any of these problems. Occasionally babies may be prescribed treatment for reflux, if it is severe or causing complications.

Summary

Acid reflux is common- but if causing frequent symptoms, more than once or twice per week, you should see your doctor. Never ignore worsening symptoms, particularly if you have difficulty swallowing, weight loss or chest pain that is worse on exertion. Lifestyle changes can be very effective, but sometimes medication is also needed.  Seek medical advice if you have frequent or worsening symptoms.

References

• https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/indigestion
• https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/
• https://www.rch.org.au/kidsinfo/fact_sheets/Reflux_GOR_and_GORD/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753679/

Support and further information

• https://www.reflux.org.au/
• https://raisingchildren.net.au/guides/a-z-health-reference/reflux