Gastric Reflux

Gastric reflux, also called Gastro-Oesophageal Reflux Disease (GORD), is a condition where the stomach’s contents rise up from the stomach into the oesophagus. Food mixed with the stomach’s digestive acids can irritate and damage the oesophagus.


Heartburn is a symptom of Gatro-oesophageal reflux disease and occurs when stomach acid refluxes back into the oesophagus and burns its sensitive lining. 


Gastro-oesophageal reflux occurs when the anti-reflux mechanisms of the lower oesophageal sphincter and crus muscles of the diaphragm weaken making it easier for acid to reflux back up the oesophagus.


Weakening of the crus muscles of the diaphragm and widening of the opening in the diaphragm where the oesophagus passes through is called a Hiatus Hernia. Weakening of these anti-reflux mechanisms may be genetic and may also occur with age. Obesity itself is also risk factor for weakening of these anti-reflux mechanisms.


When a Hiatus Hernia occurs, the normal opening in the diaphragm for the oesophagus becomes stretched and enlarged and the upper part of the stomach may slide up into the chest. This causes the one-way valve between the oesophagus and stomach to become faulty.


If left untreated, chronic GORD can cause serious complications such as inflammation of the oesophagus, oesophageal ulcers, narrowing of the oesophagus, chronic cough and reflux of liquid into the lungs (pulmonary aspiration). Some people may develop Barrett’s oesophagus, a condition characterised by changes in the oesophageal lining, which that may lead to oesophageal cancer.

Causes of Gastric Reflux

Gastric Reflux occurs when the anti-reflux mechanisms of the Lower Oesophageal Sphincter (LOS) or diaphragm fail. Weakens of the Lower Oesophageal Sphincter or the development of a Hiatus Hernia oftern leads to Gastro-Oesophageal Reflux. 


Normally, the stomach contents are retained in the stomach with the help of the lower oesophageal sphincter (LOS) and diaphragm.  These muscles work together and contract and relax to maintain the one-way movement of food.


The exact cause for weakening of the LOS and diaphragm is not known, however, certain factors including Obesity, smoking, pregnancy, family history and possibly alcohol, may contribute to GORD.


The following foods and medicines may worsen Gastric Reflux symptoms:


  • Spicy foods
  • Onions
  • Chocolates
  • Caffeine-containing drinks
  • Mints
  • Tomato-based foods
  • Citrus fruits
  • Alcohol
  • Certain medications: GLP1 agonists - Ozempic, Wegovy, Mounjaro

Symptoms of Gastric Reflux

  • Heartburn - burning-type pain in the lower part of the mid-chest, behind the breastbone. Usually the main symptom of GORD
  • A bitter or sour taste in the mouth
  • Trouble swallowing
  • Nausea
  • Dry cough or wheezing
  • Regurgitation of food
  • Hoarseness or change in voice
  • Chest pain or even shortness of breath


Diagnosis of Gastric Reflux

The diagnosis of Gastro-Oesophageal reflux is often made by taking a history of the patients symptoms.


We may order some of the following tests to diagnose Gastric Reflux:

 

  • Endoscopy: To examine the inside of your oesophagus, stomach and portions of the intestine with an instrument called an endoscope, a thin flexible telescope.


  • 24-Hour pH Monitoring: involves inserting a tube through your nose into the oesophagus and positioning it above the LOS. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into the oesophagus. The tube will be left in place for 24 hours. This test is very rarely performed & usually only performed if there is any doubt about the diagnosis of gastro-oesophageal reflux.


  • Oesophageal Manometry: A tube placed into the oesophagus measures how well the muscles of the oesophagus work which is helpful in examining the function of the oesophagus in patients who describe difficulty swallowing. This test is also rarely required.

Treatment Options for Gastric Reflux

Treatment is aimed at reducing reflux, relieving symptoms and preventing damage to the oesophagus.


Most patients require some form of treatment for their reflux. Some patients respond to non-surgical treatments such as avoiding trigger foods, lifestyle changes and many patients require medications.


If conservative non-surgical treatment options fail to resolve your GORD, we may recommend a surgical option called Hiatus Hernia repair + Fundoplication. 


Gastric Reflux Non-Surgical Options include:

 

  • Avoiding foods that trigger reflux symptoms
  • Avoiding lying down within 3 hours of a meal
  • Elevating the head of the bed during sleep
  • Antacids: over-the-counter medicines that provide temporary relief to heartburn and indigestion by neutralizing acid in the stomach
  • PPI drugs (Somac or Nexium): reduce the production of acid in the stomach


Gastric Reflux Surgical Options include:


  • Hiatus hernia repair and Fundoplication: A Laparoscopic (key-hole) surgical procedure in which the upper part of the stomach is wrapped around the lower end of your oesophagus where it is sutured into place. This surgery strengthens the sphincter and helps prevent stomach acid and food from flowing back into the oesophagus.