Ask the Doctor: ‘Since having kids, I’ve suffered from terrible acid reflux at night. What can I do?’

“Ever since having my children, I have suffered from terrible acid reflux at night. I take Gaviscon after dinner but this still disturbs my sleep most nights. Is there anything that I can do for this?”

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Answer from Mr Mashood Ahmed, Consultant General and Laparoscopic Surgeon, Beacon Hospital.

It sounds like you are suffering from Gastroesophageal Reflux Disease (GORD), a very common condition affecting up to 20% of the western population.

GORD occurs when acid from the stomach repeatedly flows back into the oesophagus. This can irritate the lining of the oesophagus. Acid reflux can happen from time to time to many people but if this happens repeatedly it is called GORD.

GORD can be managed in most people with lifestyle change and medications, but a small percentage may need surgery to control severe symptoms if they are not responding to medications. The cause of GORD involves an interplay of chemical, mechanical, psychologic, and neurologic mechanisms, which contribute to symptoms. Recent research has alluded that GORD should be approached as a disorder beyond acid.

Symptoms and signs of GORD include:

• Heartburn which is a burning sensation in your chest and usually worse after eating food and at night A bitter unpleasant taste in the back of throat
• Upper abdominal pain or chest pain
• Dysphagia (difficulty in swallowing)
• The feeling of a lump in the throat
• A general feeling of being unwell

Common risk factors:

• Obesity: Extra weight will put pressure on the sphincter muscle allowing acid to rise into the oesophagus
• Drink: Alcohol and fizzy drinks can trigger heart burn
• Pregnancy: Hormonal changes and pressure in the stomach from the uterus during pregnancy can affect the lower oesophageal sphincter leading to reflux
• Stress: Stress and lack of sleep can trigger heart burn by putting strain on your body
• Food: Spicy food, chocolates or eating a big dinner can cause reflux
• Smoking: Affects the sphincter muscle and causes reflux

For a diagnosis of GORD, your GP will send you to a specialist for diagnosis who may recommend the following tests:

• Upper endoscopy (OGD): a thin flexible tube with a camera is placed down the oesophagus into your stomach where photos and tissue samples can be taken to exclude infections, or the presence of bacteria called helicobacter
• X ray of the upper digestive system called barium swallow
• Ambulatory pH study: a probe is placed in your oesophagus to monitor when acid reflux occurs
• Manometry: a test to measure the rhythmic muscle contractions in the oesophagus. This is typically done for people who have trouble swallowing

Treatment of GORD:

Symptoms are often controlled with lifestyle changes and medications. Your GP or specialist will be able to guide you on these. Medication includes antacids, such as Gaviscon. These reduce acid production such as cimetidine. Medications knows as proton pump inhibitors, such as Omeprazole and Esomeprazole can stop acid production. If bacteria is discovered, antibiotic treatment would be needed.

Fortunately, it is rare that a patient may require surgical intervention such as fundoplication which involves wrapping the stomach around the lower oesophagus to tighten the muscle and prevent reflux. With lifestyle changes and medication, GORD can be treated and alleviated and treated.

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