Reflux that will not stay away: when heartburn needs a closer look

Almost everyone gets heartburn. A heavy meal, something peppery, lying down too soon after eating, and there it is. That is normal and not what this article is about.

This is about reflux that has become a fixture. The kind where you have taken antacids so long you have a preferred brand, where it returns the moment you stop the medicine, and where you have quietly rearranged what you eat around it.

What reflux actually is

At the base of your oesophagus is a muscular valve that should stay shut between swallows. When it leaks, stomach acid climbs back up into the oesophagus, which has no protective lining against acid. That is the burn.

Occasional leaking is normal. Persistent leaking, over years, is what causes trouble.

When it stops being ordinary heartburn

Take it more seriously if any of these apply:

• It happens more than twice a week, most weeks
• It has been going on for years
• It returns immediately whenever you stop medication
• You are waking at night with acid or a sour taste
• You have a persistent cough, hoarse voice or sore throat with no other explanation

None of these is an emergency. All of them are a reason to have the oesophagus looked at rather than medicating indefinitely.

The symptoms that need seeing sooner

These are different, and should not wait:

• Difficulty swallowing, or food that sticks going down
• Losing weight without trying
• Vomiting blood, or black, tarry stool, which need seeing today
• Persistent vomiting
• Anaemia with no clear cause

What long-term reflux can do

Repeated acid exposure inflames the oesophageal lining, which is called oesophagitis. In some people the lining adapts over years, changing into a type more like the stomach's. That change is called Barrett's oesophagus. It is not cancer, and most people with it never develop cancer, but it does slightly raise the risk, which is why it is worth knowing about and monitoring.

This is the main reason we do not simply medicate persistent reflux forever without ever looking. A gastroscopy tells us whether the lining is healthy, inflamed or changed.

What actually helps

Before medication, the practical things do more than people expect:

• Eat your last meal at least three hours before lying down
• Raise the head of your bed slightly, which works better than extra pillows
• Identify your own triggers, commonly pepper, fatty foods, chocolate, coffee and alcohol
• Eat smaller portions rather than one large evening meal
• Lose weight if you carry it around the middle, which is the single most effective change
• Stop smoking, as it weakens the valve directly

Medication that reduces acid works well and has its place. The point is not to avoid it, but to make sure it is treating something you have actually identified.

When we scope

A gastroscopy is recommended when reflux persists despite proper treatment, when it has run for years, or when any alarm symptom is present. It takes minutes under sedation, and lets us see the lining directly, take biopsies if needed, and test for H. pylori while we are there.

Most people leave reassured. Some leave with a specific diagnosis and a proper plan. Either is better than another year of guessing.

If your heartburn has become a permanent feature, call 070 7056 6272 and let us look properly.