When should you worry about acid reflux or heartburn?

The feeling of a burning sensation in your chest is hard to ignore. Photo / 123rf

Whether you call it acid reflux or heartburn, the feeling of a burning sensation in your chest is hard to ignore.

The burning sensation is caused by stomach acid travelling up out of the stomach and into the food pipe towards the throat. As it moves, it irritates the lining of your gastric tract, causing an unpleasant sour taste in your mouth alongside hiccups, coughing, feeling sick, bad breath and a hoarse voice.

It’s a common problem and usually something that’s easily treated. But there are certain red flag symptoms that might indicate further investigation, to rule out something more serious – a stomach ulcer, or even cancer.

What triggers acid reflux?

Food and drink triggers

Acid reflux can be triggered by certain foods like spicy or citrus foods, alcohol, coffee and even chocolate. Smoking can also exacerbate it. It’s possible that you might naturally produce more stomach acid, or are particularly sensitive to irritation from the acid. As long as other more serious diagnoses are excluded, medications can be used to reduce stomach acid production from the source or neutralise it to reduce irritation.

Carrying excess body weight can increase the pressure in the abdomen. Photo / 123rf

Being overweight

We all produce stomach acid, and it’s necessary for digestion and barrier defence but carrying excess body weight can increase the pressure in the abdomen. That, in turn, leads to the junctions between the stomach and food pipe becoming leaky, allowing acid to reflux up into the food pipe and throat. It’s the same reason some women experience symptoms of acid reflux during pregnancy.

A bacterial infection in your stomach

Helicobacter Pylori is a common bacteria that can infect the lining of the stomach and early intestine (the duodenum) causing irritation and inflammation, as well as increasing the production of stomach acid. In some cases, this can lead to stomach ulcers. It’s common to have H.Pylori in your stomach, but for many people it won’t cause any symptoms or problems.

A hiatus hernia

This is where the junction between the food pipe (oesophagus) and stomach weakens, allowing acid from the stomach to flush back up into the throat, causing irritation in your gastric tract.

Anaemia (which includes shortness of breath, tiredness and pale skin) is another symptom you should be aware of. Photo / 123rf

When could acid reflux be a sign of something more concerning?

There are some cases where acid reflux is a symptom of something more serious including cancer of the digestive tract (oesophagus, stomach, or duodenum, which is part of the small intestine). If cancer is present, it’s likely there are other symptoms present alongside acid reflux. Cancers can be insidious and have vague presentation, they do usually present as multiple symptoms. Other symptoms to be aware of include unintentional weight loss, early satiety and feeling of fullness, anaemia (which includes shortness of breath, tiredness and pale skin), pain or difficulty on swallowing, persistent cough, lump in your throat or a new hoarseness of voice.

Acid reflux can also be part of the presentation of a heart attack, particularly in females. If there is any chest pain, shortness of breath, irregular pulse or sweating then follow guidance for a suspected heart attack. Don’t take the symptoms lightly just because acid reflux seems like an unusual presentation.

It’s also worth investigating if the acid reflux is followed by vomiting (and the vomit contains blood or is unusually dark), a change in bowel habits (including diarrhoea, constipation, or blood in the stool) or if there is any feeling of persistent cough.

If your symptoms persist, worsen or increase in frequency or severity, go to your GP for a review. Even if your symptoms turn out to be nothing serious, it’s uncomfortable and your GP will be able to find ways for you to better manage it. If you have already sought medical advice, perhaps you have been using over-the-counter or prescribed medications to reduce the acid for longer than two weeks without satisfactory relief, it’s also worth going back.

Get a proper diagnosis from your GP. Photo / 123rf

How to relieve your symptoms

Do

• Get a proper diagnosis from your GP to help you manage it. For example, if caused by H.Pylori, this can be treated with a combination of medications including antibiotics.
• Eat smaller, more frequent meals.
• Speak to your doctor or pharmacist about medications such as proton pump inhibitors (PPIs) which reduce stomach production, or acid-neutralisers called antacids.

Don’t

• Consume irritating substances such as NSAID painkillers, culprit food and drink triggers, e.g. alcohol or spicy foods and smoking.
• Eat too close to going to sleep. Ideally, eat your last meal 3-4 hours before bed as lying down flat can encourage the acid to reflux and exacerbate symptoms.
• Lie flat. Some people find adjusting the head of their bed to raise their upper body by 10-20cm in bed means gravity will keep the acid in the stomach (however, propping up with pillows can sometimes raise the pressure in the abdomen and make the problem worse)

If you have tried any of the above suggestions and the acid reflux persists or worsens in severity/frequency, or if the acid reflux is in the presence of other symptoms, then it’s worth getting checked out again. Although heartburn is a term thrown around, and seemingly everyone experiences at some point, it can also be an unpleasant symptom to put up with each day. Your doctor won’t think you’re overreacting by wanting some investigation and reassurance it’s nothing more serious, and usually can optimise your management of symptoms.