Digestive Health

GORD! That really burns.

In 2005, Australians Barry Marshall and Robin Wren were awarded the Nobel Prize for Physiology or Medicine. It was recognition that some 20 years earlier they had demonstrated that it was chiefly the Helicobacter pylori bacteria which were the underlying cause of peptic (stomach) ulcer; and they thus revolutionised the treatment of this condition.

A disease which so frequently required hospitalisation and surgery could now be treated effectively by medicines – a better patient outcome at a lower cost.

Heartburn is one of the symptoms of peptic ulcer; but more usually it is a symptom of reflux. In fact it is a defining symptom of reflux - that somewhat less serious but certainly more common condition which, when it occurs frequently and becomes really troublesome, is known as “gastro-oesophageal reflux disease” or simply GORD.

Reflux occurs when what goes down the oesophagus – that is the “food pipe” to the stomach – comes back up again to where it’s not meant to be. And it comes back up again mixed with stomach acid and other chemicals. So it’s not surprising that the regurgitation or backwash of swallowed food causes a burning feeling. It’s generally described by reflux sufferers as beginning in the stomach or lower chest and moving upwards behind the breastbone towards the neck or throat.

Most of us will have experienced reflux now and again. And when it’s only just a little, and just now and again, it doesn’t cause too much discomfort. We have a circular band of muscle which acts like a valve at the top of the stomach; it’s called the lower oesophageal sphincter (LOS). Normally it works pretty well but when the LOS is weak or faulty, problems of backwash can occur.

Prolonged exposure to gastric acid causes inflammation of the oesophagus, possible ulceration and haemorrhage. Scar tissue can develop and there is a small increased risk of oesophageal cancer. So prevention and management of reflux is important.

Occasional heartburn usually responds well to antacids. As the name implies, antacids neutralise the acid in the stomach. They provide quick, but not long lasting, relief from most mild reflux symptoms. Ingredients include aluminium hydroxide, magnesium salts, calcium carbonate and sodium bicarbonate – often in combination. Other ingredients such as alginates and simethicone are sometimes added. The alginate forms a “raft” over the stomach contents to prevent leakage into the oesophagus; and the simethicone helps to reduce wind. Despite their wide availability, antacids are not suitable for everyone (so, if you are taking other medicines, check with your pharmacist first as to whether antacids are appropriate) and they are not the best choice medication for people with frequent heartburn symptoms.

More effective as treatments for frequently occurring or more severe symptoms of reflux are the so-called “histamine-2 blockers” (for example: Gavilast and Zantac) and the “proton pump inhibitors” (PPIs) (such as Somac) which are now available in some strengths without prescription. They work by reducing the production of acid in the stomach. They don’t act as quickly as the antacids but they provide longer lasting and more complete relief. Currently the PPIs cannot be advertised directly to the public or self selected at the pharmacy, so you’ll need to ask your pharmacist as to whether they are suitable for you.

In any event, it’s worth remembering, a faulty LOS doesn’t happen by accident; and often there’s an identifiable trigger factor. It could be obesity, tobacco smoking, spicy foods, excess alcohol, carbonated or caffeinated drinks; and certain medicines can also loosen the muscle around that sphincter.

If you have any questions or would like to learn more about GORD. Please do come in and have a chat with one of our friendly pharmacists.