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This month I’d like to have a think about the current ad campaign sweeping the nation – you know, the one with people holding their stomachs and being advised to see their doctor. The advert is very helpful and gets the right message across, but of course there is a limit to how much information they can give us in the short time available to them. So what’s it all about?

Just to clear up some confusion, ‘heartburn’ has nothing to do with your heart, but is instead caused by pain in your stomach which is felt when the stomach lining is damaged, allowing the acid in your stomach to cause you pain, typically just after you have eaten a large meal, particularly if the meal has involved a lot of fat or alcohol. Gastro-oesophageal reflux (or just ‘reflux’) is what happens when the acid in your stomach (where it should be) leaks out of your stomach and up your oesophagus (where it shouldn’t be) and burns it, which is also painful, and can cause an unpleasant taste in your mouth or an irritating persistent cough. The two conditions are very similar but can cause slightly different problems in the long term; however, for most people in the early stages the treatment is the same.

Heartburn and reflux can be caused by a high fat diet, being overweight, being pregnant, drinking excess alcohol and sometimes by a bacterial infection that many people have in their stomachs called H pylori (more about this later).

Most of the time this is relatively harmless and can be easily resolved by changing our lifestyles – the clue to this is in the list of causes! As with so many other conditions, eating a lower fat diet, losing excess weight if you have any, keeping alcohol consumption to modest levels if you drink, and generally living a healthy lifestyle can make a significant difference to any heartburn/reflux symptoms.

But the whole point of the advertising campaign we are currently seeing is that sometimes there can be complications of heartburn/reflux, and so while it is likely that there is nothing to worry about, equally it is important to mention your symptoms to your GP to ensure that you get the correct tests and treatment for your individual situation. Most people get heartburn/reflux occasionally, but if your symptoms are happening more regularly than it’s worth a visit to your surgery just to check it out.

Your doctor will want to ask you a few questions about when your pain happens, how long it lasts, whether you have lost weight or noticed any change in your bowel habits (how often you visit the loo) as these would make it more likely that your symptoms are caused by conditions that need further testing, and about your lifestyle in general which is likely to include your diet and alcohol consumption. They will then want to examine you. At this point they may well suggest simple lifestyle changes, or start you on some medication to relieve your symptoms.

The two main medications used to alleviate symptoms of heartburn/reflux are antacids, which are either liquid or chewable tablets which coat your stomach and lower oesophagus with a protective layer to prevent the pain, or ‘proton pump inhibitors’ (don’t worry about the big words!) such as omeprazole or lansoprazole which work by reducing the amount of acid in your stomach. As with most medications, these do have long term side effects including an increased risk of osteoporosis, so it is better to resolve your symptoms by changing lifestyle rather than popping pills if possible.

Your doctor will probably want to organise some further testing depending on your situation – sometimes a few weeks of medication is all it takes to settle things down and the condition is resolved. But if medication either does not help, or only helps while you are taking it and your symptoms come back as soon as you stop taking it, then a few simple tests may help to make things clearer.
You will probably need to have some blood tests, including a check for anaemia as this can be an indication that something more significant than simple heartburn is going on, and a check for H pylori – this is usually either a blood test or a check on a stool sample, depending on your local laboratory protocol.

H pylori is a simple bacterium that is found in the stomachs of about half the world population, but is mainly found in the developing world; in the UK about 15% of people are affected. If you turn out to have H pylori in your stomach, then it may be that a week of a high dose of two different antibiotics and reflux treatment may be all you need to get rid of your symptoms altogether.
Sometimes you can have longer term conditions as a result of heartburn/reflux, including oesophagitis (inflammation of your oesophagus), ulcers or, thankfully quite rarely, cancer. If you have any symptoms that make your doctor concerned that this may be the case – including anaemia, weight loss, difficulty swallowing or pain that does not improve with standard treatments – then you may need to have an endoscopy.

During an endoscopy, a long, very thin camera is inserted into your mouth and then down through your oesophagus, into your stomach and often into the first part of your intestines to check for inflammation/ulcers or cancers. In most hospitals you can have this done with sedation (you can take some medication just before the procedure to relax you) if it all sounds a bit too unpleasant! Most people seem to find that it is not as bad as they anticipated.

If you do have oesophagitis or ulcers then the treatment is fairly straightforward and includes medication similar to the management of heartburn/reflux. Obviously, if you are one of the overwhelming minority of people who end up being diagnosed with stomach or oesophageal cancer at this point then the treatment is rather more involved, and beyond the scope of this article. But that’s very unlikely.
As with most conditions, it is important to know if you have any of the more complicated causes of heartburn/reflux, as the sooner they are diagnosed, the better they can be treated. The chances are that if you visit your doctor, almost all of the time they will be able to reassure you that there is nothing serious wrong and give you simple lifestyle advice and medication (proton pump inhibitors in particular are very effective), and if there is more to your particular story then there is still a lot they can do to help.


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