Information Persistent heartburn Persistent heartburn Heartburn Heartburn is a burning sensation behind the breast bone, usually caused by acid and/or bile reflux. This occurs when the muscles at the lower end of your oesophagus, sometimes called your gullet or food pipe, become weak and allow digestive juices from your stomach and small bowel to flow back up. This is more likely to occur if you have a hiatus hernia, which means that part of the stomach has moved up from its normal position to above the diaphragm. Digestive juices containing acid and bile cause the typical feeling of a burning pain in your chest which may rise up and spread to your throat and jaw. You may have other symptoms such as: a sour taste in the back of your mouth. food coming back up into your mouth after eating (regurgitation). a hoarse voice. a cough that does not go away. If you often have heartburn, you may find it useful to try to track the foods and drinks that trigger your symptoms, so that you can avoid them. Spicy foods, smoking and alcoholic drinks can provoke symptoms and should be avoided. Do not ignore persistent heartburn. If it lasts more than 3 weeks, see your GP. It is tempting not to take heartburn too seriously. Lots of people get it. You may think that it will go if you were just less stressed, or lost weight, or ate more regularly. But if you frequently suffer from heartburn, and regularly have to take off-the-shelf or over-the-counter medicines to relieve it, talk to your doctor sooner rather than later. Your doctor may prescribe you drugs called proton pump inhibitors (PPIs), which suppress the acid before it can cause damage. In some cases you may be referred for an endoscopy (camera examination of the oesophagus and stomach). Click here to read a real life story from one of our supporters who did just that and whose health has changed for the better as a result. Treatments to Relieve Acid Reflux Individuals with Barrett's oesophagus often have bad acid reflux, but curiously not all people have symptoms. The treatment for reflux in people who have Barrett's oesophagus is the same as for those who do not. There are three approaches: 1. Things you can do for yourself Avoid eating large meals within 2 to 3 hours of going to bed. Avoid eating the foods that you know will trigger reflux. These will often include fatty foods such as cheese and red meat; chocolate; coffee; alcohol; fizzy drinks; spicy foods and citrus. It is worth making these lifestyle changes, although they only abolish symptoms in about 1 in 5 people. 2. Medication Antacids immediately neutralise the acid that has already been made. They may be either liquids or tablets and should be taken as soon as you get symptoms. Rennie, Tums and most of the other medicines which you can buy over the counter work in this way. Alginates also contain antacids but, in addition, have a special ingredient which coats the lining of the stomach and oesophagus. This barrier prevents the acid from reaching the area where it would otherwise cause damage. Gaviscon and Gastrocote are examples of this class of medicine. Acid suppression tablets work to stop acid being made before it can cause damage. There are two types; histamine receptor antagonists like Ranitidine (Zantac) and Proton Pump Inhibitors (PPIs) such as Omeprazole, Lansoprazole, Pantoprazole, Rabeprazole and Esomeprazole. PPIs are far more effective at controlling acid reflux. Most Patients with Barrett's oesophagus will be taking one of these routinely. 3. Anti-reflux Surgery Anti-reflux surgery, such as Nissen Fundoplacation, is a treatment which aims to restore the normal valve mechanism at the lower end of the oesophagus. It often does not work properly in individuals with Barrett's oesophagus. This treatment is routinely carried out as a keyhole operation. You would only need to stay in hospital for one or two days, although it usually takes four weeks to recover completely from the operation. Fundoplacation surgery is successful in stopping acid reflux in the majority of people who are treated. It does have recognised side effects. Before agreeing to surgery it is important to discuss these with the surgeon. Things which can trouble people after surgery include bloating of the abdomen, difficulty in swallowing and, rarely, diarrhoea. For more information you should ask to meet a specialist surgeon. LINX® (Bead System) The LINX® system is a medical device designed for patients with gastro-oesophageal reflux disease (GORD) who have not had a strong response to medical treatment. It comprises of a small bracelet of magnetic titanium beads that is placed around the muscles at the lower end of the oesophagus (called the Lower Oesophageal Sphincter) through a keyhole procedure under general anaesthetic. The procedure typically takes less then 1 hour and most patients can go home the same day. The magnetic beads are designed to separate during swallowing which allows food and drink to pass into your stomach. The magnetic attraction between the beads then tightens the bracelet around the lower oesophagus to prevent back flow of digestive fluid from the stomach. Clinical studies have shown the LINX® system is effective in treating GORD symptoms, with 85% of patients no longer requiring antacid treatment 5 years after having the LINX® in place (1,2) The LINX® system will not suit every patient with reflux symptoms and so should only be considered with the advice of an expert surgeon. Ganz RA, Edmundowicz SA, Taiganides PA, Lipham JC, Smith CD, DeVault KR, et al. Long-term Outcomes of Patients Receiving a Magnetic Sphincter Augmentation Device for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2016;14(5):671-7. Bonavina L, DeMeester T, Fockens P, Dunn D, Saino G, Bona D, et al. Laparoscopic sphincter augmentation device eliminates reflux symptoms and normalizes esophageal acid exposure: one- and 2-year results of a feasibility trial. Ann Surg. 2010;252(5):857-62. If you have Barrett's oesophagus and would be interested in participating in a clinical trial which looks at using the LINX® system as an alternative treatment to life-long medication then please take a look at our research page for more details and to get in touch. Oesophagitis Oesophagitis is an inflammation of the lining of the oesophagus. In most people this is caused by the digestive juices in the stomach repeatedly moving upwards into the lower oesophagus (causing reflux). Sufferers may experience a burning sensation in the lower chest immediately after swallowing hot fluids (eg tea or soup), alcohol, concentrated fruit juice or hot fatty foods such as bacon and eggs. A similar discomfort may be felt after meals, on bending or lying flat. Food or fluid may come up into the mouth (regurgitation) especially when lying down or in bed at night. In severe cases a person may wake up coughing or with a choking sensation. A person with oesophagitis may experience difficulty swallowing first solid foods and then more liquid foods, with the solid food feeling as though it is stuck. Most importantly, remember never to suffer in silence. If you are constantly having to take off-the-shelf or over the counter medication you should make an appointment to see your GP. You may need to be referred for an endoscopy.