In this article Mr Nick Boyle – one of the UK’s leading experts in the treatment of reflux – talks about reflux disease, and why the diagnosis and treatment of this common problem requires a multidisciplinary approach.
What is Gastro-Oesophageal Disease (acid reflux)?
Gastro-Oesophageal Disease is caused by reflux of acid, pepsin, bile and other substances which naturally occur in the stomach contents, travelling from the stomach into the oesophagus, throat, mouth and even lungs.
This is normally prevented by a valve mechanism at the bottom of the oesophagus, the lower oesophageal spincter (LOS).
In reflux disease, this valve fails and the substances including acid will irritate and even burn the oesophagus and other organs.
What are the most common symptoms of acid reflux?
Many people will have occasional reflux symptoms without having reflux disease. However, experiencing significant symptoms associated with reflux two or more times per week is not normal, in which case you may well be suffering from gastro-oesophageal reflux disease (GORD).
Some of the most common symptoms include:
- Recurrent cough
- Difficulty swallowing
- Chest pain
- Sensation of a lump in the throat
- Throat clearing
- Husky or weak voice
- Bad taste in the mouth
- Sensation of shortness of breath
Why is acid reflux often so difficult to treat?
The list above exemplifies that reflux can cause a wide variety of symptoms, and sometimes other conditions can cause similar problems. For instance, as many people experience throat symptoms (known as ‘silent reflux’ or ‘lpr’) as suffer from the more commonly cited symptom of heartburn. These throat symptoms may occur in isolation. So, for instance, the only problem might be a cough or voice problems without any associated heartburn. Reflux can also cause respiratory problems, such as asthma.
The priority is to reach the right diagnosis. It’s important that if you develop new symptoms, you seek medical advice and undergo tests to exclude other potentially serious illnesses, including cancer.
Once other causes of symptoms have been excluded, lifestyle modifications will be suggested. These can include changes to diet, losing weight and avoidance of eating late, to name just ta few.
You may also be offered medication. The options include alginates, such as Gaviscon, which coat the oesophagus and protect it from stomach juices. More often, powerful drugs known as proton pump inhibitors (PPIs) such as Omeprazole are prescribed. These are very powerful antacids and, in some people, can be very effective.
However, overall these don’t work adequately in 20-30% of people, probably because they only affect acid and don’t neutralise other elements of stomach contents that can cause reflux such as pepsin and bile. If you have lpr symptoms, you’re more likely to experience continuing symptoms even with high doses of PPIs (this is true in perhaps 80% of cases).
PPIs can cause side effects and you may feel uncomfortable about taking drugs for what may be many years. Furthermore, PPIs are known to affect the gut microbiome, sometimes causing growth of abnormal microorganisms in the small bowel, known as SIBO.
This can cause symptoms such as irritable bowel syndrome (IBS) and can exacerbate reflux symptoms, causing bloating and belching.
A ‘cycle of frustration’
There is often a gap between how doctors assess the impact of reflux on their patients and how you might feel when suffering from reflux every day.
If you’re waking up every night with acid in your mouth, or you’re a singer and your voice keeps failing, your quality of life can be severely impacted.
Because you may find that conventional treatments don’t work for you, or a definitive diagnosis is not reached, it’s quite usual to feel frustrated. You’re not alone: it’s estimated that around 1% of the population – 500,000 people in the UK – have persistent reflux symptoms, despite taking the usual treatments, including high doses of medications.
It’s common that you endure what we call a ‘cycle of frustration’, as people are often referred from one doctor to the next and prescribed ever-increasing doses of drugs that may not help and can have side effects. But it doesn’t have to be this way.
How can multidisciplinary teams help to break the cycle?
Reflux is complicated. Reaching the right diagnosis is not always straightforward and there are many treatment options available. From our experience of treating other complex conditions, we know that a multidisciplinary team approach is best. Experts in reflux from different fields, who work with the latest diagnostics and technologies, can provide you with the best care and treatment.
Such teams make the best use of their combined areas of expertise, which helps to improve your chances of getting the right diagnosis and a treatment plan tailored to you. You may receive specific dietary advice, drug modifications, treatment of another non-reflux diagnosis or, in some cases, surgery.
What treatments are best for acid reflux?
Surgery has been available to treat reflux for decades. However, the standard operations offered in most hospitals are unpopular. This is primarily because of side-effects that can occur – for instance, some people can’t belch or vomit following surgery and, over time, there is a significant failure rate. Studies have shown that after fundoplication (a standard operation for reflux), 50-60% of people will have to return to use regular PPIs.
In recent years, great technological strides have been made to help us diagnose reflux and other problems that may cause reflux symptoms. We can now offer alternative, cutting-edge treatment options. Among these is LINX. LINX is a flexible bracelet of small magnets placed around the lower oesophageal sphincter. This helps to strengthen the valve, the failure of which is the usual cause of reflux. One of the great benefits of LINX is that it is a minimally invasive and quick procedure (you can typically go home within 24 hours of the surgery and return to normal activities in just a few days).
It also has a high success rate. Over 40,000 procedures have now been performed since LINX was introduced in 2007. A decade after surgery, 80% remain off medication, enjoying significantly improved quality of life. LINX can successfully treat all symptoms of reflux, including lpr, and for some it can be life changing. For instance, in patients suffering regurgitation, a study showed that 90% experienced dramatic reductions in those symptoms following LINX, while in those treated with high dose PPIs, it was just 10%.
Keep in mind that LINX may not be the best option for you, based on your particular symptoms and diagnosis. We’ll talk through the best, bespoke treatment for you.
- King Edward VII’s Reflux Centre is a fully equipped unit, staffed by experts with access to the most up-to-date tests and treatments.
- Mr Nick Boyle is a specialist laparoscopic, upper GI and reflux surgeon. He has particular expertise in reflux surgery, offering the full range of surgical options including LINX. He is one of the leading LINX surgeons in Europe and has operated on more patients than any other surgeon in the UK. He and the reflux team at King Edward VII’s Hospital can provide expert treatment, advice and guidance. Make an enquiry.