The stomach makes acid to help digest food as one of its normal functions. Normal and regular movements in the digestive system (motility) that push food along help to keep this acid where it belongs – in the stomach. Reflux occurs when some of this acid and food regurgitates into the oesophagus (gullet) – the tube connecting the mouth to the stomach. The problem is not usually too much acid, but simply that it is in the wrong place. Reflux generally occurs because the muscle (sphincter) that keeps the oesophagus closed off from the stomach is not working properly, allowing acid and food to rise back up. In addition, the normal movements of the digestive system may be weaker or less regular than they should be. If this happens, any acid that gets into the oesophagus tends to stay there instead of being moved back into the stomach before it has a chance to cause any damage. Reflux affects about one in ten of us at any time and anyone, from children to the elderly and people from all walks of life, may experience the pain and discomfort it causes.

Reflux can cause a variety of symptoms. Most people with reflux get heartburn – a feeling of burning, discomfort or pain in the chest. However heartburn can be totally absent in some people with quite severe reflux and its absence does not exclude reflux. Another typical symptom is regurgitation, the sudden rise of stomach contents into the back of the throat or mouth. This can often taste bitter and may make you feel like being sick. Other less common symptoms of reflux can include:

• Sudden mouth watering
• Husky voice
• Throat irritation
• Pain or difficulty when swallowing
• Coughing or wheezing at night
• Feeling sick, full or bloated and unable to finish a meal.

Most people with reflux experience symptoms about 1-2 hours after a meal. Usually the symptoms are quite mild and may pass unnoticed. However if reflux is severe it can cause painful inflammation of the oesophagus (oesophagitis). Interestingly, patients with the worst symptoms do not always have the most severe disease, i.e. some people with severe oesophagitis have only mild symptoms. There are many things that can make reflux worse including:

• Eating large meals
• Eating too quickly
• Spicy or fatty foods
• Alcohol, or beverages containing caffeine – tea, coffee and some soft drinks
• Smoking
• Bending over or straining
• Being overweight
• Being pregnant

Treating Reflux – Lifestyle People with reflux can do a lot to help themselves feel better. Making some simple changes to the daily routine is worth trying.

• Eat frequent small meals at regular times during the day
• Eat slowly, taking care to chew the food well
• Cut down on coffee, tea and cola
• Drink less alcohol, particularly before going to bed
• Raise the head of the bed or use extra pillows
• Lose weight if necessary
• Stop smoking

For some people this may be all that’s necessary to keep symptoms under control. If these changes are not enough your doctor may also prescribe medication to help control the symptoms and stop reflux from happening. Medications that reduce the amount of acid produced by the stomach (while leaving enough for normal food digestion) can help. However, they do not prevent acid reaching the gullet, they just reduce the amount that gets there. That is why acid-lowering drugs have no effect on the cause of reflux and cannot stop the symptoms from coming back. Medications that stop reflux from occurring work by helping the digestive system to work as it should, keeping acid where it belongs. Known as prokinetic agents, they help restore the normal function of the sphincter. They also help restore normal movement (motility) in the digestive system so any acid that does get into the wrong place is quickly swept back into the stomach. In other words, prokinetic agents relieve the symptoms of reflux by tackling the cause of the problem.