I Suffer with Heartburn; Should I Consider Lifelong Medications or Keyhole Surgery

In this article, Mr Ahmed Hamouda, Consultant General, Upper GI and Bariatric Surgeon, explores the causes, symptoms and treatment options for heartburn and acid reflux, including the considerations around long-term medication and keyhole surgery. Drawing on his specialist expertise in upper gastrointestinal conditions, Mr Hamouda outlines when further investigation may be needed and how patients can make informed decisions about their care.

Symptoms:

Heartburn or reflux is a common symptom suffered by almost 30% of the population. It can be triggered by spicy food intake, acidic drinks or even stress. A sensation of burning behind the chest plate or discomfort accompanied with food sticking or difficulty swallowing are hallmarks of acid reflux. Sometimes regurgitation of food or fluid into the back to the throat or mouth can occur when lying flat.

Initially, dietary modifications such as avoiding foodstuffs responsible for increasing acid reflux and sleeping propped up in bed can help treat the most troublesome symptoms. Weight management and using over the counter medications such as Gaviscon can also help.

As a last resort your GP will prescribe anti-acid medication, the most popular being proton pump inhibitors (such as Omeprazole or Lansoprazole).

Anti-acid medication:

Proton pump inhibitors are effective medications decreasing the acid production of the stomach significantly so that hardly any acid travels up into the gullet to cause inflammation and symptoms. However recently there has been more research and awareness regarding the long-term effects of using these medications. The resultant reduction in stomach acid may contribute to decreased absorption of essential minerals which may lead to decreased bone density, lack of essential vitamins and early onset of neurological change amongst other risks.

Diagnosis:

When your symptoms become severe and increasing doses of anti-acid medication are required to control them, or if you are worried about the risks of long-term use of the medication then getting your GP to refer you for diagnostic tests is a good idea. As a first step, performing an endoscopy to visualise the lining of the gullet is essential and can confirm findings such as oesophagitis, hiatus hernia or Barrett’s oesophagus. To enable conversations about keyhole surgery as an alternative to use of anti-acids, a Bravo pH test may be required. The tiny wireless probe is placed by endoscopy in the gullet 2 inches above the stomach. It sends wireless information about the amount of acid coming up over a period of 3-4 days and then falls off to be eliminated through the bowel.

Treatment:

With our recent awareness of the risks of anti-acid use, more and more people are now considering having keyhole surgery to treat their reflux in the long term. The operation takes 30-45 minutes to perform and has 3 stages; freeing up and reducing a hiatus hernia (if one is found), stitching the diaphragm and wrapping the stomach around the lower end of gullet to re-create a valve that stops acid reflux. The procedure can be performed as day surgery or require a single night and recovery is usually swift.

About Mr Ahmed Hamouda

To find out more about heartburn, reflux investigations, and the full range of treatment options available, or to book a consultation with Mr Ahmed Hamouda, please click here. A personalised assessment can help determine the most appropriate and effective long-term solution for you.