Twenty Years of Relief: Understanding and Addressing Chronic Acid Reflux
For two decades, I battled persistent acid reflux, a condition that substantially impacted my quality of life. The journey to finding lasting relief led me to a deeper understanding of the condition, its triggers, and the expert-recommended strategies for potential permanent resolution.
Acid reflux, also known as Gastro-Oesophageal Reflux Disease (GORD), occurs when stomach acid flows back up into the oesophagus. Treatment options vary in their approach and effectiveness. Proton Pump Inhibitors (PPIs) are commonly used, with esomeprazole available over-the-counter, while others like lansoprazole require a prescription. However, these medications aren’t universally prosperous. Gastroenterologist Dr. Inder Mainie notes that “some 18 per cent of patients will suffer with reflux symptoms despite taking medication.”
This lack of consistent success is attributed to several factors. Dr. Mainie explains that symptoms may not always be caused by acid reflux itself. Moreover, PPIs can lose effectiveness over time. Proper timing is also crucial; tablets should be taken “30-60 minutes before a meal” to maximize their impact.
Interestingly, PPIs can also inadvertently contribute to digestive issues. Mr.Boyle points out evidence suggesting they can alter the gut microbiome, potentially leading to Small Intestinal Bacterial Overgrowth (SIBO) - a condition that can mimic reflux symptoms, creating a frustrating cycle of treatment and continued discomfort.
Long-term PPI use has also been linked to potential health risks, including increased susceptibility to osteoporosis, kidney damage, and infections. Therefore, Dr. Mainie emphasizes the importance of discussing “whether long-term use is appropriate for you - and if there are choice approaches – with your GP.”
Alternatives to PPIs include H2 blockers like cimetidine, famotidine, and nizatidine, wich reduce stomach acid production. However, these are “generally aren’t as effective as PPIs.”
when medication proves insufficient, surgical intervention offers a potential path to notable symptom improvement. The most common procedure is fundoplication,where part of the stomach is wrapped around the lower oesophagus to strengthen the valve preventing acid leakage. Mr. Boyle states that fundoplication “adds 20-50 per cent of the final strength of the new sphincter and also helps prevent recurrence.” This procedure is widely available on the NHS and typically performed using keyhole surgery, boasting an 80-90% success rate. Repairing a hiatus hernia is often performed concurrently. Potential side effects include gas, pain, bloating, and swallowing difficulties.
Less invasive options are also available. The LINX procedure involves placing a bracelet of magnetic beads around the valve, allowing food to pass through while magnetically sealing afterward. While highly successful, it’s unsuitable for individuals with pre-existing swallowing problems and can cause difficulty swallowing, bloating, and wind. It’s available on the NHS in some hospitals and privately, costing between £10,000 and £12,000.
A newer procedure, RefluxStop, involves inserting a silicone device at the top of the stomach to reinforce valve closure. This is particularly suitable for patients with pre-existing swallowing difficulties as it doesn’t compress the oesophagus. Currently, RefluxStop is only offered in three NHS hospitals (two in London, one in Southampton) and privately, at a cost of £15,000 to £17,000.
This exploration of treatment options,combined with a focused understanding of individual triggers,has been instrumental in my journey towards managing and potentially resolving my chronic acid reflux.
