Updated: May 11
Were you aware that your reflux and heartburn symptoms are most likely NOT due to excess stomach acid? Although acid lowering drugs like Losec (Omeprazole), Mylanta & Gaviscon can do a great job of relieving your symptoms they aren't actually addressing the underlying cause.
So what are the underlying causes of gastro-oesophageal reflux (GORD) and what can you do differently to heal and prevent the symptoms?
Most of us have experienced some kind of indigestion or heartburn at some point in our adult life. Maybe after pigging out on a huge plate of greasy fish 'n' chips?
Heartburn is that awful burning feeling which rises from the upper stomach or lower chest up towards the neck. If it occurs around twice a week it is considered acid reflux. More than twice a week, it is called GORD (or GERD in the US).
Other common symptoms of GORD include:
pain in the upper abdomen and chest
an acid taste in the mouth
nausea or a sick feeling
burning pain when you swallow hot drinks
Less common symptoms include:
A persistent cough (particularly at night)
Abdominal pain and/or bloating
Enamel erosion of the teeth and frequent cavities
Regurgitation of food after eating
Sleep issues such as sleep apnoea
Recurrent ear infections, sinusitis and pharyngitis.
To understand the causes we must first understand how digestion works.
Just thinking of a delicious piece of chocolate cake kicks our stomach and mouth salivary glands into action. This is our body's way of preparing itself for the essential task of digestion.
Digestion allows us to convert food into energy and the vital nutrients required for our body to function. A large number of organs are involved, from our mouth (and brain), all the way down to our anus.
In our mouth, saliva contains enzymes to help break down food into smaller particles we can absorb and use. Any swallowed food and saliva reaches the stomach by way of wave like motions along a long tube called the oesophagus.
Once in our stomach, the food is further broken down by digestive enzymes.
One potent enzyme, pepsin, breaks down proteins but it requires adequate hydrochloric acid to become active. Hydrochloric acid is produced by the cells in the stomach wall, however, it is reliant on adequate levels of zinc, vitamin B1 and B6.
Around three times after each meal the contents of our stomach very briefly reflux up into the oesophagus. Swallowed saliva helps to neutralize the acidic contents and prevent any damage to the oesophagus.
A bundle of muscles called the lower oesophageal sphincter (LOS or LES in the US) normally helps prevent any prolonged or frequent reflux. So effectively anything that interferes with the normal opening and closing of this sphincter has the ability to cause the symptoms of reflux or GORD. Though reflux symptoms can also be due to a lack of protective mechanisms for the oesophagus such as a lack of saliva production or a damaged oesophageal lining.
The most common treatment of GORD involves the use of acid lowering drugs. Some are over-the-counter antacids like Mylanta, Gaviscon or QuickEz, or H2-receptor blockers like Ranitidine and Cimetidine. A more heavy hitter is the drug Omeprazole, also known as Losec. It is the third most dispensed drug in New Zealand.
These medications aim to neutralize, reduce or block stomach acid production. However, an overproduction of stomach acid is rarely the underlying cause, and instead only address the sym