How can i improve my reflux symptoms?
Reflux symptoms are a common problem that I see in my gastroenterology clinic in Oxford. Gastro-oesophageal reflux disease (GORD or GERD) is when acid or non-acid stomach contents come back up into the oesophagus (gullet), and sometimes into the back of the throat and mouth. This can cause inflammation and damage, as well as troublesome symptoms. The most common symptoms of reflux are:
Heartburn (pain or discomfort in the chest, behind the sternum (breastbone).
Belching or burping
Upper abdominal discomfort or pain (dyspepsia)
Metallic or bitter-tasting fluid in the back of the throat
Sore throat, cough or excessive mucus
First, it's important to see your doctor or a specialist for persistent or worsening reflux symptoms, particularly in patients over 45. Sometimes new or worsening reflux disease can be a sign of serious illness, including cancer, and further investigations, most commonly a gastroscopy (OGD - camera test in the stomach) is needed.
Reflux symptoms are often treated with medications like proton pump inhibitors (omeprazole, lansoprazole, esomeprazole), histamine receptor blockers (famotidine), and antacids (Gaviscon or similar. However, changes to diet and lifestyle are just as important to get your symptoms under control.
Lifestyle changes to manage reflux:
Manage your weight. Losing excess weight can really help with reflux. Maintaining a healthy weight reduces abdominal pressure that can compress the stomach and worsen reflux.
Stop smoking and reduce nicotine use. Smoking and nicotine causes the muscles at the bottom of the oesophagus to relax, which can increase reflux. This also applies to nicotine replacement products (although these are much safer in other ways).
Wear loose-fitting clothing. Tight waistbands and constrictive clothes around the abdomen can worsen symptoms.
Try relaxation approaches. Stress and anxiety can aggravate reflux, and there is evidence that a range of relaxation approaches can help symptoms.
Try a gentle walk after meals, particularly in the evening. This can help stomach emptying and reduce reflux.
Elevate your head when sleeping. Raising the head of the bed by 15-20cm can help reflux overnight. Try putting something under the legs of the bed or under the mattress, or use a triangular wedge cushion under your pillow.
Diet changes to manage reflux:
Smaller, more frequent meals. Large meals will fill the stomach right up and take a long time to empty from the stomach, which can worsen reflux.
Eat early. Try to eat most of your calories in the first half of the day. For your evening meal, eat light, avoiding high fat foods, and eat early, ideally 3-4 hours before you usually go to bed.
Eat slowly and mindfully. Eating fast can lead to overeating and not chewing food completely, which will slow stomach emptying.
Identify your food triggers: Common culprits that worsen reflux include coffee, chocolate, tomatoes, fatty meals, alcohol, and spicy food. You may not need to avoid them completely, but reducing the size of portions may help also.
Stay hydrated with water. Dehydration can worsen reflux. Try to stay hydrated with water intake throughout the day. Try not to drink too much at meals (to avoid the stomach getting too full) and avoid drinking too much volume in the 1-2 hours before bed.
Try ginger infusions. Ginger teas can help with stomach emptying.
If symptoms are bothersome, persistent or progressive, or if you have any issues with bleeding, swallowing problems, loss of appetite or weight loss, you may need urgent investigations. Troublesome reflux which does not improve with the measures above may be due to conditions like hiatus hernia, or may need further intervention like anti-reflux surgery.
If you would like to book a consultation at the Manor Hospital, Oxford, or online with Dr Michael FitzPatrick to discuss your reflux and arrange investigations, please do get in touch.
