What tests might be done?

Tests are not usually necessary if you have typical symptoms. Many people are diagnosed with 'presumed acid reflux' when they have typical symptoms, and the symptoms are eased by treatment. Tests may be advised if symptoms: are severe, or do not improve with treatment, or are not typical of GORD.

• Endoscopy is the common test. This is where a thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. With oesophagitis, the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid, and can have symptoms with little or no inflammation to see.
• A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.
• Other tests such as heart tracings, chest x-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

The following are commonly advised. However, there has been little research to prove how well these 'lifestyle' changes help to ease reflux.

• Smoking. The chemicals from cigarettes relax the sphincter muscle and make acid reflux more likely. Symptoms may ease if you are a smoker and stop smoking.
• Some foods and drinks may make reflux worse in some people. (It is thought that some foods may relax the sphincter and allow more acid to reflux.) It is difficult to be certain how much foods contribute. Let common sense be your guide. If it seems that a food is causing symptoms, then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include: peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee, and alcoholic drinks.
• Some medicines may make symptoms worse. They may irritate the oesophagus, or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include: diazepam, theophyline, nitrates, and calcium channel blockers such as nifedipine. Tell a doctor if you suspect that a prescribed medicine is making symptoms worse.
• Weight. If you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms.
• Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach which may make any reflux worse.
• Bedtime. If symptoms recur most nights, it may help to go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime, and don't drink in the last two hours before bedtime. If you raise the head of the bed by 10-15 cms (with books under the bed's legs), this will help gravity to keep acid from refluxing into the oesophagus.

What are the treatments for acid reflux and oesophagitis?

Antacids
These are alkali liquids or tablets that neutralise the acid. A dose usually gives quick relief. There are many brands which you can buy. You can also get some on prescription. You can use antacids 'as required' for mild or infrequent bouts of heartburn.

Acid-suppressing medicines
Two groups of medicines are used - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 antagonists). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. PPIs include omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 antagonists include cimetidine, famotidine, nizatidine, and ranitidine. You can buy some low dose brands at pharmacies. You can use these low dose brands 'as required', or take short courses when you get short bouts of heartburn.

If you get symptoms frequently then see a doctor. You may be advised to take a daily dose of an acid-suppressing medicine to prevent symptoms from occurring. The dose that a doctor prescribes is usually higher than the dose that you can buy. The treatment plan with acid-suppressing medicines can vary from person to person.

• You may be advised to take a full dose course for a month or so. This often settles symptoms down and allows any inflammation in the oesophagus to clear. After this, all that you may need is to go back to antacids 'as required'.
• Some people need a course of treatment every now and then when symptoms flare up.
• Some people need long-term daily acid suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment is thought to be safe, and side-effects are uncommon. The aim is to take a full dose course for a month or so to settle symptoms. After this, it is common to 'step-down' the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed in some cases.

Prokinetic medicines
These are medicines that speed up the passage of food through the stomach. They include domperidone and metoclopramide. They are not commonly used but help in some cases, particularly if you have marked bloating or belching symptoms.

Surgery
This is an option if medicines fail to prevent symptoms, or if you need medication every day to control symptoms. An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery, and has a good success rate.

Are there any complications from oesophagitis?

• Stricture. If you have severe and long-standing inflammation it can cause scarring and narrowing (a stricture) of the lower oesophagus. This is uncommon.
• Barrett's oesophagus. In this condition the cells that line the lower oesophagus become changed. The changed cells are more prone than usual to become cancerous. (About 1 or 2 people in 100 with Barrett's oesophagus develop cancer of the oesophagus.)
• Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.

It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty (food 'sticking') when you swallow which may be the first symptom of a complication.

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