Are you one of the 1 in 3 Australian adults who have heartburn at least monthly? New guidelines from the Gastroenterological Society of Australia advise the use of more powerful drugs called proton pump inhibitors, which give quick and effective relief for most reflux sufferers.

What is reflux? 

Reflux occurs when stomach acid escapes into the oesophagus (the gullet), as a result of a leaky valve between the stomach and oesophagus. This can cause a chemical burn in the lower end of the oesophagus. 

Common symptoms are:

• Heartburn: a burning feeling rising up from the stomach or lower chest towards the neck. 
• Regurgitation: The taste of sour or bitter acid in the mouth. 
• Indigestion: a burning pain or discomfort in the upper tummy.
• Belching, dyspepsia or nausea.

Symptoms are often worse after meals, at night and when bending over.

How is it investigated?

Patients with minor symptoms do not need investigation. However, if symptoms are severe or do not respond to treatment, your doctor may advise endoscopy, in which a a flexible telescope is used to examine the oesophagus and stomach, while under sedation.

How is reflux treated?

Lifestyle changes can help in many cases:

• Avoid foods that provoke your symptoms such as fatty and spicy foods, cola, excess coffee, chocolate, peppermints, tomato and orange juice. 
• Do not eat large meals within two hours of lying down or going to bed. 
• Avoid tight-fitting garments. 
• Raise the head of the bed or use a wedge pillow for night-time symptoms. 
• Avoid excess alcohol.
• Stop smoking. 
• Reduce weight if obese.

For troublesome symptoms, the new guidelines recommend the proton pump inhibitors (PPIs) be used first. These drugs dry the acid in the stomach and relieve symptoms quickly and effectively in most cases. Minor cases may be treated with antacids or older acid-suppressing agents (eg ranitidine, cimetidine).

After initial treatment, most patients will require ongoing therapy, either with a short course of medication from time to time or long-term daily use. PPIs are well tolerated and side effects from continuing use are uncommon.

For more information, go to http://www.gesa.org.au/.