This awful burning sensation

Published: Wednesday | March 4, 2009



After eating a meal, have you ever had the uncomfortable experience of 'repeating' the food or drink at the back of the mouth and burping accompanied by an awful burning sensation in the throat and the middle of the chest? Well these are symptoms of gastro-oesophageal reflux (GOR). If you have this experience more than twice per week, you could be having a more serious form of GOR, called GORD or gastro-oesophageal reflux disease (also known as GERD in the US).

The condition, GORD, has some association with asthma, but classic symptoms are acid indigestion, regurgitating stomach acid, a burning pain behind the breast bone, and difficulty swallowing. The burning pain sometimes radiates to the neck and face.

GORD in babies

Acid reflux is common in babies and children and should be investigated if after age one the child experiences frequent regurgitation, stomach discomfort, dry coughing or wheezing, especially during or after feeding.

The weight problem

GORD is common in people who are overweight or pregnant. Smoking is a contributing factor. Some foods and drugs are associated with the disease. These foods stimulate the stomach to produce more acid:

Fatty and fried foods

Spicy foods, including garlic, onion and pepper

Alcohol

Acidic foods like citrus fruits, tomato and its sauces

Caffeine-containing drinks like coffee and some sodas

Mint products

Chocolate

Managing GORD

Of course, based on the above, lifestyle changes are a favourable option for treating GORD:

Lose weight. Watch out for The Gleaner's Health section's weight management series starting next Wednesday!

Stop smoking.

Avoid excessive alcohol and the aggravating foods.

Avoid lying down within three hours of eating.

Raise your bedhead about six inches to encourage acidic stomach contents to flow away from the oesophagus while you lie down.

Eat small, frequent meals.

Drug treatment

While we practise lifestyle changes, drug treatment for GORD may offer immediate relief.

Antacids taken one hour after meals and at bedtime will neutralise the stomach acid. Additionally, some antacids like Rennie and Gaviscon contain compounds called alginates extracted from algae (seaweeds). This forms a thick gel which floats on the top of the stomach contents, acting like a raft to prevent the stomach acid from going backwards into the oesophagus.

People with high blood pressure and those on sodium-restricted diets must choose antacids that don't contain sodium. People with kidney trouble should not take antacids that have aluminium or magnesium.

If you find that you are using antacids for more than two weeks without much relief, check with your physician. Antacids are sometimes prescribed with drugs from either of the two groups below.

Proton pump inhibitors like esomeprazole (Nexium), lanso-prazole (Ogastro,Lanzap), ome-prazole (Losec), pantoprazole (Pantecta), and rabeprazole (Pariet) are remarkably effective in stopping stomach acid production. When there is minimal or no stomach acid, the oesophagus and stomach get time to heal. Treatment with these products lasts four to eight weeks. Proton pump inhibitors should be used with caution in pregnant women and people with liver disease.

Histamine-2 receptor antagonists like ranitidine (Zantac, Apo-Ranitidine), cimetidine, and famotidine (Pepcid) relieve the symptoms of GORD by reducing the amount of stomach acid produced. You may purchase the ranitidine without a prescription in its lower 75mg strength. Exercise caution with these products if you are pregnant, breastfeeding or have kidney trouble.

Motility stimulants like metoclopramide (Apo-Metoclop) make the stomach empty faster and in the right direction - downwards. They also help the ring of muscles at the end of the oesophagus to shut more tightly, preventing upward movement of acidic stomach contents.

The option of surgery is only explored when lifestyle changes and medication are not helpful. The oesophageal muscle is repaired.

Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: yourhealth@ gleanerjm.com.