Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon

Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

Information is supplied only upon the condition that the viewer will make their own determination as to the suitability of the information for its purposes prior to use. There will be no responsibility for information that is misused or misinterpreted and the information should not be used as a substitute for consultation with a health care professional. It is not possible to answer questions regarding individual cases or to enter into individual correspondence.

Gastro-oesophageal reflux

In some people, stomach acid or its contents may come up in to the throat and oesophagus (the gullet connecting the throat to the stomach). This may occur at any time day or night but is most common after meals and when lying down. Some of the symptoms that may occur from this include recurrent coughing, sore throat, heart burn or indigestion, hoarseness or changes in voice, constant throat clearing, excessive mucous or “post nasal drip”, a bad taste at the back of the mouth or a sensation of a lump in the back of the throat. The oesophagus has condensations of circular muscle at the upper and lower end to prevent reflux but these are controlled by the same nervous connections and both contract to the same stimulus. This is why reflux at the lower end alone can also produce a feeling of tightness at the top of the oesophagus. Your ENT Surgeon will be able to exclude other causes for these problems. This may require a contrast x-ray or an endoscopic examination, sometimes under general anaesthetic.

The following instructions are designed to help neutralise the stomach acid, reduce the production of acid, and prevent acid coming up the oesophagus or gullet.

Posture

Obesity is a significant factor in promoting reflux of stomach contents. One should avoid clothing that fits tightly across the midsection of the body, avoid slumping, bending or stooping as much as you can, especially after eating.

For many people, acid reflux occurs mostly at night and sets up the irritation, which continues to bother during the daytime. One of the most important things you can do is to sleep on a bed, which is elevated at the head end. To do this, use wood or bricks or even telephone directories underneath the legs at the head of the bed. The elevation should be 4-10” but not so high that you will slide down when sleeping. The use of pillows to get the head up is not effective because they cause the body to curve and it is difficult to remain upright on them all night. Furthermore, pillows promote sleeping on the back but it is preferable to sleep on the right side or on the stomach since this will allow gas to escape from the stomach and reduce the reflux of acid material.

Antacids

These are available without prescription at your local pharmacist. Gaviscon is not an antacid but floats on top of the stomach acid preventing oesophageal irritation. Antacids can interfere with the absorption of certain drugs such as tetracyclines from the intestine and it is therefore important that patients are aware of this side effect. In the beginning you may wish to take the antacids just at bedtime, but if symptoms are very persistent, they should be taken 45 minutes after eating, every two hours between meals and at bedtime.

Medications which promote reflux

Several different medications may increase stomach acid. These include: Progesterone, Theophylline, Anticholinergics, Betablockers, Aspirin or aspirin containing compounds especially the group called non steroidal anti-inflammatory drugs. Vitamin C is also an acid and can give stomach symptoms if taken in large doses. Tobacco also increases the amount of acid reflux. It is wise that any patient consults his or her General Practitioner before making any changes in these medications.

Diet

1. Avoid eating large meals. Eat smaller, more frequent meals rather than one or two meals per day. Sit up straight during and after eating and do not eat for two or more hours before going to bed.

2. Certain foods tend to cause acid production. These include caffeinated and decaffeinated coffee, tea, carbonated drinks, chocolate, spearmint, peppermint and alcohol. These foods are known to cause relaxation of the muscle band between the stomach and the gullet, allowing the stomach acid to come up and irritate the oesophagus and throat. Many of these can also stimulate acid production, therefore making the problem worse.

3. You should avoid any other foods which cause you to have heartburn. Certain foods which may cause heartburn are highly spiced foods, tomato and tomato products and citrus fruits and juices.

© Vincent Cumberworth 2005