Reflux and Barrett’s oesophagus

What is reflux?

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid flows back into the oesophagus, the tube that connects your mouth to your stomach. This acid reflux can cause irritation, discomfort and in some cases lead to serious health issues.

What are the symptoms of GORD?

Common symptoms include:

• Heartburn (a burning sensation in the chest)

• Regurgitation of stomach contents

• Tasting acid in the mouth

Less typical symptoms may include:

• Chest pain

• Chronic cough

• Hoarse voice

• Bad breath and dental issues

• A sensation of a lump in the throat

What is Barrett’s Oesophagus?

People with long-term, untreated reflux are at risk of developing Barrett’s oesophagus. This condition occurs when prolonged exposure to stomach acid causes the normal lining of the lower oesophagus to change. Instead of its usual flat, pink cells (squamous epithelium), the oesophageal lining transforms into cells resembling those found in the stomach and intestine (columnar epithelium).

Barrett’s oesophagus is diagnosed during a gastroscopy and confirmed through tissue biopsies. Importantly, it is a recognised risk factor for oesophageal adenocarcinoma (a type of oesophageal cancer). However, Barrett’s oesophagus itself does not usually cause new or different symptoms beyond typical reflux. In fact, most people diagnosed with oesophageal cancer have not previously been diagnosed with reflux.

What causes or worsens GORD?

Several factors can contribute to or aggravate GORD, including:

• Overweight or central obesity

• Smoking

• Alcohol consumption

• Hiatus hernia (when part of the stomach moves up into the chest)

• Pregnancy (due to hormonal changes and increased abdominal pressure)

• Certain medications

• Family history of reflux disease

• Older age and male sex

How is GORD diagnosed?

Diagnosis is typically based on symptoms and response to acid-reducing medication. If further evaluation is needed, tests may include:

• Gastroscopy (upper GI endoscopy): A thin, flexible camera is passed into the oesophagus to check for inflammation or complications.

• 24-hour pH impedance study: A thin tube is inserted through the nose into the oesophagus to measure acid exposure and reflux events over 24 hours.

How is GORD treated?

Lifestyle modifications

Making certain lifestyle changes can help manage symptoms:

• Weight management: Losing weight if overweight or obese

• Smoking and alcohol: Stopping smoking and limiting alcohol to recommended levels

• Avoiding triggers: Reducing intake of foods that worsen reflux, such as spicy, fatty, or fried foods, acidic foods (e.g., tomatoes, citrus), chocolate, mints, coffee, tea, cola, carbonated beverages and alcohol

• Dietary habits: Eating smaller meals and avoiding food or drinks 2-3 hours before lying down. Avoiding bending over after meals

• Bed position: Consider elevating the head of the bed when sleeping

• Clothing: Avoiding tight-fitting clothing around the waist

Over-the-counter treatments

Antacids help neutralise stomach acid and provide temporary relief. Common options available in Australia include:

• Gaviscon

• Mylanta

• Quick-Eze

• Rennie

• Eno

Prescription medications

If symptoms persist, prescription medications may be needed. These may be taken as needed or for a longer course (typically 4–8 weeks in more severe cases).

• Proton pump inhibitors (PPIs): These are the most effective medications for GORD. They work by blocking acid secretion in the stomach. Commonly used PPIs in Australia include:

  • Esomeprazole

  • Pantoprazole

  • Omeprazole

  • Rabeprazole

  • Lansoprazole

• H2-receptor antagonists (H2RAs): These also reduce acid production but are less potent than PPIs. Available H2RAs in Australia include:

  • Cimetidine

  • Ranitidine

  • Famotidine

  • Nizatidine

Surgical treatment

Surgery may be considered if:

• Medications do not adequately control symptoms

• Side effects from medications occur

• A patient prefers to avoid long-term medication use

The most common surgical option is laparoscopic fundoplication, a minimally invasive procedure that strengthens the valve between the stomach and oesophagus to prevent reflux.