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Dear doctor: acid reflux

Dear doctor: acid reflux

From InterAction 93, autumn 2016    

Our joint medical advisers, Prof Julia Newton and Dr Gregor Purdie, answer a reader's question about acid reflux.

I have acid reflux and try my best to help myself by monitoring my diet but my doctor is only interested in prescription-only medication, or surgery to wrap the stomach around the oesophagus (quite frightening for anyone at any age). It seems there is no one to go to. The specialist I did see knew less about acid reflux and diet than I do, or friends of mine who have it. Can you share any advice? 

Prof Julia Newton says:

This question raises some important issues that I think probably affect a large number of people with M.E. Sometimes clinicians neglect to consider the fact that people with M.E. can have other common conditions like gastro-oesophageal reflux disease (GERD), or peptic ulcer disease (PUD).

Both GERD and PUD are very common conditions that affect a large proportion of the population, and they are just as likely to occur in patients with M.E. as they are in anyone else. In clinic, what I often hear are people’s descriptions of the fact that when they go to see their GP or a secondary clinician with existing or new symptoms, they are frequently told “it’s all related to your M.E.”

This can sometimes be correct, but not always. More often than not, new symptoms do warrant investigation in their own right. However, it can sometimes be very difficult to convince clinicians that new symptoms may be related to a new disease, or to the development of an existing disease, and are not always related to M.E.

I do have some considerable anxiety that there are large swathes of people with the diagnosis M.E. who have simply given up visiting their GP because of the perception that it is all related to their M.E. diagnosis, and that they are living with multiple, potentially treatable common conditions, such as GERD.

Dr Gregor Purdie says:

When an M.E. patient presents with a new symptom, it must be assessed on its own merits. Although M.E. can affect every system of your body, people with M.E. can and do suffer from other illnesses. From the general practice perspective, it is important that your symptoms are fully assessed and acted upon. Acid reflux is a symptom to be taken seriously, especially in older people, and particularly if it is a new symptom that the patient has not complained of before.

Indigestion or heartburn after a large celebration meal is not uncommon, but persistent symptoms that do not settle need looking into. Appetite, weight and other potential causes should be considered. If your appetite has been falling off for no apparent reason, it is important to have this investigated.

Loss of appetite can signify important underlying illness – particularly if that loss of appetite is associated with loss of weight too, and if you find the reflux will not settle with antacids or medications that are available over the counter. Acid reflux as a symptom of serious illness is rare, but ruling out serious conditions must be in the doctor’s mind.

It is well recognised that becoming overweight can set off acid reflux. This is particularly the case when one has a large waist measurement. It is purely mechanical: the abdominal organs push the stomach up against the diaphragm, and this pressure causes the reflux.

Trigger foods

Regarding diet, I totally agree that looking at this is core to managing the problem. It is important to not smoke or drink alcohol, and also to look at whether there are any specific foods or drinks that trigger symptoms or, conversely, that ease it (for example, a good drink of water can help dilute the stomach acid). I’m pleased to say that I’ve worked with patients over the years to achieve symptom management this way. Fortunately in the region where I work, there is a supportive dietetics service.

In unravelling the person’s problem, it is vital to make sure that there is not a new, serious illness here. If that has been excluded, then it is right and proper to take a holistic approach to treatment, including looking at diet.

For those who would like to consider medication in response to symptoms, your pharmacist or GP can advise on a good antacid to neutralise the acid – for example, Gaviscon, which protects the stomach lining. There are also more powerful, prescription medications such as Ranitidine or Omeprazole which switch off the acid production in the stomach.

As a final observation, it’s worth noting that consultants are becoming highly specialised, and so while a surgeon would be able to advise on whether an operation is required, they would not be expected to have knowledge of M.E. That’s why I feel it’s important that those with expertise in M.E., as well as seeing patients with M.E. themselves, act as a resource for their clinical colleagues.