For most people, an occasional bout of heartburn or acid reflux - a burning sensation in the middle of your chest - isn’t a cause for concern. If you’re experiencing it most days, this may be an indication of a more serious condition that requires medical attention. In this article, we explore some of the causes of heartburn and steps to take if you are a frequent sufferer.
Heartburn is a common condition affecting up to one in every four UK adults (Guts UK). It causes a burning sensation in the chest, usually after eating, and occurs when stomach acid or bile irritates the lining of the oesophagus (gullet), the tube that connects the mouth to the stomach.
The lower oesophageal sphincter (LES), a ring of muscle at the bottom of the oesophagus, typically prevents stomach contents from flowing back into the oesophagus. However, if the LES weakens or relaxes abnormally, stomach acid can reflux into the oesophagus, causing heartburn.
Several factors can contribute to this weakening of the LES, such as overeating, consuming spicy or fatty foods, drinking alcohol or caffeine, and smoking. Other contributing factors can include obesity, pregnancy and certain medications like aspirin or blood pressure drugs.
Lifestyle factors like stress and eating large meals close to bedtime also increase the likelihood of experiencing heartburn. While occasional heartburn is common, and can be managed by over-the-counter medication or lifestyle changes, in some cases a condition called Gastro-Oesophageal Reflux Disease (GORD) can develop, characterised by frequent and severe heartburn episodes.
Damage caused by GORD can lead to more serious medical problems such as difficulty swallowing (dysphagia), narrowing of the oesophagus (strictures) and Barrett’s oesophagus, a change in the cellular structure of your oesophagus lining, so it’s important to get yourself checked.
If you have symptoms of GORD, such as severe heartburn, pain when swallowing, or regurgitation (food coming back up into the oesophagus), see your GP, who may recommend a gastroscopy and a pH test using the Bravo™ Reflux Testing System.
What is a gastroscopy?
A gastroscopy is a test to ensure there are no underlying problems with your oesophagus or stomach. It is usually carried out as an outpatient procedure in our Ambulatory Care Unit (ACU), which means you won't have to spend the night in hospital.
The procedure involves gently passing a thin, flexible tube with a camera on the end (called a gastroscope or endoscope) through the mouth down into your oesophagus, stomach and start of your small intestine (duodenum). Your throat will be numbed with a local anaesthetic spray, and you may also be offered conscious sedation to make you sleepy and relaxed. The Consultant will then examine the lining of the gullet, stomach and duodenum, looking for signs of inflammation. The procedure is not painful, but it may be a little uncomfortable at times.
Forty to sixty percent of patients with typical reflux symptoms may have no evidence of inflammation of the oesophagus or of abnormal acid exposure.
You may also be recommended to have a Bravo™ pH test, an additional test that can be performed during the gastroscopy to determine if you have GORD.
Evaluation of symptoms with a Bravo™ pH test
A Bravo™ pH capsule monitoring test is a minimally invasive method of measuring the pH levels (acidity) in your oesophagus to discover if stomach acid is backing up into it.
It is a diagnostic test, so doesn't treat the symptoms of heartburn or acid reflux but gives your Consultant an indication of what's causing your symptoms.
How does the Bravo™ pH test work?
In a quick five-minute procedure performed under sedation in our JAG-accredited Endoscopy Unit, your Consultant will place a Bravo™ Reflux capsule onto the wall of your oesophagus. When in place, you may have a vague sensation that something is there, but it shouldn’t be painful.
You’ll then receive a recorder - to be worn on a waistband/belt - which receives pH data wirelessly transmitted from the capsule.
You’ll then be discharged from our hospital to begin your test period. If you have had sedation, you will need someone to help you get home and stay with you for 24 hours.
The length of your test period will have been indicated by your Consultant but will last between 48-96 hours. During this period, you’ll also be asked to complete a diary detailing your food, drink and any symptoms experienced.
Once the test period is up, your disposable Bravo™ reflux recorder will detach from your oesophagus and be passed in your stools. The pH data is then downloaded onto a computer and analysed by your Consultant, who will discuss treatment options.
The test is often useful when considering if anti-reflux surgery such as fundoplication would be appropriate.
Bravo™ Reflux Testing at Benenden Hospital
If you’re experiencing frequent indigestion, heartburn or acid reflux, you may benefit from the Bravo™ Reflux Testing System to evaluate your symptoms.
To book an appointment, contact our Private Patient team by completing our online enquiry form, get in touch via Livechat or by calling 01580 363158.
Published on 14 January 2025