Acid Reflux and IBS

Acid reflux and IBS commonly coincide. Heartburn or a discomfort in the chest occurs in a lot of people, but no more so than with this condition.

Other symptoms can include burping, belching, fullness, sore throat, pain on swallowing, acid brash (acid taste in the mouth), loss of tooth enamel with subsequent decay and wheeze.

Wheeze occurs because of acid refluxing in to the upper airway and can mimic asthma.

I commonly get referrals from ENT surgeons who have investigated unexplained cough.

Troublesome cough or wheeze, that is worse at night, is classic for GERD as well as asthma.

Acid Reflux and IBS

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Mechanisms That Prevent Reflux

It’s intriguing that this is such a common symptom in IBS and there are mechanisms that may explain this.

To understand this further, you need to know how your body prevents gastroesophageal reflux disease.

When you swallow food, it travels down your esophagus by a process known as peristalsis.

When it reaches the junction between the esophagus and stomach, known as the gastroesophageal junction or GEJ, the junction opens to allow food to enter your stomach.

There are various mechanisms which prevent the acid in your stomach coming back in to the esophagus.

These include closure of the GEJ by a muscular ring when your stomach contracts, changes in your intrabdominal pressure with breathing and straining, peristalsis itself and food acting as a buffer.

If any of these are affected, acid reflux and IBS can be an issue.

So....

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What Increases Heartburn?

If you are overweight, intrabdominal pressure is altered and GERD can occur.

Certain foods including caffeine (in tea, coffee, carbonated drinks), chocolate, alcohol and peppermint can all relax the muscle ring at the GEJ.

If you have been pregnant before, you will know that heartburn is common due to the pressure exerted by the growing baby and womb.

Smoking relaxes the GEJ as well as reducing the contractions in your stomach. 

Structural abnormalities such as a hiatus hernia, where your stomach protrudes through the diaphragm muscle in to your chest, increases symptoms.

The diaphragm splits your chest from your abdomen. If your stomach is in your chest, you no longer have the GEJ to prevent heartburn.

You also have an acid producing organ in your chest, and acid therefore has a ‘free run’ in to your esophagus.

So….

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Why Acid Reflux and IBS?

Some of the medications used in IBS are peppermint based and these can relax the muscle ring, Colpermin, Mintec and Peppermint Oil capsules to name but a few.

Some sufferers have weight issues largely due to the diets they eat.

High carbohydrate diets tend to cause weight gain and this is associated with increased heartburn.

IBS-C or constipation predominant symptoms can increase reflux due to the increased abdominal pressure you create by straining.

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Treatment of Acid Reflux

Simple lifestyle measures may be all that is needed for you.

If you smoke, this needs addressing. If you are gaining weight, you need to address this by increasing your level of exercise, but also by trying to reduce the number of calories in your diet.

If reflux has occurred since taking a peppermint based treatment, ask your doctor if they can offer you an alternative.

Cutting out caffeine and alcohol may help improve your symptoms too.

If you have IBS-C, addressing the symptoms may signal an improvement in your acid reflux and IBS symptoms.

Drugs that reduce stomach acidity can be prescribed by your doctor if your symptoms persist.

The main drugs used are proton pump inhibitor drugs commonly referred to as PPI’s.

There are many different ones available, the most common ones being Omeprazole, Esomeprazole, Lansoprazole and Pantoprazole.

Other drugs in reflux include H2 antagonists, the most common being Ranitidine, Sucralfate, prokinetic drugs (Metoclopramide and Domperidone) and Calcium or Magnesium based antacids.

Surgery can be considered if all these measures fail, but needs to be discussed with your doctor or surgeon.

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When Should I Have Investigations For My Reflux?

Most people with acid reflux and IBS don’t require investigation, as the diagnosis is made on the set of symptoms you have.

Helicobacter pylori infection, a bacterium that lives in some peoples stomachs, is associated with reflux and indigestion as well as ulcers.

A simple blood, stool or breath test can determine whether you have this infection which can be treated with a combination of antibiotics and acid suppressants

Investigations should be considered if your symptoms are persisting, particularly if you are over the age of 55 years.

Unusual symptoms such as odynophagia (pain on swallowing), dysphagia (food sticking), weight loss and anemia should all be investigated further.

The main test is a gastroscopy, a flexible camera that is passed through the mouth and down the esophagus to the stomach and duodenum or small bowel.

It is performed under sedation or with a local anesthetic spray to the back of the throat.

An alternative to gastroscopy is a barium swallow and meal where barium, a dye that shows up on x-ray, is swallowed and its course followed with x-rays.

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