Almost everyone has had heartburn at some point. It feels like a burning pain behind the breastbone, caused by stomach acid rising up and irritating the lining of the oesophagus. Some people notice it more when lying down, when the valve at the top of the stomach does not close properly and lets acid flow back up.
What is GORD?
GORD stands for gastro-oesophageal reflux disease, a condition where stomach acid repeatedly flows back into the oesophagus. It can cause more than the familiar burning feeling behind the breastbone. Other signs include frequent throat clearing, hoarseness, difficulty swallowing, a long-lasting cough or the feeling of a lump in the throat. Any chest pain that is new or unexplained should always be checked by a doctor.
How can heartburn be prevented?
For many people, lifestyle changes are the first step. Very fatty, acidic or spicy foods often trigger symptoms, and smoking can make heartburn worse. If you get reflux, it helps to notice whether symptoms follow particular foods or drinks. Common triggers include spicy meals, citrus juices, tomato-based foods, fizzy drinks, alcohol, coffee, chocolate and fast food. Large evening meals are also best avoided, and it helps not to lie down for a couple of hours after eating.
What helps when heartburn occurs?
The usual first-line treatments are antacids and alginates, such as Gaviscon, which are available over the counter and work by neutralising acid or forming a protective layer over the stomach contents. If you need them often, or they are not controlling your symptoms, speak to a pharmacist or doctor rather than relying on them long term. Raising the head of your bed can help if your symptoms are worse at night.
Does heartburn matter before weight loss surgery?
If you get heartburn, whether occasionally or often, it is important to mention it at your pre-operative consultation. Your team will take it into account when choosing the most suitable procedure. A gastroscopy may be recommended to confirm whether reflux is the cause. If stomach acid has already affected the oesophagus, a gastric bypass may be advised instead of a gastric sleeve, as a bypass tends to reduce reflux. A gastric sleeve may still be possible if the heartburn is caused by a hiatus hernia, which can be repaired during the operation.
What if heartburn appears after surgery?
Carrying excess weight can cause heartburn, but a gastric sleeve can also change the anatomy in a way that brings on new symptoms, more often than many people expect. On average, around a third of gastric sleeve patients develop new reflux, around a third find existing reflux worsens, and around a third notice no change or an improvement.
In many cases, new reflux settles over time, and acid-blocking medication can be used for a while and then reduced as your diet returns to normal. Some people have longer-lasting symptoms and may need ongoing medication. If reflux is severe and does not respond to treatment, converting a gastric sleeve to a gastric bypass can provide significant relief. Even after a bypass, some people still get occasional reflux, which can usually be managed with dietary changes or antacids.
When to see a doctor
Speak to your doctor if heartburn happens more than twice a week, is not controlled by over-the-counter treatment, or disturbs your sleep. Some symptoms need prompt medical attention, including difficulty swallowing, food feeling stuck, unintentional weight loss or bringing up food. These are not typical of ordinary heartburn and should always be checked.
