Reflux disease leading to severe complications and death

Dr. Pulak Sahay, Campaign Against Reflux Disease

If Reflux disease is poorly controlled, it can cause considerable discomfort and lead to poor quality of life. Heartburn can cause a host of complications like nocturnal cough, asthma and laryngitis while gastrointestinal infection(GI) problems can cause severe complications such as Oesophageal ulcers, Barrett's oesophagus and Oesophageal Cancer (OC).

In 2014, OC was the 6th most common cause of cancer deaths in the UK and killed an estimated 7800 people per year, equating to 21 deaths per day. Data from the same year estimated the 10-year survival rate of oesophageal cancer at around 12%, with late diagnosis being thought as one of the contributing factors of such a low survival rate, in comparison to other forms of cancer. Therefore, early detection can play a pivotal role in increasing the survival rate of this condition.

Any patients using anti-reflux medications for two months and who are still suffering from heartburn at least twice a week, should be reviewed by their GP. It is important to ensure that the patients are taking proton pump inhibitors (PPI) 30 minutes before meals as taking PPI with or after food makes acid suppression inefficient and inadequate. Inappropriate timing of PPI is the commonest cause of PPI failure. (H2RA) H2 receptor antagonists like Ranitidine should be taken nightly but only intermittently as these are subject to tachyphylaxis where the body becomes resistant to the drug within 2 weeks of their regular intake. Alginates form a raft over the refluxate and hence are best taken after food especially at night before bed to control heartburn. Red flag symptoms or alarm features, which warrant urgent referral to the gastroenterologist includes:

  • Weight loss 
  • Iron-deficiency anaemia 
  • Any GI bleeding 
  • Persistent vomiting 
  • Difficulty swallowing 
  • The feeling that food is getting stuck in the chest or in their throat

Scope of the problem 

It is widely accepted that most people will suffer from heartburn at some stage in their life and people will simply accept it as a normal part of their daily life. However, they do not appreciate that if left untreated, they are putting themselves at greater risk of developing more serious conditions, including OC. A great deal of public education needs to be done to highlight to the public that suffering from heartburn is not something that can be ignored or tolerated, and that they should seek help as soon as possible to ensure that the risk of developing complications, are reduced.

One such charity that promotes education about Reflux disease is called Campaign Against Reflux Disease (CARD). The website provides information about the condition and about life style modifications that the patients can take on board to self-manage their condition and reduce the risk of associated complications as well as seek help from their doctors if symptoms persist or there is development of alarm features.

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