The stomach naturally produces acid to help sterilise and digest food. However, sometimes the acid has unwanted effects on the lining of the gullet (oesophagus), stomach or duodenum causing an acid-related disorder.

Normal amounts of acid will cause discomfort or pain if these parts of the digestive system are weakened or damaged. Infection, older age, alcohol and certain drugs can all weaken the lining of the digestive system.

The stomach may also produce more acid than you need. Cigarettes and stress have this effect. Two common acid-related disorders are heartburn, also know as gastro-oesophageal reflux and peptic ulcer disease.

What is heartburn?

The sphincter is a one-way valve at the lower end of the oesophagus that allows food and liquid to pass into the stomach and prevent it going back into the gullet. If the sphincter becomes weak or defective, the acid juices in the stomach may be pushed back up into the oesophagus causing a burning sensation (heartburn). This condition is also known as gastro-oesophageal reflux or reflux disease. When these acid juices inflame the lining of your gullet this is called oesophagitis.

The symptoms of heartburn include:

• A painful burning sensation in the upper chest.
• Sour and burning taste of reflux when it reaches the mouth.
• Hoarse voice from irritated larynx.
• Difficulty breathing.
• Excessive belching.
• Chronic coughing.

The factors contributing to heartburn include:

• Food high in fat and oil.
• Excess weight can cause extra pressure on the sphincter.
• Certain medications, like aspirin.
• Stress, because this strains the nerves controlling the muscular ring.
• Smoking which stimulates stomach acid.
• Pregnancy, as the enlarged uterus presses on the stomach.
• Hiatus hernia.
• Large meal portions.
• Lying down.

How is heartburn diagnosed?

The doctor will ask you about your symptoms You may need to have an endoscopy carried out in hospital as an outpatient, to view the oesophagus.

The doctor may recommend that you have a pH study of your oesophagus over 24 hours, to show how often and how long the reflux episodes last. To rule out heart problems, your doctor may send you for a recording of the heart’s electrical activity (ECG or electrocardiograph).

An endoscopy may be necessary to rule out hiatus hernias, peptic ulcers and other conditions whose symptoms mimic the symptoms of gastro-oesophageal reflux.