Wednesday 18 July 2018

Dear Dr Nina: I'm suffering with reflux but can I treat it myself?

Photo posed
Photo posed

Nina Byrnes

Q: Years ago I was treated for a stomach ulcer and gastro-oesophageal reflux disease (GORD) brought on by a hiatus hernia. I managed the condition by eating well and avoiding alcohol since then. But now, stress, poor sleeping, eating on the go and lots of coffee has brought it back. I have a burning pain in the centre of my ribcage, feel bloated and can only eat small amounts at a time. Since last suffering from the condition, drugs like Motilium are available over the counter. I was hoping to avoid going to my GP, and just to treat myself until the pain subsides. However, I've heard that GORD can cause oesophageal cancer in later life if not treated properly. Should I be taking the problem more seriously?

Dr Nina replies: GORD occurs when acid that is normally contained in the stomach manages to flow upwards into the tube which carries food from the mouth to the stomach, the oesophagus. The lining of the stomach is designed to cope with an acidic environment but the lining of the oesophagus is not and it becomes irritated and inflamed leading to discomfort.

Symptoms include soreness or burning in the throat or chest, a sensation of acid coming back into the mouth or soreness in the upper abdomen. Symptoms commonly occur when lying or stooping and may be food related.

In a healthy individual, there is a band of muscle at the bottom of the oesophagus that stays closed unless allowing the passage of food. This sphincter keeps acid in the stomach where it should be. If there is pressure in the abdomen, such as with pregnancy and obesity, the sheer pressure from the lower abdomen into the chest can push acid back up.

Over time acid can damage the lining of the oesophagus leading to erosion (Barrett's oesophagus). This chronic irritation can permanently damage the lining of the oesophagus over time and can increase the risk of cancer of the lower part of the oesophagus. Those who have been diagnosed with Barrett's oesophagus require regular surveillance to watch for changing potentially cancerous cells. Chronic gastric irritation can result in ulcers and potentially life-threatening bleeding into the gut. Chronic gastritis is also associated with the development of cancer of the stomach.

For adults, there are a number of over-the-counter remedies that may help neutralise or block acid in the stomach. If symptoms are occurring intermittently they are worth trying. However, those with prolonged symptoms (more than a month), anyone aged over 55, those experiencing associated weight loss or anaemia, and those with a family history of stomach problems need further checks.

If you feel food sticking when swallowing or if you feel full very easily it is essential to see a doctor, as these symptoms are particularly worrying.

The most common investigation is a gastroscopy, which involves passing a camera on a fine tube along the oesophagus and into the stomach to look for any erosion, damage or ulcers.

If a hiatus hernia is diagnosed it is likely that long-term treatment with tablets that block acid production will be required.

If there is no acid, any gastric inflammation can heal and there will be no further irritation to the oesophagus.

Lifestyle modification works. If you are overweight or obese, losing weight can really help reduce discomfort. Smoking also increases the chance of reflux occurring so it's yet another reason to quit.

Lastly, for some people alcohol and certain foods or spices can cause a flare, so knowing your own triggers and avoiding them can help.

Stress, eating on the go and caffeine are all potential triggers so I'm not surprised your symptoms have flared. You don't mention your age but given your symptoms, I wouldn't self medicate - a consultation with your doctor is warranted. Don't delay, get checked and get treated.

 

Q. I’m the mother of two teenage sons and I’ve heard that there’s a new HPV vaccine available for boys. Should my boys be getting it? I thought it was only needed for teenage girls

Human Papilloma Virus (HPV) is a group of viruses that can cause infection in the throat, anus, cervix, vagina and external genitalia. It is one of the most common sexually-transmitted infections we know and it is estimated that most people come in contact with this virus within 18 months of commencing sexual activity.

There are over 100 different types of HPV. Most are harmless but certain types are known to be associated with cancers of the area they infect. Types 16 and 18 are considered high risk and are known to increase the risk of cancer of the cervix and throat. Types six and 11 are low risk and are associated with the development of warts.

HPV is thought to be responsible for up to 5pc of cancers worldwide. Apart from its association with cervical cancer, it is also associated with cancer of the vaginal, genital area, penis and anus. One of the fastest growing types of HPV related cancer is oropharyngeal cancer. It is felt to be associated with 70pc of these in the USA.

Since 2010 we have access to two vaccines, which can prevent infection with certain strains of the HPV virus. The vaccine is currently offered to girls in first year in secondary school. There is a big drive to extend this to boys as they are also at risk from HPV-related cancer. Australia, the USA, Canada and Austria have been recommending this for boys for many years. The vaccine is the same for boys and girls and is most effective when given to those who are not yet sexually active. Unfortunately, those wanting to vaccinate boys in Ireland have to pay for the vaccine and its administration. Your GP can advise you how best to arrange this.

Don’t hesitate. HPV vaccination saves lives.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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