Regurgitation

Regurgitation isn’t a medical condition; it is a symptom of other medical conditions. As such, the only symptom of regurgitation is the backflow of the stomach contents into the oesophagus. This can cause:

• Vomit in mouth

• Heartburn or chest pain

• A strong acidic or sour taste in your mouth

• Difficulty swallowing

• A feeling of something in your throat

• Hoarse voice

• Repeated coughing

• A feeling of pressure or pain behind your breastbone

Symptoms of regurgitation can get worse when lying down or bending over, as gravity works to increase the flow into the oesophagus. This is often a problem when sleeping during the night.

Regurgitation of food and liquid can cause several problems. These include:

• Aspiration: Small particles of food or liquid may enter the airways or lungs, leading to coughing or even pneumonia in severe cases.

• Breathing difficulties: When food particles enter the respiratory tract, it can cause wheezing, shortness of breath, or other respiratory issues.

• Choking: The sudden flow of stomach contents upward can cause a choking sensation, especially if it occurs during sleep.

• Dental problems: Chronic exposure to stomach acid can erode dental enamel, leading to tooth decay and sensitivity.

• Poor appetite or weight loss: Persistent regurgitation can lead to a reluctance to eat due to discomfort and fear of symptoms, potentially resulting in weight loss.

Each time regurgitation happens, the risk of aspiration or any of the other issues is present. That’s why it’s critical to understand the condition and seek medical attention.

In adults

Regurgitation is primarily caused by an issue with the lower oesophageal sphincter (LOS). While it’s not uncommon for acid and other liquids to backflow into the oesophagus, it’s much rarer for food also to be regurgitated.

The most common cause of regurgitation is gastroesophageal reflux disease (GORD). This term refers to the backflow of acid from the stomach; however, some food might also be regurgitated. Known as gastroesophageal reflux (GOR), its symptoms include heartburn, nausea, and difficulty swallowing.

Other adult causes of regurgitation include:

• Hiatus hernia. Part of the stomach enters through the diaphragm (the layer of muscle separating the chest from the abdomen) into the chest, often via tear.

• Pregnancy. It’s common to experience some regurgitation during pregnancy, especially in the third trimester. The increased pressure in the stomach can force food back up into the oesophagus. 

• Surgery. Previous surgery, including bariatric surgery, can affect the normal function of the LOS. It increases the risk of heartburn and a hiatus hernia.

• Smoking: Smoking aggravates both heartburn and GORD, often worsening symptoms like regurgitation. Quitting smoking can lead to noticeable improvements in these symptoms.

• Overweight or obesity: Excess weight increases abdominal pressure, which can push stomach contents upward, leading to GORD and frequent regurgitation. Managing weight can significantly reduce these occurrences.

• Achalasia. Achalasia is a rare disorder where the oesophageal muscles fail to relax. As the LOS will not open, food cannot enter the stomach and begins to back up. Usually, people do not experience any symptoms of heartburn as there is no acid backflow.

• Rumination syndrome is an eating disorder in which people involuntarily regurgitate food after eating. The underlying cause is not clear. However, it is linked to stress and other mental health conditions.  Alongside these causes, people with preexisting GORD can exacerbate their condition with certain foods and drinks, which increase stomach acid production. These include alcohol, coffee, chocolate, and fatty or spicy foods. 

  Stress and anxiety can also increase regurgitation. This could be an exacerbation of GORD. However, in extremely stressful situations, people might force themselves to vomit, regurgitating their stomach contents. 

  In babies

  Regurgitation is relatively common in infants and babies as they haven’t yet got full control of their oesophagus, and it is much smaller in size. Usually, there are no other symptoms present. If regurgitation occurs more than once a day, it’s known as functional infant regurgitation. The condition will subside within the first year of life.   

The terms acid reflux and regurgitation are often confused. After all, both terms refer to the movement of the stomach contents back up into the oesophagus.

Acid reflux exclusively refers to the backflow of acid into the oesophagus. It’s not uncommon for some food to also travel into the oesophagus; however, it does not usually enter the mouth. Regurgitation, on the other hand, regurgitation can involve either food or acid moving not just into the oesophagus but also into the mouth. This might seem like vomit, but the act of vomiting is more vigorous.

If left untreated, regurgitation will persist, leading to several potential problems. Unlike acid reflux, regurgitation is not a normal condition. Any movement of the stomach contents into the mouth should be investigated by a medical professional.

As acid usually accompanies the food, it can cause inflammation in the oesophagus. If this is occasional, the oesophagus can heal. However, repeated episodes of regurgitation can lead to permanent damage to the oesophageal lining.

Potential long-term complications include:

• Oesophagitis is the inflammation of the oesophagus. Inflammation affects the lining, increasing the risk of ulcers.

• Oesophageal stricture is a narrowing of the oesophagus. This occurs due to repeated episodes of inflammation that scar the lining. Eventually, it becomes permanently narrowed (stricture), preventing the normal passage of food into the stomach and exacerbating regurgitation.

• Oesophageal cancer occurs when the cells lining the oesophagus begin to change. Initially, this is known as Barrett’s oesophagus, a precancerous condition. However, continued inflammation increases the risk of oesophageal cancer.

Regurgitation is also a sign of several severe conditions, including achalasia, strictures, cancer, and more.

An episode of regurgitation can feel extremely uncomfortable and distressing. If you’re experiencing any heartburn, it can be relieved with an over-the-counter (OTC) antacid. However, this will not treat the regurgitation itself.

During an episode of regurgitation, it’s important not to lie down. This will exacerbate your symptoms. Avoid eating or drinking until your symptoms subside. Certain foods, such as citrus fruits, chocolate, caffeine, alcohol, and spicy or fatty foods, will increase acid production, leading to more severe heartburn. It’s sensible to limit your intake.

If you find yourself becoming distressed, find a calm, quiet environment. Allow yourself to relax, breathing slowly and deeply. Lowering your stress levels can help your symptoms.

Identifying the cause of your regurgitation is crucial to treating the problem. Each test looks at your oesophagus to understand what’s going wrong. That could be testing for the presence of acid to confirm GORD or performing an X-ray to see if achalasia is present.

Common regurgitation tests include:

• Oesophageal manometry. This test measures the contractions in your oesophagus after swallowing. A tiny tube is fed into your oesophagus via your nostril. You will then be asked to swallow food or liquid while the tubes determine if the sphincters are working correctly.

• 24-hour pH impedance monitoring. Similar to manometry, a small tube is inserted into the oesophagus until it reaches the bottom. The tube contains a pH sensor which detects if any acid enters the oesophagus. It is diagnostic for acid reflux.

• Gastric emptying test. Part of the problem is often that food exits the stomach too slowly. This test measures the speed at which food leaves the stomach.

In addition to these tests, your doctor might recommend a barium swallow. This involves swallowing liquid barium and undergoing an X-ray. The barium allows your doctors to visualise the oesophagus and stomach, detecting achalasia or other structural abnormalities like a hiatus hernia or tumour.

Everyone who experiences regurgitation should seek medical care. Often, the underlying condition is relatively mild and easily managed with medications. However, it’s crucial to understand what’s going on in case the cause is more severe.

It’s especially important to talk to a doctor if:

• You experience heartburn more than once a week

• You have other associated symptoms

• You have difficulty swallowing

• Your heartburn persists despite treatment

• You’re over the age of 60

• You have a tight or squeezing chest pain

• You cough up blood

Acid reflux and regurgitation are closely related. If you notice any symptoms, including vomit in the mouth or heartburn, you can benefit from oesophageal testing. The Functional Gut Clinic is experienced in performing tests for people with regurgitation. We’ll advise you on the best test to take, help you understand the results, and help you seek appropriate care.