Gastroesophageal reflux: what you need to know

Published on: Saturday, May 20, 2023

By: Sheela Vijayan, FMT Lifestyles

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Heartburn or pain in the chest are among the symptoms of gastroesophageal reflux disease or GERD. (Envato Elements pic)

PETALING JAYA: It is normal to occasionally experience acid reflux, especially after a large meal or when you’ve eaten too late at night. However, frequent bouts of acid reflux can be a cause for concern as this could mean you’ve developed a condition called gastroesophageal reflux disease (GERD).

“Gastro refers to the stomach while the oesophagus is a tube that connects the mouth to the stomach,” Dr Shanthi Palaniappan, a consultant gastroenterologist and physician based in Kuala Lumpur, told FMT.

While the stomach needs acid to help digest food and kill bacteria, an acidic environment is not suitable for the oesophagus. Over time, the constant flow of acid into the oesophagus can damage its lining.

She explained that when food is swallowed, it moves down the oesophagus in a series of wave-like motions called “peristalsis”.

“At the lower end of the oesophagus where it meets the stomach, there is a sphincter called the lower oesophageal sphincter. And if this sphincter is loosened, stomach acid can flow back into the oesophagus.

“The constant backwash of the acid can irritate the lining of the oesophagus and cause inflammation.”

GERD is a condition when acid content from the stomach refluxes into the oesophagus. (Gastro Health pic)

Symptoms

A common symptom, according to Shanthi, is heartburn. Other symptoms include pain in the chest or upper abdominal area, regurgitation of food or sour liquid, constant burping, bloating, feeling nauseated, difficulties in swallowing and sore throat.

“Sometimes, if the reflux happens at night, it can cause a dry, hacking cough when the acid travels all the way into the throat and causes irritation,” she said, adding that this can be further worsened if a person has asthma.

The acid can also move into a person’s sinuses and cause a condition called “post-nasal drip”, where mucus accumulates in the back of a person’s throat.

Additionally, there can be oral implications. “When a person lies down, the acid can move all the way into the mouth and cause erosion of the enamel of our teeth,” she said.

Risk factors

Acid reflux can be aggravated by smoking, consumption of fatty or fried food, alcohol or caffeine, and certain medications.

But what can cause a person to develop GERD? According to Shanthi, obesity is one of the risk factors as excess belly fat can place increased pressure on the abdominal area.

This, in turn, can lead to “hiatal hernia”, a condition that occurs when the upper part of the stomach lies within the chest cavity and subsequently results in an incompetent lower oesophageal sphincter.

Pregnancy is yet another risk factor, and this can be further worsened if the mother is obese.

“The pressure exerted by the baby on the stomach makes it easier for the contents of the stomach to move up. Additionally, high levels of progesterone, a pregnancy hormone, can cause the lower oesophageal sphincter to loosen.”

Hiatal hernia is a condition when the upper part of the stomach lies within the chest cavity, resulting in an incompetent lower oesophageal sphincter. (Wikipedia pic)

Other risk factors include diabetes and autoimmune diseases which can affect the “peristalsis” of the gastrointestinal tract.

When should you see a doctor?

Shanthi stressed that if you are experiencing symptoms a couple of times per week, it is imperative to consult a doctor.

“It is important to remember that chest pain could also be a symptom of heart problems, so don’t assume that it is acid reflux,” she said.

If left untreated, she added, GERD can lead to other complications – “oesophagitis” (inflammation of the tissue in the oesophagus); oesophageal stricture (narrowing of the oesophagus), and Barrett’s oesophagus (a change in the tissue lining of the oesophagus and is associated with an increased risk of oesophageal cancer).

Diagnosis and treatment

To ascertain if a patient has GERD, these methods can be used:

Endoscopy: this is a short procedure where a tube is inserted through the mouth into the patient’s stomach. According to Shanthi, this popular option takes approximately five to 10 minutes and patients can opt for a sedated or non-sedated procedure;
Oesophageal PH monitoring: catheters are inserted into the patient’s oesophagus to monitor the PH content of the oesophagus and correlate with the symptoms that the patient is experiencing.

Dr Shanthi Palaniappan advises that you see a doctor if you are experiencing GERD symptoms twice a week. (Moganraj Villavan @ FMT Lifestyle)

Upon diagnosis, treatment options include:

various medications to suppress acid production in the stomach such as H-2 receptor blockers, Ranitidine, proton-pump inhibitors (PPI);
antacids, which is an alkaline to neutralise the acid;
prokinetics to stimulate “peristalsis”;
fundoplication, a surgical procedure during which the top of the stomach is wrapped around the lower oesophagus to tighten the lower oesophageal sphincter.

Shanthi also highlighted a condition called “non-erosive reflux disease” or NERD. This is when a patient experiences GERD symptoms but an endoscopy shows no signs of injury on the oesophagus.

“We will still treat this with PPI therapy. Although there may not be erosion, acid reflux could still happen.”

According to Shanthi, although most patients respond to medication, it is vital to make necessary lifestyle modifications. This includes losing weight and avoiding food that can trigger acid reflux.

“Other changes include avoiding smoking and consuming alcohol, cutting down on caffeine, eating three to four hours before bedtime and sleeping in an inclined position.

“By changing your lifestyle, it will help in the long-term symptom control as you don’t want to take medicine perpetually.”