Do you sometimes experience your food coming back up your oesophagus and you don’t know why? We have some answers.

 

About 10 percent of adults in Singapore have GERD (also known as acid reflux), according to a study in Singapore done in 2005 by Dr SL Lim (mentioned in an article titled “Changing prevalence of gastroesophageal reflux with changing time: Longitudinal study in an Asian population”). So what is GERD exactly and how can it be treated?

Ageless Online talks to Dr Michelle Gowans, consultant, Division of Gastroenterology & Hepatology, National University Hospital (NUH), to find out more about GERD:

 

Is it GERD not GORD?

GERD and GORD are both acronyms for the condition Gastro Oesophageal Reflux Disease. The only difference is whether it is the American spelling (esophagus) or the British spelling (oesophagus).

 

What is gastroesophageal reflux?

Gastroesophageal reflux is when gastric (stomach) contents reflux back up into the oesophagus. The oesophagus is the tube that carries food from your mouth to your stomach. Some degree of reflux is normal but if it causes symptoms or complications, then it is labelled as GERD.

 

What are the factors that contribute to GERD?

At the lower end of the oesophagus, there is a circular ring of muscle called the lower oesophageal sphincter. After swallowing, the muscle relaxes to allow food to enter the stomach and then tightens to prevent food and acid going back into the oesophagus.

If the sphincter is weakened (for example, due to muscle weakness or a hiatus hernia) or if there is an increase in abdominal pressure (for example, due to central obesity or the stomach is very full) reflux is more likely to occur.

 

What are some common symptoms of GERD?

The symptoms include:

• Burning in the chest, known as heartburn.
• Burning in the throat or an acid taste in the throat (acid brash).
• Stomach or chest pain.
• Less commonly, people may have a raspy voice, a sore throat or unexplained cough.

 

What is the treatment for GERD?

GERD can be treated with lifestyle measures in mild cases, but if these are not effective, medicines may be required.

Lifestyle modifications include:

• Losing weight if you are overweight.
• Avoid foods that make your symptoms worse (examples include: coffee, chocolate, alcohol and fatty foods).
• Stop smoking, if you smoke.
• Eat smaller meals.
• Avoid lying down for three hours after a meal.

If the symptoms are not responding to these lifestyle measures but are relatively mild or infrequent, simple treatment with antacid medication may be enough. This is taken only when the symptoms are present.

If the symptoms occur frequently or are more severe and not treated adequately with antacids, acid-suppressive medication may be required.

 

What if the symptoms continue to persist?

Please see your doctor. We would usually optimise the acid-suppressive medication first and ensure it is taken correctly. If the symptoms are frequent, we suggest that the medication is taken regularly at least half an hour before a meal. Sometimes people also require additional medication to help the stomach empty faster.

An oesophagogastroduodenoscopy (upper endoscopy or OGD) is sometimes performed to ensure there is no burning of the oesophagus (oesophagitis) or other complications, and to look for other causes of the symptoms.

 

Does GERD require surgery?

Occasionally if the symptoms are very resistant to medication or there are complications, a surgical procedure called a Nissen Fundoplication can be done.

 

Are there long-term complications with GERD?

Some patients with GERD will have oesophagitis (ulceration of the lower oesophagus). If this is present for a long time, changes may occur in the lining of the oesophagus (Barrett’s oesophagus). This is considered a pre-malignant condition but is very uncommon in Asia.

Occasionally damage from the acid may lead to scarring and narrowing of the oesophagus (stricture).

 

Can one prevent GERD?

Lifestyle changes such as weight loss (if you are obese), stopping smoking and drinking alcohol in moderation will help reduce your risk of GERD.

 

How does GERD relate to the condition of dyspepsia?

Dyspepsia is group of symptoms, whereas GERD describes a disease process.

 

What is dyspepsia?

Dyspepsia is a term used to describe upper abdominal discomfort. The symptoms are variable and include bloating, pain, burning and feeling full quickly when eating.

 

What are the common causes?

Many cases of dyspepsia are considered functional (idiopathic or non-ulcer dyspepsia as no cause is found), but some diseases such as stomach ulcers, GERD, gallstones, cancer and some medications can also cause the same symptoms.

 

One can then make some lifestyle changes. Can you share some advice on what one can do?

In regards to lifestyle choices for dyspepsia, we suggest a healthy diet and exercise. If certain foods trigger the symptoms then they should be avoided as much as possible as long as your diet is otherwise healthy. There are certain diets that can help some patients with dyspepsia, and these can be discussed with your doctor.

 

What is the treatment to dyspepsia?

Firstly, an evaluation is required to look for a cause of the symptoms. If a cause of the pain/discomfort is found, this of course should be treated. For example, if the person has GERD then a stomach ulcer medication to reduce stomach acid should help.

If the condition is diagnosed as functional dyspepsia, the treatment depends on the particular symptom(s) and the severity of the symptom(s). Some people may respond to changes in their diet, such as avoiding fatty foods, eating small frequent meals and avoiding foods that make you feel worse. People with more severe symptoms may require medication but not all medications work for all people. The type of medications that might work includes medicine to reduce stomach acid or empty the stomach, or that work on the nerves to reduce pain.

 

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