Gastroesophageal Reflux (GERD) aka Acid Reflux

Causes, Symptoms and Treatment

What is Gastroesophageal Reflux? (GERD)

GERD is a medical condition resulting in the malfunction of the valve between the esophagus and the stomach. This valve is supposed to allow food to go down and keep stomach acid from refluxing back upwards to damage the lining of the esophagus. In reflux disease this mechanism is defective and acid can ascend from the stomach to burn the esophageal lining.

How common is GERD in Singapore?

In Western countries in ranges from 18 to 26% of people. In Singapore we have statistics to show that about 9% plus of people have it. This figure is increasing because of increasing obesity and adoption of Western food habits and lifestyle.

What causes GERD?

The valve mechanism is complex and there are 6 or 7 mechanism that are integral to its function. Any of these factors can be disrupted to cause reflux. Reflux means to flow back or return. This means the contents in your stomach, primarily the acid, goes up into your esophagus. This is also known as heartburn.

What are the symptoms of GERD?

The most common symptom is heartburn. This is a burning sensation behind the breastbone. This can be severe and mimic the chest pain of a heart attack. It can escalate to become incapacitating and interfere with lifestyle. Some people have trouble differentiating heartburn and heart disease. One differentiator is that heartburn is unlikely to appear during physical exercise, whereas heart disease will worsen the pain.
There are secondary effects. The acid reflux can cause chronic cough, sore throat and vomiting or regurgitation. Classically the vomit or regurgitated fluid would taste sour. Regurgitated fluid over the long term may even cause lung issues. The acid could also result in tooth decay.
Over many years the acid causes esophagitis which may lead to ulcers and strictures in the oesophagus. Prolonged inflammation and irritation of the oesophagus may lead to the development of cancer of the oesophagus.
Other symptoms include:

  • Vomiting
  • Swallowing difficulties
  • A lump in your throat
  • A chronic cough
  • Sleep difficulties
  • laryngitis

How do we diagnose GERD?

The most important investigation is a gastroscopy or upper GI scope. The endoscopists can see how bad the damage done by the reflux, check the valve and also biopsy the lower esophagus to look for cancer or precancerous changes. This is important to plan treatment.
Other tests that can be done are acidity measurements and pressure measurements of the lower esophagus to assess the severity of the reflux disease objectively and to see if there are any pressure defects in the lower esophagus musculature.

What is the treatment for GERD?

The two most common ways to treat this problem is medical treatment or surgery.

1. Medical treatment is aimed at reducing the acid in the stomach so that the esophageal lining will not suffer acid burns.

Antacids

These drugs provide temporary relief by neutralizing acid in the esophagus. However, the side effects of long term use include: diarrhea, build of magnesium which could be dangerous to individuals that have kidney problems and altered calcium metabolism.

proton pump inhibitors (PPIs)

It works for mild reflux and situations when symptoms are infrequent. It does not cure or reverse the underlying problem and it may not protect you from the complications of reflux or reduce cancer risk. In fact, long term consumption may actually increase risk of stomach cancer because the stomach is deprived of acid which is an abnormal state for the stomach to endure. There is strong scientific evidence to show this.

2.The more definitive solution to reflux is anti-reflux surgery. 

There are many variations to this. The most common method is a laparoscopic fundoplication. A new valve is created by wrapping stomach tissue round the bottom of the esophagus. This leads to instant relief of the reflux and protects the lower esophagus against injury. The reflux is usually totally and permanently cured. There is however a small recurrence rate.

The operation is relatively pain free, takes about one hour and involves one night stay in hospital. It is done by keyhole surgery and is usually minimal downtime. Normal eating resumes within a few days.

This option should be considered for people with severe reflux, those with inflammation of the lower esophagus and those suffering from secondary effects of reflux. This option should also be considered if you are taking high doses of PPIs to control GERD symptoms which could prove dangerous in the long term. Please consult one of our specialist before choosing any surgical options.

What are the signs of trouble GERD?

It is important to note that GERD is rarely life threatening, however, serious complications can occur:

Ulcers

As the lining of your esophagus slowly erodes from the constant acid damage, it can form sores or ulcers that bleed and are painful. This makes consuming food painful.

Barrett’s esophagus

Constant acid damage changes the cell tissue that lines the esophagus. This can lead to higher risk of cancer and is usually observed by the lining becoming thick and red.

Esophageal stricture

This is when there is a build up of scar tissue in the lower part of the esophagus. This scar tissue constricts the pathway of the esophagus, hence making it hard to swallow food.

Asthma or Pneumonia

There are cases that the reflux goes to the back of your throat and into your lungs causing irritation and pain. This has the potential of causing asthma and even pneumonia.

What are the risks of untreated GERD?

Generally GERD is not life threatening but can cause:

  • Chronic cough
  • Tooth decay and caries.
  • Esophagitis
  • Stricture of esophagus
  • Increased risk of lower esophageal cancer.
  • Increase risk of stomach cancer if on long term medication with proton pump inhibitors
  • Lung disease from inspired gastric acid

How do I prepare for an appointment with ASG?

Most appointments concerning GERD and reflux would require a gastroscope. It would be good to come on an empty stomach before undergoing that procedure. If you are experiencing symptoms of GERD, please make an appointment with us.

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Dr. Peter Goh