Have you ever felt a burning sensation rush up the back of your throat from what seemed like an innocent burp after a big meal? If you have, that is most likely a case of acid reflux. Stomach acid flows into your oesophagus, which gives you that burning sensation.

Many people experience acid reflux from time to time, especially after a heavy meal, and that’s normal. When acid reflux happens repeatedly over time, it causes gastroesophageal reflux disease (GERD). Before we get to the treatments and what we can do about the disease, let’s first talk about the symptoms.

What Are The Symptoms of GERD?

There are a range of symptoms of varying intensity for every individual. Typically, we might experience:

• Burning sensation in our chest (some would call it heartburn). This usually occurs after eating, which can feel worse when lying down.
• Backwash or regurgitation of food and sour liquid
• Upper abdominal or chest pains
• Difficulty in swallowing (dysphagia)
• The sensation of a lump in our throat
• Nausea

If we are experiencing night-time acid reflux, we might also experience:

• An ongoing cough
• Inflammation of the vocal cords, also known as laryngitis
• New or worsening asthma

Again, not all symptoms may be present in your case. But if any of these symptoms are causing you discomfort, then it’s best to see a physician.

Now, let us talk about what causes GERD.

What Causes GERD and What Are Some Risk Factors?

Frequent acid reflux or the regurgitation of contents of the stomach causes GERD. When we swallow, the circular band of muscles at the bottom of our oesophagus (sphincter) relaxes to allow food and liquids to flow into our stomach before the sphincter closes again.

If our sphincter does not relax as intended or it weakens, stomach acid can flow back into our oesophagus. This constant reflux of acid irritates the lining of our oesophagus, causing it to become inflamed.

Generally speaking, that’s the chain of events that causes GERD.

Not everyone is as susceptible to developing GERD – there are risk factors to consider.

Some conditions that can increase your risk of GERD include:

• Obesity
• Bulging of the top of the stomach up above the diaphragm (also known as a hiatal hernia)
• Pregnancy
• Connective tissue disorders like scleroderma
• Delayed stomach emptying
• Smoking
• Habitual eating of large meals or eating late at night
• Habitual eating of certain foods such as fatty and fried foods
• Drinking certain beverages such as coffee and alcohol

Thus, it would be a good idea for us to practice good eating habits and take beverages like alcohol and coffee in moderation to lower our risk of developing GERD and its associated complications for our health.

What Are The Potential Complications of GERD?

There’s no way stomach acid washing up our oesophagus is good for us. Our stomach walls have a lining to protect against the acid, but not our other organs. In bad cases, chronic acid reflux could affect not only our oesophagus but also our windpipe and airways, which could develop complications like:

• Barrett’s oesophagus
  • It’s the name for intestinal metaplasia; when the tissue lining of our oesophagus changes to look like our intestinal lining, which is a risk for esophageal cancer.
• Oesophagitis
  • This refers to the inflammation of our oesophagus which can lead to the development of ulcers in our oesophagus.
• Oesophageal stricture
  • To protect our oesophagus from stomach acid, we may develop scarring in our oesophagus which causes it to narrow. This is known as a stricture, making it more difficult for us to swallow.
• Laryngopharyngeal reflux (LPR)
  • This happens when acid reflux travels to our throats. Especially when we are sleeping, the acid can make its way up our throat causing swelling and hoarseness in our vocal cords, and sometimes aspirate acid particles into our airways.
• Asthma
  • Acid in our airways may aggravate asthma (if it’s an existing condition) or cause asthma-like symptoms which in turn causes breathing difficulties.

How is GERD Diagnosed?

A gastroenterologist would evaluate our oesophagus to diagnose GERD. Depending on your state of health and the institution you work with, they could choose from these tests:

• Oesophagram
  • This is a type of X-ray exam taken while you are swallowing a chalky liquid called barium. This allows physicians to see the movement of your oesophagus.
• Endoscopy (upper)
  • A camera on a thin tube is passed through your mouth while you are under light sedation to look inside your oesophagus.
• Esophageal pH test
  • This test measures the acid content inside your oesophagus through a small wireless receiver.
• Esophageal manometry
  • The goal of the manometry is to measure the muscle activity in your oesophagus using pressure sensors embedded in a nasogastric tube. This can give physicians an idea if your muscles are working right, or not.

How is GERD Treated?

Not to worry, GERD can be treated in a variety of ways. Some people can reduce acid reflux through simple lifestyle changes like changing their eating habits, reducing alcohol intake, and losing weight.

For chronic cases, medication would be the usual next step. Some over-the-counter medicines include:

• Antacids
  • Antacids neutralise stomach acid so that when reflux happens, the acid will not be as corrosive to our oesophagus. They work well for occasional acid reflux but have side effects if taken too often, so it’s not typically recommended as a long-term solution.
• Alginates
  • Alginates help to create a physical barrier between your stomach acid and your oesophagus by floating on top of the acid. They are sometimes taken with antacids or by themselves depending on the case.

Prescription medications for GERD would include:

• Histamine Receptor Antagonists (H2 Blockers)
  • Reduce stomach acid by blocking chemical receptors that tell our body to produce stomach acid. Can be taken more frequently than antacids, but don’t always work long-term because our body can adapt to its effects.
• Proton Pump Inhibitors (PPIs)
  • PPIs are stronger acid blockers that have the added benefit of promoting healing. They could be prescribed by our physician if our GERD is relatively severe or if they detected signs of tissue damage in our oesophagus.

Most patients with GERD respond well to medication and lifestyle modification, however, some patients continue to have troublesome symptoms. For those cases, we can provide anti-reflux surgery which involves creating an effective valve mechanism at the bottom of the oesophagus.

This can be done via traditional open surgery or laparoscopic surgery (also known as keyhole surgery). The latter makes smaller incisions which results in less pain and shorter recovery time after the surgery.

Final Words

We hope this article has helped you understand GERD better. We encourage you to try lifestyle changes and be mindful of your diet before anything else as prevention is always better than cure. If you are concerned about worsening symptoms or suspect there could be something amiss, then it’s always best to consult a physician to get to the root of the problem so you can get the help you need.

If you’d like, you could book an appointment here with our surgeon, Dr. Cha.

Cheers to the best of health!