If you’ve ever felt your chest burn then you might just have unfortunately fallen victim to acid reflux or its nastier cousin, Gastroesophageal Reflux Disease (GERD). And you wouldn’t even be alone—around one in five Singaporeans are known to experience acid reflux. As caregivers, it is of paramount importance to educate ourselves about such common ailments. This way we can then take better care of ourselves and our loved ones.
Here at Homage, we’ve curated a simple and easy guide to understanding acid reflux and Gastroesophageal Reflux Disease (GERD). Read on to find out about their causes, symptoms, and suitable treatment plans.
What is Acid Reflux & Gastroesophageal Reflux Disease (GERD)?
Acid reflux refers to when stomach acid flows back into your esophagus, or the tube that connects your mouth and stomach. This can then irritate the lining of your esophagus, causing pain and discomfort. Many of us may experience acid reflux from time to time, without much cause for major concern.
Gastroesophageal Reflux Disease (GERD), however, occurs when acid reflux happens frequently enough.
You have GERD If you experience:
- Mild acid reflux at least twice a week
- Moderate to severe acid reflux at least once a week
What Causes Acid Reflux & GERD?
When you swallow, a ring of muscles at the lower end of your esophagus, also called the gastroesophageal sphincter, acts as a valve that allows food into the stomach, but not back up into the esophagus. The sphincter works by relaxing and opening up for food to enter the stomach, before closing back up again to prevent food from flowing back up into your esophagus.
When this sphincter malfunctions, either relaxing abnormally, weakens, stomach acid can flow back up into the esophagus, causing irritation to the esophageal lining and thus acid reflux. If it happens too often, acid reflux progresses to GERD.
Acid Reflux & GERD Symptoms
It’s important that we learn to recognise common signs and symptoms of acid reflux and GERD.
- Heartburn, or burning sensations in your chest, typically after eating, that worsen during nighttime
- Pain in your chest
- Swallowing difficulty
- Vomiting food or sour liquid
- Feeling a lump in your throat
Additionally, if your acid reflux occurs at night, you might also experience:
- Chronic cough
- Laryngitis, or an inflammation of your voice box
- Development or worsening of asthma
- Sleep disruption
While acid reflux and GERD symptoms can be relatively mild, it is important to recognise when they become too unbearable or when they prove to be too disruptive to daily living. Furthermore, the correct response to intense and unabating chest pain is to immediately seek medical help as there is a possibility that it may be an instance of heart attack instead of acid reflux or GERD.
Risk Factors for GERD
While acid reflux or GERD can affect anyone regardless of age, there are some risk factors that heighten your risk or worsen your symptoms.
Risk factors for GERD can include:
- Hiatal hernia, or when the top of your stomach bulges up into your diaphragm
- Connective tissue disorders, such as scleroderma
- Gastroparesis, or delayed stomach emptying
Aggravating factors for acid reflux can include:
- Consuming large meals or eating food late at night
- Consuming certain trigger foods, such as fatty or fried foods
- Drinking certain beverages, such as alcohol or coffee
- Taking certain medications, such as aspirin
Some of these factors can be hard to discern on your own. If you suspect that they might be contributing to the onset or deterioration of your acid reflux or GERD symptoms, you may want to consult a doctor as soon as possible so that preventive action can be taken.
Potential Complications of Acid Reflux & GERD
Now, you may be wondering what’s the big deal with a little heartburn—why can’t I just bear with the pain and wait for it to go away? After all, on the surface, acid reflux and GERD sound like relatively minor medical conditions that resolve on their own.
But that’s where you’re wrong.
Left unaddressed and untreated, acid reflux and GERD can potentially lead to worrying and even life-threatening complications.
Potential complications of acid reflux and GERD include:
This refers to the narrowing of the esophagus. Esophageal stricture happens when the damage from acid reflux and GERD to your lower esophagus causes scar tissue to form. Over time, this scar tissue can then build up and narrow your esophagus, leading to problems with swallowing.
This refers to the development of an open sore in your esophagus. Stomach acid from acid reflux and GERD can eat away tissue in your esophagus, causing an open sore to form. Esophageal ulcers may bleed, cause pain and make swallowing difficult.
This refers to when the damage over time from acid reflux causes the tissue lining in your esophagus to change into the same type of tissue that’s normally found in your stomach instead. In practical terms, it means that your esophageal lining will thicken and turn red over time. While it sounds innocuous, these changes are in fact premalignant and are associated with an increased risk of esophageal adenocarcinoma, or esophageal cancer.
If you suspect that you’re experiencing any of these complications from acid reflux and GERD, it may be prudent to arrange for a medical check up as soon as possible to avoid further deterioration of your health. You can arrange for an online doctor’s consultation, or if you’d prefer to have the check up done in the comfort of your own home, Homage offers dedicated house call doctor services for your convenience as well.
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So you’ve been experiencing heartburn and other associated symptoms of GERD and you want to get a diagnosis—naturally the next step to take is to get a diagnosis.
It is possible for your doctor to make a diagnosis based on a physical examination and your history of experienced symptoms. To confirm a diagnosis or to check for complications like esophageal stricture and ulcer, or Barrett’s esophagus, however, your doctor may recommend one of several tests:
- Upper Endoscopy
- Ambulatory Acid (pH) Probe Test
- Esophageal Manometry
During an upper endoscopy, an endoscope, or a thin flexible tube equipped with a light and camera is inserted into your throat to allow your doctor to examine the inside of your esophagus and stomach.
Although test results may often present normal when reflux is present, an endoscopy has the added benefit of being able to detect esophagitis, or inflammation of your esophagus and other complications.
In particular, an endoscopy can be used to collect a biopsy, or tissue sample to test for complications such as Barrett’s Esophagus.
Ambulatory Acid (pH) Probe Test
For many doctors, the ambulatory acid (pH) test is the gold standard for diagnosing GERD. The test involves having a catheter, or thin flexible tube inserted into your esophagus through your nose. At the end of the tube is a monitor that is used to monitor, or pH sensor that tracks the acid exposure levels in your esophagus over the course of a day, or 24 hours. The monitor connects to a small portable computer that may be worn around your waist or with a strap over your shoulder.
After the tube is removed, the data is collected and interpreted. The results are then compared to what is known to be normal levels of acid exposure in the esophagus to determine if you have GERD.
For those of us that are uncomfortable with having a catheter inserted into our nose, a new wireless pH measuring device, or Bravo probe is also available for conducting the ambulatory acid (pH) test. The probe is clipped to the lining of the esophagus and since it comes attached with a pH sensor, there is no need for a catheter to be inserted through your nose. Instead, the device sends the information collected to a portable computer. When the test is concluded, the clipped probe will slowly detach itself from your esophagus and be passed out along with your stool and discarded.
Esophageal manometry measures the rhythmic muscle contractions of your esophagus as you swallow. It also measures the coordination and force exerted by the muscles of your esophagus. This helps your doctor determine if there is anything abnormal with your swallowing that is causing acid reflux and GERD symptoms.
During this test, your nose and throat are numbed before a small diameter tube is passed through your nose into your esophagus. Once the tube has been inserted, you will be asked to swallow. Measurements of your esophageal function are then taken based on the pressure readings that the tube registers.
While esophageal manometry alone cannot decisively confirm your GERD diagnosis, it can help your doctor pinpoint whether issues with your esophageal muscles’ ability to undergo contractions are contributing to your GERD symptoms.
The esophagram is a radiographic study, or X-ray of the esophagus. You will be asked to first swallow barium, or a chalky white liquid that helps provide contrast and aids the radiologist to accurately produce images of your esophagus.
This test can help detect if you have esophageal stricture, or narrowing of the esophagus and also if you have a hiatal hernia, or bulging of the top of your stomach into the esophagus. It is also able to provide a rough picture of your esophageal muscle contractions.
It is, however, not useful in detecting cases of mild esophageal inflammation or Barrett’s Esophagus. Also, it should be stressed that having normal esophagram results does not conclusively prove that you do not have GERD.
As with all diagnostic options for medical conditions, you should consult a doctor to figure out which diagnostic test is suitable for your particular medical needs and preferences. For example, if you are suspected to have Barrett’s Esophagus, an esophagram may not be sufficient for your doctor to make a diagnosis. If you’d like guidance on this, our Homage Care Advisors and Care Specialists are just a phone call away at 6100 0055
Once you’ve seen a doctor and gotten a diagnosis for GERD, you should be looking towards exploring possible treatment options. Generally speaking, treatment options for acid reflux and GERD fall into the following categories:
- Over-the-Counter Medication
- Prescription Medication
- Surgeries and Other Procedures
Over-the Counter medication options for GERD include:
Antacids such as Mylanta or Rolaids neutralize stomach acid and lower the acidity in your stomach. They are able to provide short-term relief for your GERD symptoms but antacids alone cannot heal an inflamed esophagus and damage caused by stomach acid. Be wary of becoming over dependent on antacids, as they can cause side effects, such as diarrhea and sometimes, even kidney problems.
H2-receptor blockers like Tagamet HB, Pepcid AC, or Axid AR reduce acid production in your stomach. They do not act as fast as antacids but provide longer relief and may lessen stomach acid production for up to 12 hours. Stronger versions are available by prescription if your symptoms require extra treatment.
Proton Pump Inhibitors
Proton pump inhibitors are medications that block acid production and help the esophagus to heal. They are stronger than H2-receptor blockers and help buy time for your esophagus to heal from the damage caused by stomach acid. Common over-the-counter proton pump inhibitors include Prevacid 24 HR, Prilosec OTC, and Zegerid OTC.
Prescription medication options for GERD include:
Prescription-Strength H2-Receptor Blockers
Such prescription-strength drugs include medication such as pepcid and nizatidine. While they are generally well-tolerated, long term use may be associated with a small increase in risk of vitamin B-12 deficiency and bone fractures.
Prescription-Strength Proton Pump Inhibitors
Such prescription-strength drugs include Nexium, Prevacid, Prilosec, Zegerid, Protonix, Aciphex, and Dexilant. Although generally well-tolerated, they may cause diarrhea, headache, nausea and vitamin B-12 deficiency. Long-term dependence may even heighten the risk of hip fracture.
Muscle relaxants like Baclofen may provide relief for GERD symptoms by decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects, however, can include fatigue or nausea.
It is recommended that you seek medical advice before embarking on any treatment plan for GERD, especially for prescription-strength medication. If you’d like to get immediate advice on what treatment plan is best suited for you, or even begin treatment immediately, you can consider Homage’s telemedicine and medication services. Immediate drug relief for your GERD symptoms could arrive as early as within 30 minutes after your teleconsultation with Homage’s care specialists.
Surgery and Other Procedures
Gerd can typically be controlled with medication alone. If, however, medication is not effective in relieving your symptoms, or you wish to avoid long-term drug dependence, you may wish to consider the following surgical procedures:
In this procedure, the top of your stomach around the esophageal sphincter is wrapped, to tighten it, thus preventing acid reflux and GERD from occurring. Fundoplication is typically carried out through laparoscopy, a minimally invasive surgical method. Do note that the top of your stomach may be completely or partially wrapped depending on the state of your esophageal functioning.
In this procedure, a ring of tiny magnetic beads is wrapped around where your stomach connects to your esophagus. The magnetic attraction of the device is strong enough to keep this junction closed to refluxing acid, but still weak enough to enable food to pass through. Implantation of the LINX device can be carried out with minimally invasive surgery.
Transoral Incisionless Fundoplication (TIF)
This new procedure tightens the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is carried out with an endoscopy and does not involve any surgical intervention. It allows for quick recovery time and high tolerance. Do note that if you have a large hiatal hernia, TIF alone cannot remedy your GERD complication. It might, however, be possible to remedy it if TIF is combined with laparoscopic hiatal hernia repair.
Before you decide on any surgical or other procedure to treat your GERD, you must consult a doctor and seek medical advice, to ascertain if it is suitable for you.
GERD & Acid Reflux Lifestyle
Lastly, some of us might prefer to seek relief for our GERD symptoms through lifestyle changes. Here are some dietary and lifestyle tips to help you prevent acid reflux and GERD:
Obesity is associated with a 1.5 to 2 times risk increase of GERD symptoms. Maintaining a healthy weight range through appropriate exercise and dietary regimes is therefore recommended.
Smoking drives up stomach acid production and reduces your body’s ability to heal from acid reflux damage. It may thus be wise to quit smoking for smokers who suffer from persistent acid reflux. If quitting is too hard, you should at least refrain from smoking immediately after meals.
Avoid overeating and eat small frequent meals instead. Avoid eating within 3 hours before you sleep. Learn to recognise specific trigger foods that cause the onset of your GERD symptoms and avoid them.
Avoid lying down immediately after meals. For infants and young children, position them upright after feeding for 20 to 30 minutes.
Some medications can directly irritate your gastrointestinal tract. Consume plenty of liquid if you need to take doxycycline, aspirin, ibuprofen, naproxen, iron salts, quinidine, potassium chloride, alendronate and risedronate, to mitigate potential acid reflux.
Now that you’re better equipped with this guide to acid reflux and GERD, you’re ready to tackle that weird feeling in your chest when you encounter it. But if you’d like further support and tailored guidance in getting diagnosed and treated for GERD, you can reach out to our Homage Care Advisors and Care Specialists at 6100 0055 at any time of the day.
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- Gastroesophageal Reflux Disease (GERD). [Webpage]. Retrieved 14 May, from https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Gastroesophageal-Reflux-Disease-(GERD).aspx
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- National Health Service. Antacids. Retrieved 14 May, from https://www.nhs.uk/conditions/antacids/