Acid reflux & GERD: Symptoms, causes, diet & treatment

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 oesophagus or the tube that connects your mouth and stomach. This can then irritate the lining of your oesophagus, 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 oesophagus, also called the gastroesophageal sphincter, acts as a valve that allows food into the stomach, but not back up into the oesophagus.

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 oesophagus.

When this sphincter malfunctions, either relaxing abnormally, weakens, stomach acid can flow back up into the oesophagus, causing irritation to the oesophagal 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.

Common symptoms of Acid Reflux and GERD include:

• 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 a 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:

• Obesity
• Hiatal hernia, or when the top of your stomach bulges up into your diaphragm
• Pregnancy
• Connective tissue disorders, such as scleroderma
• Gastroparesis, or delayed stomach emptying
• Ageing

Aggravating factors for acid reflux can include:

• Smoking
• 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:

Oesophagal stricture

This refers to the narrowing of the oesophagus. Oesophagal stricture happens when the damage from acid reflux and GERD to your lower oesophagus causes scar tissue to form.

Over time, this scar tissue can then build up and narrow your oesophagus, leading to problems with swallowing.

Oesophagal ulcer

This refers to the development of an open sore in your oesophagus. Stomach acid from acid reflux and GERD can eat away tissue in your oesophagus, causing an open sore to form.

Oesophagal ulcers may bleed, cause pain and make swallowing difficult.

Barrett's oesophagus

This refers to when the damage over time from acid reflux causes the tissue lining in your oesophagus to change into the same type of tissue that's normally found in your stomach instead.

In practical terms, it means that your oesophagal 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 oesophagal adenocarcinoma, or oesophagal 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 checkup done in the comfort of your own home, Homage offers dedicated house call doctor services for your convenience as well.

Diagnosing GERD

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.

Here's what you should know.

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 oesophagal stricture and ulcer, or Barrett's oesophagus, however, your doctor may recommend one of several tests:

• Upper endoscopy
• Ambulatory Acid (pH) Probe Test
• Oesophagal Manometry
• Oesophagal

Upper Endoscopy

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 oesophagus and stomach.

Although test results may often present normally when reflux is present, endoscopy has the added benefit of being able to detect esophagitis or inflammation of your oesophagus 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 oesophagus through your nose.

At the end of the tube is a monitor that is used to monitor, or a pH sensor that tracks the acid exposure levels in your oesophagus over the course of a day, or 24 hours.

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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 oesophagus 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 oesophagus 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 oesophagus and be passed out along with your stool and discarded.

Oesophageal manometry

Oesophagal manometry measures the rhythmic muscle contractions of your oesophagus as you swallow. 

It also measures the coordination and force exerted by the muscles of your oesophagus. 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 oesophagus. Once the tube has been inserted, you will be asked to swallow.

Measurements of your oesophagal function are then taken based on the pressure readings that the tube registers.

While oesophagal manometry alone cannot decisively confirm your GERD diagnosis, it can help your doctor pinpoint whether issues with your oesophagal muscles' ability to undergo contractions are contributing to your GERD symptoms.

Oesophagal

The oesophagram is a radiographic study or X-ray of the oesophagus.

You will be asked to first swallow barium, or a chalky white liquid that helps provide contrast and aids with the radiologist to accurately produce images of your oesophagus.

This test can help detect if you have an oesophagal stricture, or narrowing of the oesophagus and also if you have a hiatal hernia, or bulging of the top of your stomach into the oesophagus.

It is also able to provide a rough picture of your oesophagal muscle contractions.

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It is, however, not useful in detecting cases of mild oesophagal inflammation or Barrett's Esophagus. 

Also, it should be stressed that having normal oesophagram 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 oesophagram may not be sufficient for your doctor to make a diagnosis.

If you'd like guidance on this, Homage Care Advisors and Care Specialists are just a phone call away at 6100 0055

GERD Treatment

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

Over-the-Counter medication options for GERD include:

Antacids

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 oesophagus and damage caused by stomach acid.

Be wary of becoming over-dependent on antacids, as they can cause side effects, such as diarrhoea and sometimes, even kidney problems.

H2-receptor blockers

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 oesophagus to heal.

They are stronger than H2-receptor blockers and help buy time for your oesophagus 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 medicine

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 the 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 diarrhoea, headache, nausea and vitamin B-12 deficiency.

Long-term dependence may even heighten the risk of hip fracture.

Muscle Relaxants

Muscle relaxants like Baclofen may provide relief for GERD symptoms by decreasing the frequency of relaxations of the lower oesophagal 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:

Fundoplication

In this procedure, the top of your stomach around the oesophagal 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 oesophagal functioning.

LINX device

In this procedure, a ring of tiny magnetic beads is wrapped around where your stomach connects to your oesophagus.

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 oesophagal sphincter by creating a partial wrap around the lower oesophagus 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:

Weight management

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.

Quit smoking

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.

Dietary habits

Avoid overeating and eat small frequent meals instead. Avoid eating within three hours before you sleep. Learn to recognise specific trigger foods that cause the onset of your GERD symptoms and avoid them.

Posture

Avoid lying down immediately after meals. For infants and young children, position them upright after feeding for 20 to 30 minutes.

Medications

Some medications can directly irritate your gastrointestinal tract.

Consume plenty of liquid if you need to take doxycycline, aspirin, ibuprofen, naproxe​​​n, 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.

This article was first published in Homage.