GERD: More than just acid reflux

IF you love spicy food, or have a sneaky habit of eating food late at night then going right back to bed, then you have probably experienced heartburn — that searing pain in the middle of your chest. Heartburn is usually caused by reflux, which happens when food and stomach acids flow in the wrong direction and tries to come back up the oesophagus.

Medical internist Dr Samantha Nicholson-Spence explains why this sometimes happens in otherwise healthy people.

“Between the oesophagus and the stomach is a sphincter, which is like a gate or valve to prevent this backflow from happening. But if that sphincter is loose, or if the patient suffers from certain conditions, then the stomach contents can go back up freely.”

Dr Nicholson-Spence points out that any condition that puts pressure on the stomach, such as hiatus hernia, advanced pregnancy, or even obesity, can increase the likelihood of reflux.

“Also, if you are lying flat while eating, or just after eating a large meal, then there is no gravity keeping the food down, so reflux can happen,” she says. “Certain foods can precipitate it too, such as coffee and chocolate and spicy foods, and even some medications, such as painkillers.”

While reassuring that a little reflux every now and then is no cause for alarm, the internist warns that frequent reflux can lead to several problems along the digestive tract, one of them being Gastro-oesophegal Reflux Disease (GERD).

“The constant return of these digestive acids can lead to inflammation along the oesophagus. Once you have that, you will be classified as having GERD.”

While GERD affects both men and women, it tends to be a bit more prevalent in women, especially as they approach menopause. The doctor explains that the most telling symptom is constant heartburn.

“In addition to the burning pain, persons who suffer from GERD might experience a sharp, stabbing pain in the same area,” she adds. “The constant reflux and irritation of the oesophagus can cause it to spasm, because it is a muscle. Some people might even think they’re having a heart attack because it can be that severe and it’s in the middle of the chest.”

Dr Nicholson-Spence says if left untreated, severe and persistent reflux can erode the lining of the oesophagus, causing ulcers to develop. “If it’s really bad, the acids can burn through the ulcer and perforate the oesophagus,” she cautions.

She also warns that if the inflammation is allowed to travel right up the oesophageal tract, it can affect your vocal chords and make you hoarse and give you a sore throat. “It can even affect the lungs and give you pneumonia,” she says.

In rare and advanced cases, too, GERD can lead to irreversible changes in the oesophagus (called Barrett’s oesophagus) that predisposes you to cancer of the oesophagus (oesophageal cancer).

The key to preventing these long-term effects of reflux, however, is early treatment, which can sometimes be remedied with lifestyle changes, she says positively.

“Eating smaller meals and staying upright after eating can help, as well as cutting back on spicy foods,” she says. “Since smoking and alcohol can predispose you to, or exacerbate reflux, you can also consider dropping those habits.”

She says over the counter antacids are fine to treat occasional reflux. “They are basic in nature, so they neutralise the acids in the stomach so it doesn’t burn if it comes back up. They usually contain milk of magnesia, calcium carbonate or other basic compounds,” she says.

If you are bothered by reflux several days per week over an extended period, however, Dr Nicholson-Spence recommends that you speak with your doctor about it.

“If you go to the doctor you may be prescribed medications that slow down acid production in the stomach,” she explains. “No acid is made, so you won’t reflux anything to burn you. There are other medications, some of which help to coat the oesophagus, and others that help the stomach to empty faster. Your doctor can determine which course of treatment is right for you.”