GERD, an acronym for gastro-esophageal reflux disease, is a condition that develops when the reflux of gastric content causes troublesome symptoms or complications. GERD can affect anyone, at any age, often times young adults in their prime of their lives, and can severely impair a person’s quality of life and their work performance.
In Malaysia, an estimated 50% of the adult population suffers from at least one gastro-intestinal condition. Misdiagnosis or under-diagnosis of GERD results in incorrect and ineffective treatment.
According to Prof Dato’ Dr Goh, Head of Gastroenterology and Hepatology at University of Malaya, many patients are unaware that they have GERD, and that the disease can have serious consequences if left untreated, such as breathing difficulties, bleeding and scarring of the esophagus, in rare cases even esophageal cancer.
Dr Tan Huck Joo, Past President of the Malaysian Society of Gastroenterology and Hepatology and Consultant Gastroenterologist at a leading private medical centre in Klang Valley advises patients not to suffer in silence and to get personalised treatment.
Patients with severe GERD may be prescribed drugs known as proton pump inhibitors (PPIs), such as esomeprazole, which essentially blocks acid production and its flow into the esophagus, triggering GERD symptoms.
Stomach acid is harsh and the lining of the esophagus is delicate.GERD patients may experience heartburn when acid backs up (refluxes) into the esophagus and if acid reflux continues without being treated, it can cause tissue damage over time in the lining of the esophagus in a potentially serious condition called erosive esophagitis.
If left untreated, the risk of esophageal cancer and Barrett’s esophagus (changes in the lining of esophagus that predispose patients to malignancy) is significantly increased. PPIs allow time for damaged esophageal tissue to heal in about four and eight weeks. It is advisable for patients to take PPIs one hour before breakfast because they will be at their peak levels in the body after meal when the acid is being created.
Other treatments include H2 blockers and antacid but they have been shown to be less effective. Apart from medication, patients can also relieve their symptoms by making adjustments to overcome pain and discomfort with lifestyle changes.
GerdQ is a six-item questionnaire that helps identify patients with GERD. Patients are asked to report frequency of symptoms over the past seven days. Answers are compiled according to a scale of options and are scored accordingly. The symptom scores and impact score are used to compile a GerdQ score, which the physician can use to make an initial diagnosis and appropriate treatment recommendations. GerdQ can also be used to monitor the effect of a therapy on patients’ symptoms and quality of life over time.
Five Burning Truths
1. Myth: GERD only affects adults
Truth: GERD affects people of all ages, ethnicities and cultures and tends to run in families.Researchers estimate children ages three to 17 years old report GERD symptoms roughly 2% to 8% of the time. Statistics show that a person’s risk increases with age and rises dramatically after 40.
2. Myth: GERD and heartburn are the same
Truth: The main symptom of GERD is heartburn. Heartburn is a form of indigestion caused by acid regurgitation into the esophagus. It causes a burning sensation in the chest, just behind the breastbone. Heartburn that occurs frequently (more than twice a week) or interferes with daily routine is considered GERD. In GERD, the reflux and heartburn lasts longer and occurs more often than ordinary heartburn.
3. Myth: Similar to heartburn, GERD is common and is no cause for alarm
Truth: Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers – also called esophagitis. Scars from tissue damage can lead to strictures – narrowing of the esophagus – that make swallowing difficult.
Some people develop Barrett’s esophagus, in which cells in the esophageal lining take on an abnormal shape and colour. Over time, the cells can lead to esophageal cancer, which is often fatal. Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis. Chronic GERD can also speeds up tooth decay, because stomach acid gets into the mouth and wears away tooth enamel.
4. Myth: GERD occurs because of increased acid production in the stomach
Truth: GERD most commonly occurs when the lower esophageal sphincter (LES) relaxes at the wrong time (for example, when one is not swallowing) and remains open too long. Normally, the valve opens for only a few seconds when one swallows. But certain foods may relax the valve so that it does not close as tightly, making reflux more likely. Alcohol, tobacco (nicotine) and some medicines can also relax the lower esophageal sphincter.
Other factors can allow stomach juices to back up into the esophagus, such as:
- Hormonal changes during pregnancy: The valve may not close as tightly during pregnancy because of hormonal changes and increased abdominal pressure. Heartburn is common during pregnancy, because hormones cause the digestive system to slow down.
- A weak lower esophageal sphincter: If this valve is weak, it will not close properly, and reflux will occur frequently. This is a rare cause of mild GERD, but among people who have severe GERD, about 25% have this problem.5
- Slow digestion. If food stays in your stomach too long before it goes to the small intestine (called delayed gastric emptying), the stomach contents are more likely to get pushed up into the esophagus and cause heartburn.
- Overfull stomach. Having a very full stomach—such as from eating a very large meal—increases the likelihood that the lower esophageal sphincter will relax and allow stomach juices to back up (reflux) into your esophagus.
5. Myth: GERD is a chronic health condition that cannot be prevented
Truth: GERD can usually be prevented with the right lifestyle choices.
- Maintain a healthy weight. Dropping just 10 percent of your body weight can stave off GERD. Extra stomach fat places pressure on the abdomen, pushing gastric juices up into the esophagus.
- Eat smaller meals. Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
- Elevate your bed. Raising the head of the bed six to eight inches can help gravity keep gastric acid down in the stomach. Use a wedge-shaped support. Don’t use extra pillows, as they only raise the head and will not help with GERD. The entire upper body needs to be elevated to get relief.
- Stay upright after eating. Wait at least three hours before lying down after a meal. Gravity normally helps keep acid reflux from developing. Lying down after eating causes acid to easily press against the LES and flow into the esophagus.
- Consume foods known to cause reflux. This includes fatty foods, spicy foods, acidic foods like tomatoes and citrus, mint, chocolate, onions, coffee and carbonated beverages.
- Smoke. Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
- Drink too much alcohol. As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
- Wear tight-fitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.