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Gastroesophageal reflux disease (GERD), or commonly known as ‘gastric reflux’, is a digestive disorder that occurs when acidic gastric juices, or food and fluids back up from the stomach into the food tract (esophagus). GERD is a common condition among many Malaysians today.
Among the many symptoms of GERD, heartburn is the primary discomfort, as manifested as a burning sensation in the chest below your breastbone. Other symptoms include:
Chest pain, especially after bending over, lying down or eating.
Burning feeling in the throat or a hot, sour or salty-tasting fluid at the back of the throat
Sudden excess of saliva
Belching or burping
Persistent sore throat
Voice hoarseness, probably due to laryngitis (the inflammation of voice box)
Wheezing or other asthma-like symptoms appearing in adulthood
If you have heartburn and/or other discomforts for more than twice a week, the doctor may suspect that you have GERD and will do further physical examinations for diagnosis.
Heartburn can be mistaken for heart angina and vice versa. Heart angina has a different cause than heartburn -- it usually has to do with the lack of oxygen delivery to the heart tissue rather than a digestive problem. If you have any chest discomfort and is unsure whether it has a heart or digestive origin, kindly consult a doctor.
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We can’t discuss GERD without talking about the crucial player -- lower esophageal sphincter (LES). The LES regulates food passage from your food tract to the stomach. It is made up of various types of muscles and is supposed to relax and contract accordingly to help food go into the stomach and to prevent food from backflowing into your food tract. However, for the reasons we will discuss later, LES can stop contracting normally, which eventually leads to GERD.
There are four factors that can increase your risk of GERD substantially.
Study has shown that if you have an immediate family member who has GERD or heartburn, you are approximately three times more likely to suffer from symptoms of GERD as well. Although the reason is unclear, such finding suggests that genes may play a role in the disease.
A meta-analysis found out that individuals who aged 50 years and above have a significantly higher chance of getting GERD.
Hiatus hernia is a medical condition where part of the stomach pushes up into the lower chest through a weakness in the diaphragm. The diaphragm is the large flat muscle that separates the lungs from the tummy (abdomen) and helps us to breathe. As a result, hiatus hernia may cause reflux of stomach acid and inhibit its clearance.
Numerous studies have demonstrated that obesity increases your risk of getting GERD. A meta-analysis also confirmed that the heavier you weigh (higher the BMI), the higher the chances of suffering from GERD.
Besides these mentioned factors, the following can also increase the likelihood of getting GERD, although the chances are not as high:
Taking medications that can reduce your lower esophageal sphincter tone, such as muscle relaxant, anticholinergics, and many more
Asthma: People with asthma are twice as likely to get GERD than people who don’t have asthma.
Taking non-steroidal anti-inflammatory drugs (NSAIDs), especially for long-term. NSAIDs are commonly used as painkillers or reducing fever. Examples of NSAIDs include diclofenac, mefenamic acid, meloxicam, ibuprofen and aspirin.
Dietary factors, including ingesting too much caffeinated foods or drinks, carbonated drinks, chocolate, citrus, and spicy foods. However the scientific evidence has been inconsistent and sparse on this regard.
Untreated GERD exposes your food tract to excess stomach acid for a long-term, which can result in the following complications:
Ulcer or perforation in your food tract
Stricture on food tract. This is a result of the healing process of your damaged food tract. A stricture can cause you to be unable to swallow solid food.
Barrett’s esophagus, a condition which the lining of your food tract becomes thickened and red. It can lead to difficulty in swallowing food and even increases the risks of esophageal cancer.
GERD is usually a long-term condition and requires prolonged medication treatment. Your doctor may prescribe a medication to you that suppresses the production of your stomach acid, it is called proton pump inhibitor (PPI). PPI usually has a name that ends with “--prazole”, such as pantoprazole, lansoprazole, omeprazole and esomeprazole; although their brand names may be different.
Other than taking medications as per the instructions of your doctor, lifestyle changes are crucial for managing GERD as well. Lifestyle changes to treat GERD include:
Elevate the head of the bed 6-8 inches when sleeping
Lose weight if you are obese or overweight
Stop smoking if you do (Check out our article on quitting smoking with the help of pharmacist here)
Decrease alcohol intake
Limit meal size and avoid heavy evening meals
Do not lie down within two to three hours of eating
Decrease caffeine intake, which include coffee, carbonated drinks, energy drinks and certain boba teas
American Academy of Allergy Asthma & Immunology - Gastroesophageal Reflux Disease (GERD). https://www.aaaai.org/conditions-and-treatments/related-conditions/gastroesophageal-reflux-disease#:~:text=Gastroesophageal%20Reflux%20Disease%20(GERD)%20is,higher%20risk%20of%20developing%20GERD.
BMJ Best Practice - Gastro-oesophageal reflux disease. https://bestpractice-bmj-com.ezp2.imu.edu.my/topics/en-gb/82/pdf/82/Gastro-oesophageal%20reflux%20disease.pdf
MyHealth - Heartburn. http://www.myhealth.gov.my/en/heartburn/
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