Acid Reflux & GERD

What Is Acid Reflux?

Acid reflux, or gastroesophageal reflux, occurs when stomach acid flows back into the oesophagus due to a weakened or improperly functioning lower oesophageal sphincter (LES). This condition can cause discomfort and symptoms such as heartburn and regurgitation.

The LES is a circular muscle that acts as a barrier between the oesophagus and stomach, tightening after food passes through to prevent acid from travelling back up. However, if the LES is weak or fails to tighten properly, stomach acid can escape into the oesophagus, leading to acid reflux.

What Is GERD?

GERD, or gastroesophageal reflux disease, is chronic acid reflux in the oesophagus, occurring at least twice a week for an extended period. Unlike temporary reflux, GERD indicates a persistent malfunction of the lower oesophageal sphincter, allowing stomach acid to regularly enter the oesophagus. This can cause symptoms like heartburn, regurgitation, and chest pain, potentially leading to complications.

What Are the Symptoms of Acid Reflux & GERD?

Here are some of the most common symptoms associated with both acid reflux and GERD:

Heartburn

A burning sensation in the chest, often after eating or at night

Regurgitation

Sour or bitter-tasting fluid backing up into the throat or mouth

Dry Cough

A persistent cough not associated with a respiratory infection

Hoarseness

A raspy or strained voice due to irritation of the throat

Chronic Sore Throat

Persistent soreness in the throat

Dysphagia

Difficulty swallowing, leading to discomfort or pain during eating

Abdominal Pain or Bloating

Uncomfortable fullness and bloating after eating

Nausea

A feeling of queasiness or discomfort in the stomach

Common Causes and Risk Factors for Acid Reflux & GERD

Acid reflux and GERD occur when the lower oesophageal sphincter (LES) weakens, allowing stomach acid to flow back into the oesophagus and causing irritation and inflammation. Several factors contribute to LES weakening:

Hiatal Hernia

When the top of the stomach protrudes through the diaphragm, it compromises the LES's ability to close effectively, leading to acid reflux.

Eating Large Meals

Consuming large meals increases pressure on the LES, resulting in heartburn and abdominal discomfort.

Lying Down After Eating

Immediately lying down after a meal disrupts digestion and hinders proper LES function, promoting reflux.

Obesity

Extra weight raises abdominal pressure, weakening the muscles supporting the LES and facilitating reflux.

Pregnancy

Elevated levels of hormones during pregnancy relax the LES, contributing to acid reflux symptoms.

Smoking

Tobacco smoke relaxes the LES and chronic coughing from smoking may weaken diaphragm muscles, increasing the risk of hiatal hernia.

Medications

Certain drugs like calcium channel blockers, antidepressants, sedatives, and asthma medications can relax the LES, exacerbating reflux.

GERD can also stem from congenital defects, connective tissue disorders affecting oesophageal muscles, or previous surgeries that have caused oesophageal injuries.

How Are Acid Reflux & GERD Diagnosed?

Diagnosing acid reflux and GERD typically starts with a review of symptoms and medical history by your doctor. Further diagnostic tests may sometimes be recommended, including:

Upper Gastrointestinal (GI) Endoscopy

This procedure examines the upper GI tract using an endoscope. Biopsies may be taken to identify complications or underlying conditions.

Oesophageal pH Monitoring

This measures acid content in the oesophagus during different activities using a pH sensor attached to a tube inserted during an endoscopy. It helps confirm GERD diagnosis and assess treatment efficacy.

Oesophageal Manometry

Also known as oesophageal motility studies, this test evaluates the strength of oesophageal muscles. A flexible tube inserted through the nose assesses muscle function, ruling out conditions with similar symptoms to GERD.

Barium Swallow

This test examines possible abnormalities in the oesophagus by having the patient drink a cup of contrast solution called barium and taking moving X-rays of the upper digestive tract.

Potential Complications of Untreated Acid Reflux & GERD

Untreated acid reflux and GERD can result in several complications, including:

Esophagitis

Chronic exposure to stomach acid causes inflammation of the oesophagus.

Esophageal Stricture

Scarring leads to the narrowing of the oesophagus, causing swallowing difficulties.

Barrett’s Oesophagus

Chronic irritation may lead to changes in the oesophageal lining, increasing the risk of oesophageal cancer.

Oesophageal Cancer

Long-term GERD can heighten the risk of developing oesophageal cancer.

Aspiration Pneumonia

Inhalation of stomach contents into the lungs can cause respiratory infections.

Oesophageal Ulcers

Prolonged acid exposure can result in open sores in the oesophagus.

How Are Acid Reflux & GERD Treated?

Your doctor may recommend lifestyle changes to manage symptoms of acid reflux and GERD. These include weight loss if you're overweight, elevating your head during sleep, quitting smoking, and changing your eating habits and diet. These lifestyle modifications can significantly reduce symptoms and improve your quality of life.

Gastroenterologists may also recommend medications or surgical interventions, depending on the severity of symptoms.

Medical Treatment for Acid Reflux & GERD

Over-the-counter medications, like antacids, are often the first line of defence. However, if symptoms persist despite using these medications, your doctor may prescribe different medications. These include:

Proton Pump Inhibitors (PPIs)

Often considered an effective medication for GERD symptoms, PPIs can help heal the oesophageal lining in most cases.

H2 Blockers

These medications reduce stomach acid production. They can help heal the oesophagus but may not be as effective as proton pump inhibitors (PPIs).

Prokinetics

These are prescribed for severe GERD or frequent attacks. They aid in faster stomach emptying and strengthen the lower oesophageal muscles.

Surgical Treatment for Acid Reflux & GERD

When medications and lifestyle changes prove insufficient, surgical intervention may be recommended. Surgical options include:

LINX Surgery

This procedure involves the placement of a small ring of magnetic beads around the oesophagus's lower end, where it connects to the stomach. This device helps prevent stomach acid from flowing back into the oesophagus while still allowing food to pass through.

Nissen Fundoplication

This surgical option entails wrapping the upper portion of the stomach around the lower oesophagus. This procedure effectively strengthens the lower oesophageal sphincter, reducing acid reflux. Additionally, Nissen fundoplication can often be performed laparoscopically, resulting in smaller incisions and a quicker recovery time.

Frequently Asked Questions (FAQs)

Can acid reflux cause tooth decay?

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Can certain foods cause acid reflux?

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Meet Our Acid Reflux & GERD Specialist

Dr Kieron Lim

MBBS, University of LondonMember, Royal College of Physicians (UK)Fellow, Academy of Medicine (Gastroenterology) SingaporeFellow, Royal College of Physicians (Edinburgh)

Dr Kieron Lim, senior consultant in Gastroenterology and Hepatology at Mount Elizabeth Hospital, also serves as Medical Director of the Liver Transplant Programme. Having held various leadership roles, including the current President-Elect of the Gastroenterological Society of Singapore (GESS), Dr Lim is skilled in the management of gastroesophageal reflux disease (GERD) and acid reflux. With his experience in advanced endoscopic procedures and medical management of complex GI cases, Dr Lim is committed to providing effective, multidisciplinary and personalised care for all his patients.