Gastroesophageal Reflux Disease (GERD)

What is Gastroesophageal Reflux Disease (GERD)?

We all have acid reflux or heartburn from time to time, but this either goes away on its own or after we have had an antacid. Acid reflux is the backflow of acid from the stomach up into the oesophagus and it happens if the lower oesphageal sphincter –which usually prevents acid backflow– does not close properly when food is in the stomach.

GERD or chronic acid reflux is long-term or repeated acid reflux that does not go away on its own or with an over-the-counter antacid.

What causes GERD?

One of the main causes of GERD occurs when the lower oesophageal sphincter does not close properly –this in turn allows your stomach acid to flow back and up into your oesophagus.

Certain factors that may be possible causes are:

Hiatal hernia: This happens when the upper part of your stomach moves up into your chest through an opening in your diaphragm.
Increased pressure on the abdomen: Pregnant women and overweight individuals are more prone to acid reflux.
Certain types of food: Spicy food or high fat food are more likely to cause acid reflux.

Medications: Medications for asthma, blood pressure, allergies, and painkillers can cause acid reflux.
Lying down after a large meal: This can cause your lower oesphageal sphincter to open and allow the backflow of acid.

What are the common symptoms of GERD in Singapore?

The symptoms of GERD are similar to those of acid reflux, which are:

Heartburn
Regurgitation
Vomiting
Sore throat
Coughing
Chest pains
Dysphagia: Feeling of food stuck in your throat
Sour taste in your mouth

Is GERD painful?

Yes, GERD can be painful especially if you experience heartburn or a burning sensation in your chest. Heartburn can often be mistaken for a heart attack, so it is important to know the difference. A heart attack is usually accompanied by shooting pain in your left arm, shortness of breath, nausea, dizziness, sweating, etc and symptoms worsen with activity/exertion.

Who is at risk of GERD in Singapore?

Although GERD is very common, there are certain risk factors that make you more susceptible, such as:

Being pregnant: Due to the large amount of pressure pregnancy puts on the abdomen, the lower osephageal sphincter may not be able to close properly, thus allowing acid backflow.
Smoking: Studies have shown that stopping smoking can reduce the likelihood of GERD.
Frequent consumption of large meals: This may prevent the lower oesophageal sphincter from closing properly.
Excessive use of non-steroidal antinflammatory drugs (NSAIDs): While NSAIDs do not affect the lower oesophageal sphincter, studies have shown that the symptoms of GERD are worsened in individuals who consume NSAIDs.
Obesity: Obesity increases intragastric pressure and increases the likelihood of hiatal hernia which is one of the causes of GERD.

How is GERD diagnosed?

GERD can be diagnosed in a number of ways such as:

Gastroscopy: A thin, flexible tube with a light and camera attached at one end, also known as a gastroscope, is inserted into the mouth and guided through the oesophagus and stomach. A biopsy may be required after the procedure if samples were taken.
pH probe for monitoring: A long, thin tube is inserted through your mouth or nose for 24 hours. It is used to monitor and measure the pH levels experienced by your oesophagus.
Oesophageal manometry: A small, flexible tube is inserted through your nose into your oesphagus to measure the strength of your lower oesphageal sphincter.
X-ray: After consuming a barium solution, an x-ray is taken of your gastrointestinal tract to identify any causes of your acid reflux.

What are the treatment options for GERD in Singapore?

For most cases of GERD, surgery may not be necessary, small changes and some medication might help. These treatment options are:

Adopting a healthier lifestyle

By eating healthy and exercising, it might help you to lose weight which can help improve or totally remove your GERD symptoms

Antacids

Might be able to provide temporary relief

H2 blockers

These help block acid release in the stomach

Proton pump inhibitors (PPIs)

PPIs block the protein required to make stomach acid

Prokinetics

Prokinetics help your stomach empty itself faster so there is less food left behind and hence, less stomach acid

Avoid high fat foods

Avoid lying down straight after a large meal

Stop smoking

Eat slower and smaller meals

Surgery may be recommended if the above options are not working for you or if you have developed other complications related to GERD. Your gastroenterologist will be able to identify the best treatment option for you.

Frequently asked questions

Is GERD curable?

Yes it is, implementing positive lifestyle changes, reducing your consumption of high fat food, and stopping smoking can all help cure GERD. Surgery is also another option that can help cure GERD.

Is GERD serious?

GERD can be serious if left untreated. They can cause complications such as oesophagitis (inflammation of the oesophagus), narrowing of the oesophagus, precancerous changes to the oesophagus (Barrett’s oesophagus, where the lining of the oesophagus evolves in response to the long-term exposure to stomach acid).

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General

Liver

Oesophagus

Biliary/Pancreas

Stomach/Duodenum

Intestinal