Gastroesophageal Reflux Disease, acronym as GERD, is reported to be a prevalent and growing medical problem in Singapore; and there are various specialists who can be relied upon to treat GERD in the country. Here is some information about GERD, its symptoms, and treatment available in Singapore to help you understand about this kind of digestive problem.
GERD is a digestive condition in which the contents of the stomach repeatedly “reflux” back up into the esophagus. GERD is also called chronic acid reflux. Acid reflux happens when the esophageal sphincter (the valve at the end of the esophagus) does not close properly when food reaches the stomach causing the acid to reflux into the esophagus and then through the throat and finally the mouth (resulting to a sour taste in the mouth). Although the incidence of acid reflux is normal, experiencing it more than two times in a week for several weeks time (i.e repeated manner) and requires an antacid or some medications for relief, then most likely, GERD has developed.
Here are the commons signs and symptoms of GERD:
- Heartburn or the sensation of burning in the chest which occurs often after eating and mostly gets worse at night or when lying down;
- Retching/Vomiting food or sour (acidic) fluid
- Chest pains or pain in the upper abdomen
- Difficulty in swallowing (or dysphagia)
- Have a feeling of a lump in the throat
- Experiencing an ongoing cough, laryngitis or developing asthma or worsening of existing asthma with nighttime acid reflux.
- Sore throat
- Voice hoarseness
Note that smoking, eating heavy meals at night, alcoholic drinks, and coffee intake can complicate or worsen acid reflux.
Risk of developing GERD can increase due to the following conditions:
- Hiatal Hernia (or stomach bloating that extends above the diaphragm)
- Scleroderma and other disorders of the connective tissue
- Delayed emptying of the stomach
GERD can lead to more life-threatening diseases in the long run. The following are complications that may develop GERD:
- Esophagitis-the esophageal lining’s irritation and inflammation brought on by stomach acid; result in esophageal ulcers, heartburn, chest pain, bleeding, and swallowing difficulties.
- Esophageal Stricture-the esophagus’s food channel becomes smaller as a result of the stomach acid’s formation of scar tissues, which makes swallowing hard.
- Esophageal cancer-cancer that formed in the esophagus
- Barrett esophagus-characterized by acid damage that may cause changes in the tissue that lines the lower esophagus; pose as an increased risk of Esophageal cancer
- Esophagitis-a lower gullet inflammation.
Alternatively, medical experts group a person’s symptoms into GERD stages. The four stages of GERD are as follows:
- Stage 1 (Mild): Once or fewer per week, a person experiences infrequent heartburn and regurgitation.
- Stage 2 (Moderate): A person experiences occasional regurgitation or heartburn.
- Stage 3 (Severe): Constant heartburn, persistent cough, regurgitation, hoarseness of voice, and food regurgitation are all present.
- Stage 4 (Esophageal cancer or Precancerous lesions): Similar signs and symptoms as in Stage 3 are present in Stage 4, plus food becomes caught in the throat’s back during swallowing.
The group of specialists that offer treatment for GERD are often called gastroenterologists. In Singapore, you have to be board certified to offer treatment for GERD and other medical problems. A gastroenterologist in general specializes in the treatment of gastrointestinal (i.e., esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts, and liver) diseases. However, as practiced in Singapore and in most countries, a referral from your primary care physician may be required before seeking a gastroenterologist.
The specialist can tell if you are just having a simple reflux by looking into your symptoms and medical history. Medication and diet recommendations are prescribed to manage the symptoms. But experiencing the symptoms frequently may prompt for additional tests to properly diagnose GERD. Here are the tests commonly used by specialists in Singapore for GERD diagnosis:
- Endoscopy-used to examine the linings and the inside of the gastrointestinal tract and collect tissue samples if needed (biopsy)
- Esophageal manometry-this test is used to check if the lower esophageal sphincter is still functioning normally or and detect of if the muscles are weak
- Upper gastrointestinal series-X-rays of the upper gastrointestinal tract to show GERD-related issues such as hiatal hernias, esophageal strictures, and ulcers, etc.
- Esophageal pH and impedance monitoring and Bravo wireless esophageal pH monitoring-tests that measure the pH levels of the esophagus as you go about your daily activities
Treatment for GERD varies from lifestyle change to more invasive procedures like surgery. Common treatments employed by specialists in Singapore to help GERD patients are the following:
- The specialist can recommend to the person suffering from GERD to alter some habits and change his or her diet to be able to manage the disease such as maintaining healthy body weight, avoiding eating late at night, not eating foods that may trigger acid reflux (e.g. high-fat foods, citrus, tomatoes, spicy food, chocolates, coffee, etc.), quitting smoking, eating small meals, and other relevant practices. Over-the-counter medicines are also sometimes suggested by specialists.
- Medications are often prescribed to patients with moderate to severe symptoms of GERD. Common prescriptions include Prokinetics to accelerate the emptying of the stomach and various kinds of proton pump inhibitors to decrease the levels of acid produced by the stomach
- There are cases where surgery is recommended to manage symptoms of GERD and done when all others (lifestyle change medications) did not succeed. Most patients do not require surgery and a consultation with a surgeon should be done prior. The most common surgical procedure in the treatment of GERD is Laparoscopic antireflux surgery which is aimed to fix the acid reflux problem by means of creating a new valve at the bottom of the esophagus (thereby increasing pressure) to support the esophageal sphincter.
One should note though that GERD is a chronic disease (which means it can be life-long) and recurs once treatment is discontinued. However, there are GERD management techniques that may help you forget about your symptoms even if they won’t necessarily make your acid reflux go away.
Andrea Digestive Clinic
#21-11/12 Royal Square at Novena 101
Irrawaddy Road Singapore 329565
+65 6264 2836