Column
OESOPHAGEAL REFLUX - What is the burning issue ?
Dr Kan Yuk Man provides the low-down on the common condition
“ 10-20 % in the West have at least weekly heartburn and / or acid regurgitation � .. treatment ( for acid re�ux ) is the biggest single pharmaceutical expenditure in the UK ….”
We are in a society where day to day demands for time , responsibilities and stress can lead to increasing health issues . One such problem is “ heartburn ,” which affects the population on a regular basis and it can be regarded as a normal event . It can occur after a stressful day , a night of drinking , too much good food or the wrong food . However , in some quarters , it is so frequent that it may signify an underlying condition and it may lead to the development of cancer . The term “ heartburn ,” which is so commonly used , does not actually refer to a condition of the heart but it is used to describe a harsh burning sensation behind the sternum , or breastbone , in the middle of the chest or a tight sensation reaching up to the throat . The cause is acid re�uxing back from the stomach ( Gastro-oesophageal Re�ux Disease � GERD ) into the food pipe ( oesophagus ). This irritates and in�ames the oesophagus , causing the symptom of heartburn and in time it will cause damage to the lining of the oesophagus .
At the lower end of the oesophagus there is a small ring of muscle ( lower oesophageal sphincter - LES ) which acts like a one-way valve . It allows food to pass through into the stomach and closes immediately after swallowing to prevent back-up of stomach juices . The mechanism leading to re�ux can be broadly broken down into three most common reasons : 1 ) increased stomach acid production , 2 ) weaken LES / disruption of the anatomy or delay transit time of food leaving the stomach ( SEE CHART ). When the LES does not function properly or it has to contend with excess acid , the stomach contents �ow back and burns the lower oesophagus . At times , the acid re�ux in the oesophagus can cause severe pain / spasm and this may be mistakenly diagnosed as a heart attack . Other symptoms may also include vomiting or regurgitation , difficulty swallowing , chronic coughing / wheezing or disturbed sleep when we lie �at as the acid �ows up causing irritation of the throat with cough on a nightly basis .
The majority of us may just pop down to the local chemist or go to our local friendly family doctor to get a course of acid remedy . On the whole , this will work as the symptoms are short lived because the majority of GERD is benign with no sinister cause . If it continues to recur or persists then treatment falls into three approaches depending on the underlying cause .
It is a common problem and when it becomes troublesome and symptomatic despite medication further investigation will be necessary . The first course of action would involve the family doctor or specialist undertaking an assessment to understand the severity and duration of the symptoms . One main aim is to exclude cancer of the oesophagus or stomach when re�ux fails to resolve after medication . The ever present acid re�ux will lead to progressive acid damage to the lining of the oesophagus resulting in a sequence of in�ammation , ulceration and changes in the type of cells lining the lower oesophagus with transformation to Barrett ’ s oesophagus . This is pre-cancerous and the development of Barrett ’ s oesophagus will lead to a 2-5 percent risk of developing cancer .
The need for further investigation starts with a gastroscopy ( �exible camera used to look down into the oesophagus and stomach ) which is used to identify any damage to the lining of the oesophagus ( oesophagitis ) or the common finding of a hiatus
INCREASE STOMACH ACID
Helicobacter Pylori infection
Caffeine ( Coffee / chocolate )
Stress / Lack of sleep
Garlic especially if raw asdf
Peppermint
Poor LES pressure / disruption of LES
Peppermint
Alcohol
Caffeine ( Coffee / chocolate )
SLOWS STOMACH TRANSIT
Spicy food ( capsaicin )
Fatty foods / cheese
Fried foods
Onions ( raw ) Cocoa ( Chocolate ) Large meals Tomatoes
Citrus fruits and juices
Fatty foods
Pregnancy ( progesterone )
HIATUS HERNIA Obesity
90 NOVEMBER 2021 GlobalHealthAsiaPacific . com