Comprehensive Guide to Acid Reflux Treatment in Singapore

Explanation of acid reflux and GERD

This is a feeling of chest discomfort with a burning sensation behind the breastbone and often acidity traveling up the throat (acid reflux).

The reason this may occur is that the muscle complex at the junction of the food gullet (esophagus) and stomach is weak and open, thus allowing gastric content to reflux upwards after a meal when the content is most acidic, causing irritation and damage to the lining of the food gullet.

Other related symptoms can be:

• “Stuck feeling” and gas bloating in the lower end of the food gullet during swallowing
• Nocturnal cough
• Breathlessness without exertion and difficulty breathing
• Usually related to a large meal, but when chronic can present with a constant pain  
• Sore throat and hoarseness of voice in the morning
• Nausea or vomiting

When it happens very often, the medical term for this ailment is GERD (Gastro-Esophageal Reflux Disease).

Reflux symptoms may be as high as 20% for Asians.

Main Causes

• Obesity
• Stress and anxiety
• Smoking
• Alcohol
• Pregnancy
• Types of food - spicy, oily, and difficult to digest
• Time of ingestion. Late night and with less than 4 hours before bedtime.
• Medicines. Painkillers like Ibuprofen
• A hiatus hernia - when part of the stomach moves into the chest because of a defect in the diaphragm

How do Medical Professionals Diagnose Acid Reflux

Acid Reflux is a common problem affecting 15% of the population in Singapore. The diagnosis of acid reflux is through history, and a family physician would have started the initial therapy.

Available treatment options for managing Acid reflux /Lifestyle and dietary change / medications

Simple remedies

Positive

• Smaller and more frequent meals
• Prop up your head with an additional pillow
• Weight loss
• Relaxation

Negative

• Excessive spicy and oily food
• Eating 3 or 4 hours before bedtime
• Smoking
• Excessive alcohol
• Excessive fluid intake before bedtime

Over the counter

• Antacids. Gaviscon. Mylanta. Actal.
• Try to take these immediately after a meal.
• Gaviscon works best with a liquid formulation. It forms an alkali pocket that prevents acidity from reaching the food gullet.

Seek Medical Attention if:

• Lifestyle changes and pharmacy medicines are not helping
• More than 3 weeks of Heartburn
• Other symptoms like food getting stuck in the throat, weight loss of more than 5%, continuous pain, passage of dark stool and vomiting

When initial treatment fails, and the patient develops more serious symptoms (see gastroscopy section), is above 40 years of age, and is severe, it will be important to proceed with gastroscopy to diagnose the condition and assess severity accurately.

Diagnostic tests and endoscopy

• Gastroscopy for persistent symptoms and increasing severity
• PH monitoring - requires a thin probe to be placed through the nostril into the oesophagus to monitor PH over 24 hours. This is an important confirmatory test if surgery is contemplated.
• HRM (High-resolution impedance manometry). Another type of fine probe is inserted through the nose, and a test involves swallowing liquids or solids to assess if the function of the muscle function of the oesophagus and refluxes are normal. A sensation of acid reflux may be due to disordered swallowing as well, in which case the treatment is more medical rather than surgical.

Surgical interventions for Acid reflux

It is important to realize that only 1-2 % of patients who do not respond to medical treatment of reflux will require surgery. This is done through an operation called “Fundoplication”, whereby the dome of the stomach is wrapped around the distal oesophagus to tighten the entrance and reduce content in the stomach from refluxing into the oesophagus (food gullet).