Wondering what causes that awful burning in your chest? DR BENJAMIN YIP, consultant gastroenterologist at Alpha Digestive & Liver Centre, shares what causes heartburn, and the difference between GERD and acid reflux symptoms. Plus what you can do to prevent them and when to see a doctor.
What causes heartburn?
“Heartburn” is a burning pain in the chest that originates not from the heart, but from the oesophagus – the tube that connects your stomach to your mouth. What causes heartburn is actually a symptom of acid reflux – a common gastrointestinal condition where the acid from the stomach flows back up into the oesophagus, explains Dr Yip.
Causes of acid reflux
The muscle that regulates the flow of food content from the oesophagus into the stomach is called the lower oesophagus sphincter (LES). Its ability to prevent acid from flowing back up is compromised when it relaxes or loosens as a result of certain factors or underlying conditions, including pregnancy, obesity and having a hiatal hernia.
Eating large meals, in particular, can cause the upper stomach to over-stretch, keeping the LES from properly doing its job. Additionally, frequent consumption of fried and fatty foods, and smoking, can increase one’s risk of acid reflux.
Acid Reflux Symptoms
In addition to heartburn, acid reflux symptoms may include:
- a sour or bitter taste in the mouth;
- difficulty swallowing;
- regurgitation of food or liquid in the mouth;
- a persistent cough; and
- the sensation of a lump in the throat.
Usually, these acid reflux symptoms can be eased with over-the- counter medication and by making certain lifestyle changes. However, if those treatment tactics don’t cut it, and you’re experiencing reflux more than twice a week, you may have gastroesophageal reflux disease (GERD) – a chronic, more severe form of reflux that can seriously impact your quality of life.
How serious is GERD?
Unpleasant symptoms aside, if left untreated, GERD can lead to complications such as oesophagitis – an inflammation that can lead to bleeding, ulcers and painful swallowing, says Dr Yip.
Another possible complication is Barrett’s Oesophagus, where longstanding inflammation causes oesophageal cells to mutate, putting the patient at greater risk of developing oesophageal cancer.
If you experience GERD symptoms, consult a gastroenterologist for further investigation, advises Dr Yip. “A gastroscopy can be done to check for any structural abnormalities such as ulcers or changes in the lower oesophageal tract.”
During the procedure, tissue samples can be collected for further testing to assess the severity of reflux and rule out Barrett’s Oesophagus.
In addition to a gastroscopy, a gastroenterologist may order other tests – for example, x-rays to view your gastrointestinal tract, 24-hour pH monitoring to test the acidity of the oesophagus, and high-resolution manometry to assess the movement of the oesophagus.
Fortunately, GERD can be resolved. Dr Yip says that medications like proton pump inhibitors can reduce acid secretion in the stomach, while antacids can neutralise gastric acid and provide temporary relief. In addition to medication, making lifestyle and dietary modifications is key to the management and prevention of acid reflux. “To decrease your risk of GERD you can refrain from eating two hours before bedtime, quit smoking, lose weight and avoid alcohol,” he says.
Additionally, certain foods can be avoided in an effort to prevent GERD symptoms. Here are 10 to keep in mind:
- fatty and oily food and beverages
- spicy foods
- citrus fruits
- carbonated drinks
- tomatoes and tomato-based foods
- fried food
- onions and garlic
If a combination of lifestyle and dietary changes and medication doesn’t suffice, you might be a candidate for surgery. Luckily, there are laparoscopic and endoscopic options available, which are less invasive compared to traditional open surgery, says Dr Yip.
Of course, it’s best to consult a gastroenterologist, who can advise on the best treatment.
This article first appeared in the July 2022 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!