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Oops... There Goes Another Burp!

21 Jun
Have you ever had the embarrassment of burping in the presence of others? Or, do you occasionally get a sour taste in your mouth or feel a burning sensation in your throat or chest?

According to Dr Andrea Rajnakova, these are some of the symptoms of reflux which happens when the acid in your stomach backs up into your throat and mouth. This constant backwash of acid can irritate the lining of your oesophagus, causing it to become inflamed. The oesophagus is the tube that connects your throat to your stomach.

She explains, “It usually happens because the junction between the oesophagus and the stomach does not function normally. This irritation causes troublesome symptoms and in the long-term may result in some complications.”

During swallowing, food passes down the throat, through the oesophagus, into the  stomach. Normally, a muscle valve at the end of the oesophagus (called the lower oesophageal sphincter) opens to allow food into the stomach and then closes up. When this muscle does not close tightly enough or remains open (called hiatus hernia), stomach acid can reflux, or wash back, into the oesophagus, causing damage to its lining.

Signs and Symptoms

Acid reflux is a common digestive condition which many people experience from time to time. Usually, they can be managed by making lifestyle changes or with
over-the-counter medication.

“However, if these don’t work or if you get the symptoms often, it is advisable to see your doctor about it,” says Dr Rajnakova.

Some of the more common symptoms of acid reflux include:

  • Burning sensation in the throat,
  • Heartburn which is a burning sensation in the chest
  • Burping and belching
  • Sour or bitter taste in the mouth
  • Coughing at night
  • Dry throat
  • Sore throat
  • Hoarseness in the morning
  • Worsening asthma

Consequences of Long-term Acid Reflux

If left untreated, long-standing acid reflux may lead to more serious conditions such as:

  • Oesophagitis: This is an inflammation of the oesophagus resulting in ulcers which are breaks in the lining of the oesophagus.
  • Stricture: This is the narrowing of the gullet or oesophagus as a result of long-standing inflammation.
  • Barrett’s Oesophagus: This may occur when long-standing inflammation leads to changes of the cells of the lower oesophagus. Patients with Barrett’s oesophagus have a higher risk of oesophageal cancer compared to the general population.

Diagnostic Tests for Acid Reflux

In the simplest case, when duration of symptoms is short and reflux improves after medication, no diagnostic tests are required. If the symptoms are long-standing and do not improve with medication, further investigation will be necessary. Some of the tests include:

  • Gastroscopy: This allows the inspection of the oesophagus and stomach, and detection of inflammation at the lower oesophagus. Tissue sample could be obtained for further testing of cell changes to rule out Barrett’s oesophagus.
  • 24-hour pH Monitoring: This is to test the acidity in the oesophagus.

Treatment for Acid Reflux

Dr Rajnakova says that the most important components for treatment of reflux are lifestyle and dietary changes. The purpose is to minimise the amount of acid refluxing from the stomach and reduce the potential risk for damage to the oesophageal lining.
Certain foods may worsen reflux. Examples of such foods are:

  • Chocolates, sweet deserts, high-fat or spicy foods, curry, citrus fruits, garlic, onion and tomatoes or tomato-based products
  • Beverages such as citrus juices, alcohol, coffee, black tea

She explains that these foods can relax the muscle responsible for stomach closure (lower oesophageal sphincter), allowing stomach juice and acid to reflux into the oesophagus. They should be avoided when you are experiencing such reflux episodes.

She also says that making lifestyle changes can improve and lessen the symptoms of acid reflux. And these include:

  • Eating regular meals and small portions each time
  • Avoid eating for two to three hours before going to bed
  • Lose weight (if you are overweight)
  • Stop smoking
  • Elevate the head of your bed by six to eight inches
  • Avoid stress

 Medications for Reflux

Antacids are the most common medication to neutralise gastric acid in the stomach. These medications are readily available over the counter at any pharmacy. However, if the reflux does not improve after this medication, more potent and targeted medicine will be necessary. These would include medications to reduce acid secretion in the stomach (proton pump inhibitors), and improving motility and stomach emptying (prokinetics). Most patients with reflux do not need surgery.

 Published in Straits Times - Mind Your Body, 08/06/2011

Dr. Andrea

Dr. Andrea Rajnakova is our Consultant Gastroenterologist and Physician.

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