After a big, hearty dinner, do you usually adopt the food coma position on the sofa in front of the TV? You know, half-lying down, half-sitting, and completely unwilling to move more muscles than necessary?
Well, if you typically experience a burning sensation in your chest and/or a sudden impulse to gag while you’re doing so, you’re experiencing acid reflux.
Also known as gastroesophageal reflux disease (GERD), “it happens when the acid in the stomach and its contents backflow into the oesophagus, causing troublesome symptoms such as heartburn and regurgitation”, said Dr Melvin Look, director of PanAsia Surgery at Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital and Parkway East Hospital.
WHAT CAUSES ACID REFLUX?
With the festive season – and lots of eating – coming up, chances are it’s going to happen to quite a few people. But even outside of it, about one in five Singaporeans is known to suffer from acid reflux, said Dr Ho Gim Hin, associate consultant with Khoo Teck Puat Hospital’s Division of Gastroenterology.
And there could be two possible reasons. “Diet plays a very important role in acid reflux,” he said. “Certain foods are known to contribute to and aggravate reflux symptoms. These include caffeinated and carbonated drinks, spicy, sour and citrus food products, oily and greasy food, chocolates, and alcohol.”
Meanwhile, Dr Andrew Ong, who is with Singapore General Hospital’s Department of Gastroenterology and Hepatology, believes that it is obesity – and not the type of food you eat – that contributes to acid reflux. “Obesity is a risk factor of acid reflux, therefore, oily food may indirectly lead to acid reflux symptoms. And our population today is more obese than before, especially in our school-going children, so this prevalence may even be higher.”
DOES LYING DOWN AGGRAVATE THE BURNING SENSATION?
Your stomach is “numb” to the acid but your oesophagus – the muscular tube that connects your mouth to your stomach – isn’t, which is why acid reflux burns, explained Professor Adam Taylor, director of the Clinical Anatomy Learning Centre at Lancaster University in England, on The Conversation website.
And while lying down after a big meal certainly helps to encourage this backflow of acid, it sometimes doesn’t require a horizontal position for the acid to rise – because you’re already so stuffed with food.
“Overeating causes indigestion when the stomach acid churns up into the oesophagus,” wrote Prof Taylor.
CAN ACID REFLUX LEAD TO SOMETHING SERIOUS?
As unpleasant as acid reflux is, it is “not life threatening”, said Dr Ong, although he warned that long-term damage to the oesophagus caused by the acid backwash can lead to its narrowing and “pre-cancerous changes called Barrett’s Oesophagus”.
“However, broadly speaking, acid reflux is still an uncommon cause of oesophageal cancer,” he clarified.
But Dr Ho highlighted that acid reflux may also bring about other health issues in the digestive system, including “oesophagitis (inflammation of the oesophagus), peptic (or gastric) ulcer disease, gallstone disease, and even disorders of the colon and pancreas”. Sometimes, acid reflux could be a sign of heart attack or asthma, too.
About one in five Singaporeans is known to suffer from acid reflux.
If you find yourself increasingly relying on antacids for the quick relief of heartburn and acid reflux, it can be a sign that something more serious is going on, said Dr Look.
Just as suspicious is when an older person above the age of 40 develops acid reflux out of the blue. “The best way to assess reflux symptoms and to exclude more serious issues is to perform a gastroscopy. This is a simple visual assessment of the oesophagus and stomach using a long, thin and flexible telescope,” he said.
WHAT’S THE BEST WAY TO DOUSE THE BURN?
There are a few options to calm down the burn, with each available as over-the-counter as well as prescription medicines. These include H-2-receptor blockers (they reduce acid production) and proton pump inhibitors (they block acid production and heal the oesophagus).
However, do note that the Health Sciences Authority has taken eight brands of ranitidine (a H-2-receptor blocker) off the shelf for containing the cancer-causing impurity, N-nitrosodimethylamine, in quantities beyond the internationally acceptable level.
Then, there are antacids, which are mostly composed of an alkaline mixture that increases the pH level of the stomach and reduces the likelihood of the acid injuring the oesophagus, said Dr Ong. Some antacids also have alginates, which bind to the top of the acid layer to reduce the likelihood of acidic injury.
According to Dr Ho, some antacids may contain aspirin and patients with a history of peptic ulcers should not take them. “Aspirin can cause ulcers, which may lead to gastrointestinal bleeding.”
Also, "many patients take antacids to treat gastritis," said Dr Ong. "Although they may find short-term relief due to the cooling nature of these substances, they have not been shown to improve symptoms. Some patients also take antacids to reduce the production of gas, but again this has not been shown to be the case."