Recurring heartburn may be a sign of a bigger problem such as Gerd, writes Kasmiah Mustapha
IT used to be commonly associated with ageing.
Previously, the average age of people suffering from gastroesophageal reflux disease, or Gerd, was 50.
Now, younger people are suffering from the chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the oesophagus.
Stomach acid is able to reach the oesophagus because of a weak or malfunctioning lower oesophageal sphincter (LES), which is the ring of muscle between the oesophagus and stomach.
In younger people, the condition is caused more by their lifestyle such as an unhealthy diet, obesity, smoking and alcohol consumption, says University of Malaya Medical Centre head of gastroenterology and hepatology, Professor Datuk Dr Goh Khean Lee.
Stress is another factor.
“I feel that obesity is the biggest factor for acid reflux especially in younger people.
When they have all these risk factors in addition to stress, it will make the symptoms worse.
Stress is not the cause of acid reflux but it contributes to symptom severity,” he says.
While he does not have the data, Dr Goh says there has been an increase in the use of over-thecounter (OTC) medications for the treatment of acid reflux in the last five years.
This is because many sufferers disregard the symptoms and think that remedies such as antacids will help ease the symptoms.
“If they are suffering from heartburn for days or weeks, they should seek medical attention.
Acid reflux is not fatal but it can affect people’s quality of life as they can’t work and sleep.
If the symptoms are mild, it can be treated with over-the-counter medications.
But if they are affecting your life, you need to see a doctor,” says Dr Goh.
Treatment varies depending on severity.
Symptoms such as heartburn can be treated with OTC medicines such as antacids.
However, these only provide short term relief.
Dr Goh said Gerd is a chronic disease but not fatal as complications are rare especially in Asian population.
The prevalence of narrowing oesophagus is less then one per cent.
As for Barrett’s oesophagus, the prevalence is also very low in our population.
In addition, the prevalence of Barrett’s oesophagus turning into cancer is one in 10,000.
“It is a common disease.
It’s not curable and is a nuisance more than anything else.
But the prevalence of erosive oesophagitis is high in Gerd due to a diet high in oil and calories, obesity and genetic predisposition.
Of course, we still need to look at it on a case by case basis.
If a patient has severe reflux, we need to keep a close monitor,” he says.
“Many Asian Gerd patients report stress and loss in work productivity due to their symptoms, which highlights its impact on quality of life.” HEALTHY LIFESTYLE Depending on the severity of the disease, healthcare professionals may introduce proton pump inhibitors (PPIs), group of prescription medications that prevents the release of acid in the stomach and intestines.
It is a long-term treatment approach when basic therapies such as overthe- counter medicines are not sufficient in managing Gerd.
PPIs will reduce acid production by turning off many of the acid pumps in the stomach.
Dr Goh says PPIs is the best treatment as it is aimed at controlling the symptoms.
Diet may help reduce the severity of the symptoms but medication is still the choice of treatment.
“Acid sensitivity should be treated with proton pump inhibitor.
It will provide relief from the symptoms.
Even with one tablet, they can feel the difference.
Gerd is a common chronic illness and patients need to be on long term therapy.
The way to manage it is to be on schedule with the medication.
Between good patients and good doctors, Gerd can be managed well,” he says.
“The use of medication is the first line of treatment.
For now, the best treatment is with acid supressing therapy with PPI.
Reflux is not as simple as a loose sphincter.
Data shows that more than 50 per cent of those who have had surgery to repair the sphincter, have to go back on PPI therapy with time.” In 2004, the prevalence of Gerd in Malaysia was 38.8 per cent.
The prevalence of erosive oesophagitis rose from two per cent to 8.4 per cent over 10 years.
This is consistent with prevalence rates in several Asian countries which also suggest an increasing trend for Gerd.
Unfortunately, the disease remains largely under-diagnosed and under-treated because the severity of its symptoms is often not recognised.
University of Virginia Health Science Centre emeritus professor of Medicine David A Peura said most patients need medication to control the symptoms.
In many cases, patients have to be on long-term medication.
“Usually I will treat patients with PPI for eight to 12 weeks.
Then will reduce the medications once the symptoms are not as severe.
If the symptoms are back, the patient will be back on the treatment.
Unfortunately, in many cases, they have to be on medications for the rest of their lives.
But the good thing is that it is not a fatal disease.
It does affect a person’s life but if he manages it well, there won’t be any problem,” says Peura.
Takeda Malaysia had launched dexilant, a PPI with dual delayed release formulation to provide two separate releases of medications and up to 24 hours of relief from heartburn associated with Gerd.
Each capsule contains two types of enteric-coated granules with different pH-dependent dissolution profiles that are designed to release drug at different locations in the gastrointestinal tract.