Journals

Always Suffering From Heartburn or Acid Reflux? You May Have a Digestive Disorder
Heartburn Symptoms, Nissen Fundoplication, Dr Ganesh Ramalingam

Article first published on The Straits Times

Do you sometimes get a nasty, acidic taste at the back of your throat? You may be experiencing acid regurgitation or gastroesophageal reflux. If you frequently experience this, Dr Ganesh Ramalingam, a specialist in General Surgery at G&L Surgical Clinic, Mount Elizabeth Novena Medical Centre says that you may have a digestive disorder known as Gastroesophageal Reflux Disease (GERD), which occurs when acid from the stomach flows upwards and into the oesophagus. Below, Dr Ganesh explains more about GERD, its risk factors, symptoms and treatment options.

What is GERD and its symptoms?

GERD is related to the junction between the oesophagus and the stomach. People may experience pain or a burning sensation within the chest, known as heartburn, which is the most common symptom of GERD.

Other common symptoms include abdominal pain, regurgitation of food or acid, and throat-related irritation such as a recurrent sore throat, cough, dry mouth, or halitosis (bad breath).

Heartburn Symptoms, Nissen Fundoplication, Dr Ganesh Ramalingam

GERD can affect your daily lifestyle and some patients often report being unable to sleep at night due to acid reflux.

What Are the Causes and Risk Factors of Gerd?

There are many lifestyle-related causes that can lead to GERD. It is especially common if a meal is eaten less than three hours before going to bed. Large meals may also cause acid reflux as it places pressure on the lower esophageal sphincter (LES), which is the ring of muscles that prevent acid from moving upwards.

To reduce these unpleasant symptoms, consume smaller meals and avoid lying down immediately after eating. Additionally, one can cut down on acidic and spicy food such as coffee, chilli, vinegar, and carbonated drinks.

Those who drink or smoke excessively may also develop GERD, while other risk factors include pregnancy and obesity. Stress is another risk factor as it may lead to  hormonal changes in your body and increase acid production.

How Is Someone With Gerd Diagnosed?

GERD occurs if you experience reflux-like symptoms more than three times a week.

Due to its symptoms, GERD can sometimes be mistaken for heart disease, chronic cough, long-term sore throat, or asthma. I often get patients referred by general practitioners or other specialists, and have to first find out their medical history to ascertain that their heart pain is not a symptom  of a heart attack, and  that their sore throat is not a sign of an  infection.

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I will also schedule patients for a gastroscopy, which will allow me to see the lining of the oesophagus, stomach, and first part of the small intestine.

What Other Conditions Can Gerd Lead To?

Prolonged acid reflux into the oesophagus can lead to oesophageal inflammation, ulceration, changes in the cell structure that may eventually lead to oesophageal cancer, or even throat cancer if the acid reaches the throat. However, this usually occurs after decades of suffering from GERD, so I would advise patients to seek treatment for symptoms as early as possible.

Patients with GERD may also develop asthma, a chronic cough, or other respiratory problems as a result of  acid being around the upper airways. They may even experience dental problems such as the erosion of their tooth enamel or gum disease due to the stomach acid reaching their mouths and affecting their back teeth (molars).

What Are the Treatment Options Available For Gerd?

The main treatment is to address the symptoms such as sore throat and chest pain.

I would first advise people to manage their diet and lifestyle. One can reduce incidents of reflux by eating earlier, consuming smaller meals, and avoiding  fatty and acidic foods. If you have to lie down immediately after a meal, remember to keep your head higher than your stomach.

Once lifestyle changes have been made to reduce the occurence of acid reflux, medication is the next step. Patients may be prescribed proton pump inhibitors (PPI), which are medication to reduce or suppress acid. Alternatively, I may recommend medication which stimulates the oesophagus to push acid back down.

GERD management is a long process that spans over months as patients must manage their dietary and lifestyle habits, and take long-term medication.

For resistant cases of GERD, there is a surgical procedure called the laparoscopic Nissen fundoplication, also known as anti-reflux surgery.

When Would You Advise Someone to Undergo Laparoscopic Nissen Fundoplication Surgery and How Does It Work?

I usually advise patients to go for a laparoscopic Nissen fundoplication if the initial treatment fails – when the patient still experiences acid reflux more than three times a week in the last three to six months, despite being on a high dose of medication.

If your condition is affecting your daily lifestyle, such as by preventing you from getting a proper night’s sleep due to acid reflux, you may have to consider surgery.

Surgery is also advised should gastroscopic findings show that the cells in your oesophagus are starting to change in the direction of becoming cancerous. After excluding the possibility of other conditions such as heart disease or a throat or lung infection, the patient may then be considered for surgery.

Surgery is performed using the keyhole technique (laparoscopic), meaning that it is minimally invasive. During a laparoscopic Nissen fundoplication, the upper part of the stomach (the fundus) is wrapped around the lower oesophagus to reduce the occurrence of acid reflux by reconstructing the lower esophageal sphincter (LES).

Laparoscopic Nissen Fundoplication, GERD, GL Surgical, Straits Times

This is the most common type of surgery for GERD. Recovery time is generally minimal – most patients stay in the hospital for two days but can be up and about within one day of being discharged from the hospital.

It is recommended that for the first two weeks after surgery, patients remain on a liquid diet before progressing to soft foods in the following two weeks. Patients should take care to eat slowly and consume smaller amounts during each meal. After three to four weeks, patients are able to resume regular exercise.

One thing to note is that the surgery may not completely cure GERD and that recurrence is possible, especially if patients do not continue to manage their diet and lifestyle. The surgery allows patients to be pain-free for five to seven years and prevents cellular change.

GERD is still an evolving field, meaning that new theories and methods of management are being discovered every day.

About Dr Ganesh Ramalingam

As a strong proponent of treating the patient holistically instead of just their condition,  Dr Ganesh Ramalingam advises patients as to how they can manage their daily habits and diets to lead healthier lifestyles. As a consultant with G&L Surgical Clinic specialising in General Surgery, he sees many patients with conditions related to the stomach and is skilled in bariatric surgery, upper GI and hernia surgery, advanced laparoscopic surgery, endoscopies, and trauma.

Dr Ganesh holds a Bachelor of Medicine & Bachelor of Surgery (MBBS) and a Master of Medicine (MMed) from the National University of Singapore. He completed his post graduate training and fellowship at the Royal College of Surgeons, Edinburgh.

As a busy father to two young daughters, Dr Ganesh still finds time to give back to the community by serving as the Director of the Rotary Club of Singapore’s Youth Service Committee.