About Acid Reflux
1. Acid reflux is common and increasing in the developed
world. A Gollop Poll in USA reported that 44% had symptoms on
a monthly basis. GERD is higher in whites and the obese. There
is also a higher prevalence in people aged 60-70 years. It is
rare in blacks. It is also lower in Eastern countries. In India
it is 7.5%, Malaysia 3% and China 0.8%. It is suggested that
this incidence will increase as these countries introduce Western
diet higher in fats.
2. Lifestyle change is an important aspect of treatment of
acid reflux. Some patients show marked improvement after losing
only a small amount of weight.
Obesity increases abdominal pressure and affects the lower
esophageal sphincter (LES). Large meals distend the stomach
and adds pressure on the LES. Certain foods affect the sphincter.
Avoid or consume in moderation, food such as fats, coffee and
3. Antacids neutralize acids in the stomach. This reaction
raises the pH and is likely to relieve heartburn or other symptoms
of reflux. Trials, however, show that antacids will not heal
The antacids commonly used are magnesium hydroxide, magnesium
trisilicate and aluminium hydroxide.
4. Acid Suppressant drugs should be used if lifestyle changes
and antacids are ineffective. The first group introduced are
the H2-receptor antagonists such as ranitidine. Side effects
from this groups of drugs are rare.
The newer proton pump inhibitors like omeprazole and lansaprazole
are more effective than H2-receptor antagonists. They are safe
and long term use has shown no ill effects. They are so effective
that most GERD patients that were unresponsive to ranitidine
were effectively treated with omeprazole.
5. A complication of GERD is bleeding from esophigitis. This
can lead to anaemia especially in children. Stricture is a distressing
complication. It can cause pain and difficulty on swallowing.
Barrett's esophagus, experts think, develop after damage
to the mucosal lining by acid reflux.
6. Most infants reflux, and conservative measures such as
thickened feeds help. Reflux generally subside before the end
of the first year. In the past Barrett's esophagus was thought
to be confined to adults but with the introduction of smaller
fibreoptic endoscopes, more biopsies are done and Barrett's
esophagus are being diagnosed in children.
7. Surgery for acid reflux is very uncommon since the advent
of effective acid suppressant medical treatment. Today stricures
are not common and there are only a rare few that do not respond
to omeprazole as acid reflux treatment.
The commonest procedure is Nissen Fundoplication. Today laparoscopic
fundoplication is popular.
8. Smoking makes acid reflux symptoms worse, especially in
children. Nicotine relaxes the lower esophageal sphincter allowing
acidic stomach contents to reflux up into the esophagus. In
addition deposited nicotine in the back of the throat when swallowed
is corrosive to the esophageal lining. Stop smoking if you have
9. Raising the head of the bed is an effective acid reflux
treatment. It is useful for nocturnal acid reflux symptoms and
reduces sensitization that results in problems during the day.
Tests have shown that adding additional pillows is ineffective.
10. Do not ignore your symptoms. Lifestyle changes may be
all that is necessary to control your symptoms but if, in addition
to over the counter medications ,your symptoms persist see your
family doctor. If you have GERD, complications can be severe
and the symptoms very distressing.
For Further Reading