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Canberra Today 13°/16° | Saturday, March 30, 2024 | Digital Edition | Crossword & Sudoku

Health / When gastric regrets get serious

AT some point, most people have had reflux, whether it’s heartburn after a particularly challenging vindaloo or gastric regrets following a big night on the town.

Dr Purnima Bhat.
Dr Purnima Bhat.

It’s so common, that most people don’t even tell their doctors about it, but when is a little reflux a real medical problem that warrants investigation?

Gastro-oesophageal reflux disease, or GORD, is estimated to occur in 60 per cent of adults at some time in their lives, with the incidence rising as we lead progressively less healthy lives.

Most people with GORD have symptoms: usually heartburn or chest pain, pain in the upper abdomen, nausea or regurgitation. More uncommonly, sufferers may have an early morning cough, a change in taste or difficulty swallowing.

Food may make the symptoms better (milk, yoghurt) or worse (spices, chillies). Worryingly, GORD is increasingly being diagnosed on routine testing in asymptomatic patients.

The stomach secretes up to three litres of hydrochloric acid per day and the lining of the stomach is protected from acid damage by mucous and specialised cells. The lining of the oesophagus, on the other hand, is structured to deal with rough food particles we swallow and lacks acid protection.

GORD occurs when acid from the stomach bypasses the gastro-oesophageal sphincter and rises up to cause damage to the oesophageal lining. This can result in ulcers, scarring and strictures, or a chronic change to the cells of the oesophagus – Barrett’s oesophagus – which can be a pre-cancerous condition. Generally, the longer the disease is left untreated or undertreated, the more likely it is that lasting damage can occur.

Lifestyle risk factors for GORD include obesity, smoking, and excess alcohol intake. There has been no evidence that coffee or tea drinking increases the risk of GORD, although it may worsen symptoms. Individual anatomy of the gastro-oesophageal sphincter, and altered motility of the oesophagus can also play a role.

Can stress cause GORD? The amount of acid production in the stomach can increase in response to stress hormones, increasing the risk of GORD. There is evidence that oesophageal motility is responsive to stress and psychological factors also.

There are many simple antacids effective for treating mild or occasional reflux. Stronger acid suppressors such as ranitidine may be more effective but take longer to work. Prescription medication with a class of drugs known as proton-pump inhibitors are very effective in the treatment of GORD.

Thus, GORD can be managed without surgery in most people. In a handful of people, surgical therapies, usually performed laparoscopically, may be required to control reflux, especially if there is an underlying anatomical cause.

When should you see a doctor about your GORD? Difficulty swallowing, or unexplained weight loss, requires urgent medical attention. If you’re having frequent and severe symptoms, your doctor may prescribe a short course of medication. Referral to a gastroenterologist for further investigation including endoscopy may be warranted if symptoms recur.

Dr Purnima Bhat is a gastroenterologist and a Senior Research Fellow at the ANU Medical School.

 

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