KARACHI, March 10: Gastro-oesophageal reflux disease is a common cause of indigestion caused by washing back (reflux) of food and stomach acid into the gullet (oesophagus).

This occurs because a muscular valve (sphincter) at the junction of the oesophagus and stomach fails to work properly, said Prof. S. M. Wasim Jafri, Consultant Gastroentrologist, acting Chairman of Medicine and Chief of Section of Gastroentrology at the Aga Khan University Hospital (AKUH).

He was giving a presentation on “Heartburn and gastro-oesophageal reflex disease” at the monthly “Signs, Symptoms and Care”, a public health awareness programme.

He said stomach contents irritate the oesophagus and cause a painful burning sensation in the chest rising up to the throat (heartburn).

These symptoms typically occur after intake of food. Large meals and fatty or spicy foods are most likely to cause problems, Prof. Wasim said adding stomach contents may rise as far as the throat (often described as repeating). When severe, it may resemble vomiting.

Occasionally, the Professor said, they may irritate the breathing passages and cause cough, hoarseness, sore throat and asthma. If this happens at night it may cause wakening with choking attacks.

He informed that in most sufferers reflex disease is not more than nuisance, bothering them only on some occasions e.g, after large spicy meals. In some people it causes regular discomfort that disrupts their lives.

Most people with reflux disease do not have any significant damage to their esophagitis and stricture, he observed and explained that esophagitis is inflammation and ulceration of the lining of the oesophagus. This can cause painful swallowing and also bleeding.

Prof Waseem pointed out that infrequently long-standing reflux may cause Barrettes esophagitis which can lead to the development of oesophageal cancer over a period of time.

He said occasional heartburn episode is often diet related. Simple self-help measures are worth trying first. If these give adequate relief you do not need to do anything further.

He advised avoiding eating large or fatty meals, and any foods that aggravate your symptoms, avoid eating within two hours of lying down or before going to bed.

He further advised: Lose weight if you are overweight, stop smoking, keep the head of the bed 10 centimetres up (one house brick) or use a wedge pillow, particularly if your symptoms bother you at night.

He said try an antacid when heartburn occurs (tablets are most convenient if they are easily carried. Choose an antacid of form and flavour that appeals to you. Only low or sodium-free antacids should be used by people who must limit their salt intake.

Prof Jafri said a specialist may advice endoscopy, “under sedation when the inside of oesophagus and stomach is examined directly with a flexible instrument to see if there is any esophagitis.

Endoscopy also excludes any other problem such as a stomach ulcer. In this process X-ray pictures are taken as you swallow a thick liquid, which outlines the oesophagus and stomach. It is most useful for seeing why food sticks. Other special tests that are available are Oesophageal acidity or pH monitoring.”

The speaker and the panelists, Dr. Ashfaq Ahmed and Dr. Shahab Abid participated in the question and answer session.—APP