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Persistent heartburn, a likely sign of gastroesophageal reflux disease

<p><span style="font-family: helvetica;">​Persistent heartburn can be a sign of gastroesophageal reflux disease (GERD) which causes the stomach acid and digestive enzymes to leak backwards into the oesophagus (the tube that carries food from the mouth to the stomach).

Acid reflux is very common and most people experience it at some point of their lives. In Kenya though no studies have been done on exact figures, about 1 to 2 in every ten people suffer from acid reflux. Over 50 per cent will have reflux symptoms over a 12 month period. The condition becomes a problem when it persists and affects ones daily activities. Frequent heartburns and regurgitation are the most common symptoms of gastroesophageal reflux disease (GERD), which seems to be increasing world-wide with obesity and advancing age.

Dr Allan Rajula, Consultant Gastroenterologist and Senior Instructor in the Department of Medicine at Aga Khan University Hospital, Nairobi explains ”Long-standing severe GERD causes changes in the cells within the lining of the oesophagus which can become either pre-cancerous, or cancerous. The condition is referred to as &#39;Barrett&#39;s Oesophagus&#39; and it occurs in about ten per cent of people with GERD.”

“Most patients with GERD have either non-erosive reflux disease (NERD) or erosive oesophagitis. If you have ongoing reflux but experience little to no relief from acid blocking medications, you may have what is known as non-erosive reflux disease or NERD, which is a sub-category of GERD.”

“NERD has GERD-like symptoms, but does not show any signs of injury to the esophagus when an upper endoscopy is performed. This is used to assess GERD-related esophageal mucosal injury such as erosions, ulceration, stricture (narrowing of oesophagus), Barrett&#39;s oesophagus, and others.”

Treatment for most people with GERD includes lifestyle changes and medication. There are some specific foods people suffering from GERD should avoid because they promote reflux. These foods include peppermint, chocolate, caffeinated drinks, alcohol, fatty foods, and spicy or acid-containing foods.

“Recently, a 45 year old male patient was referred to my clinic with long-standing discomfort, difficulty sleeping and heartburn with reflux and regurgitation symptoms. He was sensitive to acidic foods, fruits and vegetables and often had to use over the counter antacids.”

“We conducted an endoscopy procedure which revealed that he suffered from hiatal hernia, a condition that occurs when part of your stomach pushes upward through your diaphragm. Your diaphragm normally has a small opening (hiatus) through which your food tube (esophagus) passes on its way to connect to your stomach. The stomach can push up through this opening and cause a hiatal hernia.”

“I put him on proton-pump inhibitors (PPIs) specifically pantoprazole medicines 20mg twice a day for eight weeks. The condition has since improved and he can sleep comfortably and live normal life.” Dr Rajula shares a case.

According to the doctor, the strongest acid-reducing medications are proton-pump inhibitors. PPIs are more effective in acid suppression and have a longer duration of action than normal antacids and antihistamines. The duration for taking the medication ranges from eight weeks to life depending on the severity of the acid reflux.

With NERD, there is a significantly lower response rate to PPI treatments. Interestingly, the majority of GERD cases are classified as non-erosive reflux.

Gastroesophageal reflux disease is the leading cause of cancer of the esophagus especially in the West. In Western populations GERD affects approximately ten to 20 per cent of the population. The prevalence rate is also tightly linked with age and adults over 50 years are the most commonly affected. Other risk factors include obesity, smoking, pregnancy and hiatal hernia.

About 10 to 15 per cent of normal people have hiatal hernia and for those with gastroesophageal reflux disease the number is higher at 70 per cent. This hernia is congenital i.e. occurs from birth and is detected by endoscopy or imaging studies.
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