Wednesday, March 18, 2015


It is a common feeling, the sensation of burning at your upper tummy at the middle where your ribs meet. We always strike it off as something trivial, because we feel “heaty” or we ate something not agreeing with us.

Heart burn is really a symptom of acid reflux. It means the acidic gastric juices have refluxed upwards from the stomach (we do not feel in the stomach because the stomach lining protects against the acid to the throat, which has no protection against the acid. This results in corrosion and the discomfort feeling is the manifestation.

This doesn’t happen to everyone; so who is at risk?

We have a control mechanism designed to keep the juices down, called the lower oesophageal sphincter (LOS). It allows food and drink to go down into the stomach but prevents anything from refluxing upward. Failure of this sphincter causes reflux. Things like overeating, obesity, aging and certain medicines can compromise this LOS mechanism. Less commonly, a condition called hiatus hernia, where a portion of the stomach has gone into the chest cavity will also compromise this mechanism. Pregnancy can also cause reflux, especially during the later part.

Can we do anything?

Knowing the causes, it is often easier to find out how to prevent or minimize the symptoms.

Portion controlled diets are key and easiest in reducing the incidence of reflux. Instead of one big Curry Laksa, it is best to take two or three portions of it, and eat it over the span of 3 hours. Oftentimes, this also helps in weight reduction. Eat early in the evening, and a lighter meal if possible. Certain foods tend to make you reflux more. Keep an eye out, and try avoiding them. This may differ from individuals. Even after meals, keeping upright (i.e. sitting up) helps reduce the pressure on the LOS and that makes it easier to maintain its control on reflux. Important to know what medicines or supplements you are taking as well which may relax the LOS and increase your symptoms.

Of course we cannot turn back time and reduce aging but we can look out actively for signs of reflux and if there are to get investigated earlier. Simple procedure like Barium swallow (x ray taken when you are asked to swallow a drink that can be seen on the x-ray) could easily diagnose hiatus hernia. If necessary the best way to manage is by a small surgery. Having said that, not all hiatus hernias need to be operated on.

If you are prone heartburn at night when you sleep, it may help to sleep with your head and upper chest higher than your tummy - maybe try two pillows instead of one, or if you can adjust the head of the bed to angle it slightly. Although I have mentioned exercise is good, do avoid physical exertion after a meal.

Basically the medications used are to reduce acidity of the gastric juices, namely H2 antagonists and proton pump inhibitors. Be sure you go to see a doctor for these symptoms, especially if these symptoms are persistent, and especially if you are above 55 years old.

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