Very unhappy returns
Gastroesophageal reflux disease - GERD - is on the rise in Asia, yet sufferers are reluctant to adaptOnce an infrequent if normal physiologic phenomenon, gastroesophageal reflux disease, more commonly known as GERD or krod lai yon in Thai, has become such a common disorder over the last decade that antacids are, for many of us, a way of life.
GERD occurs when the acid and substance from the stomach reflux back to the oesophagus due to a weakness in the oesophageal sphincter that connects the oesophagus and stomach.
In a normal situation, after the food we eat moves from mouth to oesophagus and then to the stomach, the sphincter will close and prevent it from flowing backward. When the sphincter loses its flexibility, it lets loose food and acid that is produced back to the esophagus.
While the stomach is designed to tolerate strong acid, the oesophagus isn't. The reflux of the acid causes inflammation, heartburn, difficulties in swallowing (dsyphagia) and regurgitation. If left untreated, the GERD sufferer may go on to develop hoarseness, cough, sore throat and wheezing.
"The two major symptoms of acid reflux are heartburn and regurgitation. If you have these two, you have GERD," says clinical Professor Udom Kachintorn, adding that the loss of flexibility in the sphincter is usually due to high pressure in the stomach area, which happens when you eat too much or eat late at night then go to bed.
It takes one to two hours following a meal for the acid in the stomach to digest the food. Lying down during that time causes the abdominal area to increase and put pressure on the sphincter.
The good news is that Asians tend to have milder GERD than their Western cousins.
"One reason is that the stomachs of Asian people has less parietal cell mass that produces acid compared to Westerners. So the degree of the disease is lesser," explains Dr Udom.
He caution, however, that those who suffer with GERD for more than 10 years are at risk of cancer of the oesophagus or stomach.
"There is no 100 per cent way of detecting GERD through endoscopy or computerised X-ray. The best way is use symptom based diagnosis. If the patient has heartburn and regurgitation, then it's GERD. Doctors can diagnose more severe disease by talking with patients to find out if they have any alarming symptoms," he says.
While GERD can be cured with medication, it is important that patients change their lifestyle and dietary habits in parallel, something which most prefer to ignore.
The gold standard treatment is the Proton Pump Inhibitor (PPI) medication, which used for acid suppression.
"They should take the medication at least four weeks as well as change their lifestyle. If the symptoms don't improve, then they should again see a doctor," he says.
PPIs are also used for gastrointestinal ulcer treatment and often co-prescribed with common heart medication clopidogrel and there have been concerns that certain PPIs may interfere with clopidogrel's function, thus increasing the risk of negative cardiovascular side effect.
During an recent regional gastrointestinal media summit in Kuala Lumpur, Professor David A Peura from the University of Virginia School of Medicine, revealed that selected PPIs like lansoprazole and dexlansoprazole offer much safer options for concurrent treatment of both heart and stomach conditions. The US FDA does not recommending taking PPI medication with omeprazole or esomeprazole with clopidogrel.
A 15-year study on pantroprazole in 142 adult patients in Germany by Professor Gorig Brunner at the University Medical School of Hanover indicates that prolonged treatment with PPIs shows no increase in the signs associated with gastric cancer risk.
GERD is on the rise, however. The summit also reveals that the prevalence of the disorders is 17 per cent in China and 29.8 per cent in Hong Kong.
A recent questionnaire survey of 3,000 people in Thailand found that around 7 per cent had experienced GERD symptoms in the past six months. Hospital based surveys conducted at Siriraj Hospital discovered 4.9 per cent in 2000 and 9.6 per cent in 2006.
"But in reality, I think people who have GERD is twice as high," says Dr Udom.