LIFESTYLE NEWS - A persistent cough, a hoarse voice in the morning or a sour taste in the mouth may not immediately seem linked to the stomach.
However, these can be signs of gastro-oesophageal reflux disease (GORD), even when the characteristic burning sensation of heartburn is absent.
“Usually, when we swallow food, it travels down the oesophagus, through a valve known as the lower oesophageal sphincter, into the stomach, where it is broken down by acid for digestion,” says Dr Nasief van der Schyff, a gastroenterologist and specialist physician practising at Netcare UCT Private Academic Hospital.
Stomach acid is highly acidic, with a typical pH of between 1.5 and 3. When the lower oesophageal sphincter relaxes, acidic stomach contents can flow back into the oesophagus.
“This is what causes the burning pain in the chest known as heartburn, which is most commonly associated with reflux, yet only about half of people with GORD actually feel it,” says van der Schyff.
What are the unexpected symptoms of acid reflux?
GORD can cause a wide range of symptoms, some of which may lead people to seek treatment from other specialists.
These can include:
- Persistent or chronic cough
- Hoarseness, particularly in the morning
- Sore throat or laryngitis
- A sour or salty taste in the mouth
- Regurgitation of stomach contents
- Bloating and frequent burping
- Chest tightness or asthma-like symptoms
- Pain in the upper abdomen
- Sleep disturbances
- Water brash, when excess saliva has a sudden salty or sour taste
“Chronic cough, asthma symptoms, chest tightness and bronchitis can also be present from aspirating the fluids that rise up the oesophagus towards the mouth and nasal passages,” says van der Schyff.
Reflux may also irritate the back of the throat and contribute to enamel erosion on the teeth.
Reflux can be worse at night
GORD symptoms are often worse at night or when lying down after eating.
Some people may initially seek medical help for sleep problems or obstructive sleep apnoea before the underlying reflux is identified.
“It's always important to investigate persistent symptoms with a doctor, and if first-line treatments don't resolve the problem, a specialist opinion may be required,” says van der Schyff.
GORD is estimated to affect about 20% of Western adults and approximately 10% to 15% of adults in South Africa, although representative local data are limited.
How is acid reflux diagnosed?
Where GORD is suspected, an endoscopy or pH testing of the lower oesophagus may be required.
Doctors may also investigate other conditions that can contribute to or mimic reflux, including hiatus hernia and delayed gastric emptying.
A hiatus hernia occurs when part of the stomach pushes upwards through the diaphragm. Delayed gastric emptying can occur for several reasons, including gastroparesis associated with diabetes or a gastric obstruction.
Untreated GORD can cause complications
Although reflux can be uncomfortable, untreated GORD can also lead to more serious complications.
Repeated exposure to stomach acid can cause oesophagitis, where the lining of the oesophagus becomes inflamed. Over time, scarring can narrow the oesophagus, while repeated acid exposure may also contribute to Barrett’s oesophagus, a precancerous condition, and oesophageal adenocarcinoma.
People who continue to experience reflux symptoms despite using proton pump inhibitors (PPIs) should consult a doctor rather than continuing treatment without medical advice.
Medical attention should be sought promptly if alarm symptoms such as persistent vomiting, unexplained weight loss, difficulty swallowing or gastrointestinal bleeding develop.
Seven tips to manage acid reflux
Alongside appropriate medical treatment, lifestyle changes may help ease reflux symptoms.
- Lose excess weight to reduce pressure on the stomach.
- Identify your triggers. Common triggers include alcohol, caffeine, fatty foods and chocolate.
- Quit smoking, which can increase acid production.
- Avoid eating and drinking for three hours before bedtime.
- Do not lie down immediately after meals.
- Elevate the head of your bed or use a foam wedge.
- Seek medical advice if symptoms persist.
“Always consult a doctor or gastroenterologist to investigate symptoms that do not resolve. There is so much that can be done to bring relief and manage GORD for a better quality of life,” van der Schyff concludes.
To book an appointment with a healthcare professional practising at a Netcare facility, patients can use the Netcare app or call appointmedTM on 086 055 5565.
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