A persistent cough, a hoarse voice on waking and a sour taste in the mouth would not, in most people’s minds, be linked to stomach problems. These symptoms can, however, signal gastro-oesophageal reflux disease (GORD), even when the characteristic feature of heartburn isn’t present.

Stomach acid is extremely strong, with a pH of 1.5 to 3 in most people. The hydrochloric acid in our stomachs is almost as corrosive as battery acid.

“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.

In addition, the top of the stomach near the junction with the lower oesophagus, contains a small postprandial pocket of stomach acid that is released within 15 minutes of a meal, contributing to acid reflux.

“Sometimes, the sphincter relaxes and acidic stomach contents escape back into the oesophagus, overcoming our body’s natural defences that protect the mucosal lining of the oesophagus, which cannot withstand strong acidity like the lining of the stomach can. 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,” Dr van der Schyff says.

Diagnosis and treatment can remain elusive when troublesome symptoms are so far-reaching, even though GORD is estimated to affect 20% of the Western adult population, and approximately 10 to 15% of adults in South Africa, where representative local data are limited.

“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. Often, people with GORD consult ear, nose and throat [ENT] surgeons because irritation from acidic liquids may cause sore throat, laryngitis, middle ear infection or hoarseness,” he says.

Dr Nasief van der Schyff, gastroenterologist and specialist physician

Seven tips for managing reflux

1. Lose excess weight to reduce pressure from the stomach into the chest.
2. Identify your triggers. Alcohol, caffeine, fatty foods and chocolate are among the most common triggers.
3. Quit smoking as it greatly increases acid production in the stomach.
4. Stop eating and drinking three hours before bed.
5. Avoid lying down after meals.
6. Elevate the head of your bed or use a foam wedge.
7. Don’t delay, seek medical attention for persistent symptoms.

“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. Reflux can also burn the back of the throat, cause involuntary regurgitation of stomach contents, and erode the enamel on a person’s teeth.”

Dr Van der Schyff points out that GORD symptoms are usually worse at night or when lying down after a meal. Some patients may initially seek help for sleep disorders or obstructive sleep apnoea. Bloating, burping, and a sudden salty or sour taste in the saliva, known as water brash, can also be atypical symptoms of GORD. Pain between the navel and the ribcage, medically referred to as epigastric pain, can also suggest reflux.

“Where GORD is suspected, an endoscopy or pH testing of the lower oesophagus is required for diagnosis. Other conditions that present similarly or contribute to reflux would also be assessed. One of these is hiatus hernia, in which the muscular diaphragm that usually keeps the stomach contained in its usual place below the diaphragm weakens, allowing part of the stomach to push up through it,” Dr van der Schyff says.

“Delayed gastric emptying, whether due to gastroparesis associated with diabetes, a malignant or benign gastric obstruction, or any other cause, results in acid pooling in the lower oesophagus and reflux.”

Dr Van der Schyff explains that GORD is not only uncomfortable if untreated, but it can also lead to serious medical complications.

People with unmanaged GORD commonly develop oesophagitis, in which the lining of the oesophagus, the passage from the mouth to the stomach, becomes raw and inflamed due to acid exposure, he warns. Over time, repeated acid exposure can lead to scar tissue that narrows the oesophagus, a precancerous condition called Barrett’s oesophagus, or a type of cancer known as oesophageal adenocarcinoma.

“People often use proton pump inhibitors [PPIs] for prolonged periods for persistent reflux symptoms without seeking medical advice. It is important to consult a doctor if reflux symptoms continue despite PPI therapy, and seek medical attention immediately if any alarm symptoms develop, such as persistent vomiting, weight loss, difficulty swallowing or gastrointestinal bleeding.

“Alongside appropriate prescribed medication, there are other ways of easing reflux such as modifying diet and behaviour,” Dr van der Schyff says.

“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,” Dr van der Schyff concludes.

To book an appointment with a healthcare professional practising at a Netcare facility, download the Netcare app or call appointmed^TM on 086 055 5565.