Why do patients develop reflux?
Dr. Tan Chi Chiu looks at the symptoms and causes of Gastroesophageal Reflux Disease
There are two areas generally of concern where symptoms in the upper digestive tract normally appear, says Dr. Tan. One is in the oesophagus and the other is in the stomach and the small intestines. Occasionally we think about the liver and gall bladder and pancreas as well, for some of these symptoms, but the common things are obviously common, he adds.
In the oesophagus one of the most common syndromes is Gastroesophageal Reflux Disease and this is when acid gets into the oesophagus from the stomach, when it shouldn’t do that due to the presence of a valve. But whether it is because the valve has become weak or because the patient has got a lining of the oesophagus that is particularly sensitive to acid, what acid does get into the oesophagus may irritate the oesophagus and may even cause inflammation to the extent of causing erosions or ulcers - and at worse scarring or bleeding.
Sometimes the inflammation can be so persistent that the cells change to become dangerous, a condition called Barrett's Oesophagus, and it is from Barrett’s that adenocarcinoma arises and this is cancer of the lower oesophagus.
There are other causes of reflux that must be examined as well. Some patients are taking medicines, for example some anti-blood pressure medicines and they may cause weakness of the valve allowing acid to come up. They may be taking painkillers of a particular sort called non-steroidal anti-inflammatories that makes the oesophageal lining more susceptible to inflammation.
When a patient presents with reflux symptoms, we may sometimes assume that the most common factors are involved - and this is that the gastroesophageal junction where there is a lower oesophageal sphincter has become weakened. So acid from the stomach that normally is limited in how much can rise up into the oesophagus can, in this case, allow quite a lot to get into the oesophagus over a prolonged period of time.
When patients come to us with symptoms of reflux we have also got to be very careful to study whether there may be other causes of the reflux. Some patients are on medicines that may increase the risk of reflux. Some of these can be quite common like anti-hypertensives or anti-high blood pressure medicines. Some antibiotics can be quite caustic and if not swallowed properly and they lodge in the oesophagus, can directly cause oesophagitis or inflammation.
It is also well known that patients who drink a lot alcohol may have more reflux. Patients who are obese certainly are well known to have more reflux. So we need to look at some of these other possibilities when analyzing a patient with these reflux symptoms.