Reflux symptoms are associated with excessive acid production. Picture: Steve Lawrence
Reflux symptoms are associated with excessive acid production. Picture: Steve Lawrence

Heartburn can be a hiatus hernia symptom

By Dr Darren Green Time of article published Sep 25, 2014

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QUESTION: I have been suffering from indigestion and heartburn for three months now. When I go to sleep at night I often feel bloated and uncomfortable despite having an early dinner. When I wake up in the morning I feel like my chest is on fire.

I often find myself drinking ice cold milk for breakfast to alleviate the symptoms. My wife regularly suggests that I eat yoghurt and swears it helps her. Do you think this is true ?

I am a fairly healthy person with a hectic travelling schedule, especially during this time of the year. My weight has been pretty stable for the past four years, however I have picked up 8kg in the last six months. My exercise routine is erratic and leaves much to be desired.

When I do exercise I find that my chest seems tighter than usual and I struggle to finish my routine.

The only other ailment I have is a temperamental right knee, which I had operated on for a cartilage tear about six years ago. The pain is persistent but does improve with my chronic meds. I have a history of colon cancer in my mother’s family. Should I be worried and what can I do to stop these unpleasant symptoms?


ANSWER: Thank you for sharing your story with us.

This is a common list of complaints that many choose to ignore or self-treat until matters spiral out of control, but what you describe are the typical features of gastro-oesophageal reflux disease or Gerd.

Your history reveals a few risk factors for the condition, including stress, lack of sleep, weight gain as well as the most common cause – medication overuse, especially the anti-inflammatories.

One of the common causes of reflux disease is a hiatus hernia, and as you gain weight, it can worsen the symptoms as the hernia then increases in size.

Your tight chest and possible wheezing during exercise also points to reflux disease. Asthma-like symptoms are often caused by silent reflux at night time, leading to silent aspiration with its sequelae.


What is Gerd?

Clinically it is a collection of typical symptoms associated with excessive acid production and reflux disease. The syndrome includes burning abdominal pain, heartburn, persistent nausea as well as burping repeatedly after meals. Bloatedness after eating can also present in some cases.


What causes Gerd?

Put simply, if the stomach valve or sphincter does not close properly during digestion and acid pushes up into the oesophagus causing significant harm to the lining of the digestive tract. Inflammation then ensues, leading to further discomfort and eventually pain.

The excessive acid secretion by the stomach also plays a role in combination with a pathological organism which grows in the stomach and “drills” holes in the gastric mucosa leading to significant gastritis and ulcers.


What causes increased acid production?

Chronic stress, poor sleep and then specific medical conditions which affect the autonomic nervous system and release of acid into the stomach. The proton pump and the Parietal cells are extremely important for this process.


The way forward

Control the pH of the gut and the influence of digestive enzymes, as well as the effect of cultures on the maintenance of the gastrointestinal tract, are all part of the leading approach in dealing with this global medical condition.

Early detection and screening for gastrointestinal tract cancers are essential. For most people the problem of reflux is recurrent unless diagnosed and treated effectively with a multi-faceted approach.


What is a gastroscopy?

It basically involves swallowing a fibre-optic camera. This is done under controlled circumstances, with conscious sedation in some cases. However many people have it done while awake. Make sure your specialist is experienced and cautious as this procedure should not have major complications. It is done for a detailed view and, if necessary, a biopsy of any suspicious lesions seen.


Gerd in a nutshell

* Persistent symptoms deserve further investigation.

* Gastroscopy is bearable – do not fear.

* Eradication of harmful organisms in gut is possible (Helicobacter Pylori) – a course of two antibiotics is issued.

* Medical management with a Proton pump inhibitor decreases acid reflux.

* Dietary modifications are effective.

* Genetic predisposition to gastrointestinal tract cancers calls for vigilance.

* Weight management can assist and decrease symptomatic hiatus hernias.


Practical hints for reflux

* Place two bricks under the top end of your bed – the increased gradient aids reflux.

* Try stop eating three hours before bedtime.

* Avoid alcohol at least two hours before going to bed.

* Include Ph-controlling foodstuffs in your diet. Go easy on tomatoes and fizzy drinks.

* Get probiotics into your routine. Regular bowel motion prevents delayed gastric emptying and constipation.

If your symptoms persist despite these measures as well as using over the counter antacids, seek medical help.


Recognising that stress is not a life sentence

* Stress is a treatable condition – not a life sentence

* Stress comes in many shapes and sizes – it doesn’t discriminate between race, gender or social standing.

* Everyone possesses different abilities when it comes to coping with stress.

* There are several stress coping mechanisms that you can learn and improve.

* Breathing techniques, quality of sleep, exercise and diet are the cornerstones of stress reduction.

* Life skills like effective time management, communication and goal-centred living remain crucial in overcoming stress.

* Mild stress can be useful to kickstart action and provide the initial energy for tough tasks.

* Chronic stress can have detrimental physical and emotional outcomes, paralysing your ability and leading to underachieving.

* An inability to cope with stress steals potential and robs talented people of amazing capacity.

* Planning ahead and setting boundaries are invaluable keys to becoming a winner.

* Cortisol is the stress hormone released by the body – too much can lead to many health issues like obesity and peptic ulcer disease


* Dr Darren Green, a trusted figure in the field of media medicine, is a University of Stellenbosch graduate who adds innovative spark to health and wellness issues.

He features on 567CapeTalk, and is a regular guest on SABC3 and the Expresso show. Dr Green works as an emergency medical practitioner at a leading Cape Town hospital and completed four years of training as a registrar in the specialisation of neurology.

If you’ve got medical problems, contact the doctor at [email protected], 021 930 0655 or Twitter @drdarrengreen. Catch him in Cape Town on 567 CapeTalk, most Fridays at 1.30pm.

The advice in this column does not replace a consultation and clinical evaluation with a doctor.

Cape Argus

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