Gastroesophageal reflux disease (GERD), also known as acid reflux, is a long-term condition in which stomach contents rise up into the oesophagus, resulting in either symptoms or complications. Symptoms include the taste of acid in the back of the mouth, heartburn, bad breath, chest pain, vomiting, breathing problems, and wearing away of the teeth, to mention a few.
University Teaching Hospital of Kigali’s Dr Eric Rutaganda who is also a consultant and lecturer at University of Rwanda’s College of Medicine and Health Sciences, says the condition, locally known as ‘Ikirungurira’, is dangerous and overlooked by many.
The condition is a lot more common in young people.
Although he doesn’t do consultations every day, he says that per week, in every 100 patients, 60 per cent have gastrointestinal problems and among them, five to 10 per cent have gastroesophageal reflux disease. This, he says, is alarming.
HOW DOES IT COME ABOUT?
Dr Janvier Rusizana, a general practitioner at La Nouvelle Clinic in Remera, says stomach acid in the oesophagus causes GERD.
He explains that the oesophagus is the tube connecting the mouth and stomach; there is a valve between the stomach and oesophagus which normally only works one way, allowing food and fluids into the stomach and then closing quickly.
"When one has GERD, the valve doesn’t work as it should. It allows food and stomach acid to flow back (reflux) into the oesophagus, which irritates its lining,” he says.
The reflux, he explains, most of the time happens when one is sitting and the food tends to come back, this also goes with the excessive production of saliva because the acid that is coming down from the stomach can irritate the parotid glands (pair of large salivary glands situated just in front of each ear), which are there to form the saliva.
Experts say symptoms include shortness of breath, chest pain, and excessive saliva in their mouth. Net photos
SIGNS
Rusizana says the symptoms are common during the night, for instance, some patients are awakened by heartburn because when one is lying flat, it’s easier for the stomach to reflux.
In most cases, he says, they find out one has the condition when talking to the patient about their health history and what they have been experiencing.
Rusizana says some will say they always experience shortness of breath, chest pain, and excessive saliva in their mouth, among other things.
However, chest pain should be typically central which is different from having heart problems, where one feels the pain in the left side of the chest.
But because it’s hard for an ordinary person to distinguish if the chest pain is associated with the heart or GERD, he says it’s best to be questioned first on how they feel before deciding how to handle the case.
When such patients come for consultation, one has to make sure there are no symptoms related to the heart and that the patients are free from any heart-related issues. This is, however, done through proper diagnosis.
"After listening to some patients, most of them tend to complain about the heart yet the real problem is GERD. After analysis and confirming that one is free from heart conditions, then the issue is definitely GERD,” Rusizana says.
Rutaganda says that 80 per cent of patients with this condition suffer from heartburn.
When one has more than two episodes of heartburn a week, it’s a serious condition and they have to seek help from a physician.
WHO IS AT RISK?
Rutaganda says that obesity or increased belly circumference, increases the intra-abdominal pressure, thus making it easy to empty the stomach which leads to reflux.
Pregnant women are also at risk of suffering from the condition, as well as tobacco smokers.
He explains that this is so because when one smokes, the nicotine, a key part of it, relaxes the ring of the muscle in the lower oesophagus that keeps acid in the stomach where it belongs.
Rutaganda adds that when one smokes tobacco, it irritates the saliva glands, decreasing the amount of saliva in the mouth. When there is enough saliva, it’s easy to neutralise the acid.
"When that ring relaxes, the acid trickles, which later causes the burning sensation experienced by people with GERD,” he says.
Francis Kazungu, a general practitioner in Kigali, says other common risk factors include eating large meals and lying down immediately after the meal, snacking close to bedtime, taking medications for blood pressure, drinking certain beverages—such as alcohol, coffee or tea, among others.
When it comes to alcohol, he says, it irritates the digestive system and even a little makes the stomach produce more acid than usual.
"This can then cause gastritis which is the inflammation of the stomach lining; this triggers stomach pain, vomiting, diarrhoea and even bleeding for heavy drinkers,” he says.
Avoid uncomfortable sitting positions after eating, and eating large amounts of food at night. Net photo
TREATMENT
Although there are medicines to treat the condition, Kazungu says they do not help a lot. For instance, if the medicine is given for a serious condition, one has to be treated for up to three months. Only then will they be assured that the patients will be safe over the next three months.
Kazungu says this means that the lifestyle modification of a person plays a big role when it comes to treatment.
"It means one has to adjust some things; like when to go to bed after eating, avoiding uncomfortable sitting positions after eating, and eating small amounts of food at night,” he says.
When symptoms are severe, such as loss of weight, vomiting or bloody stool, and heartburn that has been there for more than 10 years, Kazungu says it’s important to carry out an endoscopy (a procedure that allows a doctor to view the inside of a person’s body).
He says that during treatment, if a patient is not improving, there is a need to carry out further analysis.
Kazungu says this is because the condition itself has its own complications. Because the acid is in the stomach, it will create some erosion of ulcers from the stomach acid moving up the oesophagus, a condition known as oesophageal ulcers.
Also, Rutaganda says when the acid continues to threaten the oesophagus; the body will try to get rid of the acid by bringing the cells from the stomach to the oesophagus.
He notes that as those cells are not meant to be there (in the oesophagus), they will start by multiplying, in terms of size and cell functions, and one can end up getting what is called dysplasia— the presence of cells of an abnormal type within a tissue, which may signify a stage preceding the development of cancer.
"This exposes one to cancer of the oesophagus, which is the worst complication related to GERD,” Rutaganda says.
So far, Rutaganda says, although the cases of cancer of oesophagus are not common in Rwanda, in his case, over the last two years, he has attended to seven patients with the disease and only one of them is alive today.
He adds that GERD is a serious condition that needs more awareness among the population, and that people shouldn’t wait for complications to go for medical attention.
THEIR VIEWS
For pregnant women, the best way to avoid heartburn is to always eat small meals daily and often, instead of three large ones a day. Avoid fried, spiced and fatty foods.
Iba Mayale, Gynaecologist
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Because there is no single diet that can prevent all symptoms of acid reflux, people suffering from it should watch out for the foods that tend to trigger the condition. This will help them stay away from it.
Francis Kazungu, General practitioner
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Since almost everything revolves around lifestyle, it’s ideal for people to adopt a healthy lifestyle in general. Apart from keeping diseases at bay, it also boosts one’s health.
Erick Musengimana, Nutritionist
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People should avoid citrus fruits like lemon and oranges, especially those with acid reflux problem. Consuming vegetables is helpful because they are low in sugar and fat, which helps reduce stomach acid.
Jean Marie Nsabimana, General practitioner