Acidity is treated as a normal part of Indian life, and antacids are among the most consumed medicines in the country. Most of that consumption is self prescribed and continues for years without anyone establishing what is actually causing the symptoms.
Occasional heartburn is normal. Persistent reflux is a condition, and treating it indefinitely without assessment carries its own problems.
What Reflux Actually Is
A muscular valve at the junction of the oesophagus and stomach normally stays closed except when swallowing. When it relaxes inappropriately or is weakened, stomach contents travel back up.
The oesophagus has no protective lining against acid, so the contact causes the burning sensation. Repeated over years it can cause inflammation, narrowing, and in a minority a change in the lining called Barrett oesophagus, which carries a small cancer risk.
Occasional reflux, particularly after a large meal, is normal. Symptoms occurring twice a week or more, or interfering with sleep or daily life, define gastro oesophageal reflux disease.
The Symptoms, Including the Unexpected Ones
Classic symptoms are recognisable. Others are frequently attributed to something else entirely.
- Burning behind the breastbone, worse after meals or lying down
- Sour or bitter regurgitation into the throat
- Chest discomfort that can mimic cardiac pain
- Chronic cough, particularly at night
- Hoarseness and frequent throat clearing
- A sensation of a lump in the throat
- Worsening asthma, where reflux irritates the airway
- Dental erosion from acid contact
Chronic cough and hoarseness are commonly investigated by ENT for months before reflux is considered. Our ENT department and gastroenterologists frequently see the same patient for this reason.
Alarm Symptoms Requiring Endoscopy
These features change the assessment from symptom management to investigation.
- Difficulty swallowing, or food sticking
- Painful swallowing
- Unintentional weight loss
- Vomiting blood, or black tarry stools
- Persistent vomiting
- Anaemia found on blood testing
- A lump in the abdomen
- New symptoms starting after age fifty five
- Symptoms not responding to a proper trial of treatment
- Family history of oesophageal or stomach cancer
Difficulty swallowing is the most important of these. Food sticking is never a symptom to manage with antacids and requires endoscopy promptly.
What Endoscopy Involves
Patients often resist endoscopy expecting it to be dreadful. It is generally straightforward.
A thin flexible camera is passed through the mouth into the oesophagus, stomach and first part of the small intestine. It takes ten to fifteen minutes. Throat spray or light sedation is used, and most patients under sedation remember little of it.
You fast for six hours beforehand. Biopsies can be taken painlessly, and problems such as ulcers or narrowing can often be treated in the same session.
It answers questions no amount of trial treatment can, including whether there is inflammation, an ulcer, a hiatus hernia, Barrett oesophagus, or Helicobacter pylori infection.
Lifestyle Changes That Genuinely Work
These have real effect and are frequently skipped in favour of tablets.
- Weight reduction: abdominal weight pushes stomach contents upward, and reduction is the most effective single measure
- Do not lie down for three hours after eating, which is the most commonly broken rule
- Raise the head of the bed by fifteen to twenty centimetres using blocks under the legs. Extra pillows do not work, since they bend the abdomen
- Smaller, more frequent meals rather than large ones
- Identify personal triggers: commonly coffee, tea, chocolate, mint, tomato, citrus, very spicy food, fried food, alcohol and carbonated drinks
- Stop smoking, which weakens the valve directly
- Loosen tight waistbands
Late heavy dinners followed by sleep are the single most common pattern we see, and shifting the evening meal earlier resolves symptoms for many patients without any medication.
The Problem With Long Term Acid Suppression
Proton pump inhibitors are effective and appropriate for defined periods. Taken indefinitely without review, they carry recognised concerns.
- Reduced absorption of vitamin B12, magnesium, calcium and iron
- Increased risk of certain gut infections, since stomach acid is a barrier
- Association with reduced bone density over long periods
- Rebound acid over production when stopped abruptly, which convinces people they cannot manage without them
The rebound effect is important. Stopping suddenly after months causes a surge of symptoms that feels like proof the drug was necessary. Tapering gradually, with lifestyle measures in place, avoids this.
If you have been taking acid suppression daily for over a year without review, that is a reason for assessment rather than another repeat prescription.
Helicobacter Pylori
This bacterium infects a large proportion of the Indian population and is a major cause of peptic ulcers and a risk factor for stomach cancer.
It can be tested for by breath test, stool test, blood antibody test or biopsy during endoscopy. Note that acid suppressing drugs and antibiotics must be stopped for a period before testing, otherwise results are falsely negative.
Treatment is a combination of antibiotics with acid suppression for one to two weeks. Completing the full course matters, since incomplete treatment breeds resistance and resistance rates in India are already significant. Confirmation of clearance afterwards is advisable.
When Surgery Is Considered
Most reflux is managed medically. Surgery becomes an option for a minority.
Fundoplication, in which the top of the stomach is wrapped around the lower oesophagus to reinforce the valve, is considered for patients with a large hiatus hernia, those who respond to medication but do not wish to take it lifelong, those with significant regurgitation rather than acid burning, and those with complications despite treatment.
It is done laparoscopically. Assessment before surgery includes endoscopy and often pressure and acid studies, since operating on the wrong patient produces poor results. Our gastroenterology and laparoscopic surgery teams assess this jointly.
Occasional acidity needs an antacid. Symptoms twice a week or more for months need a proper assessment rather than an indefinite prescription. Move the evening meal earlier, raise the bed head, reduce abdominal weight, and get endoscopy if any alarm symptom is present.
Our gastroenterology department at T. Nagar provides endoscopy and reflux assessment, and Dr. Kavitha Sampathkumar sees referrals.
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