GERD is a chronic digestive disorder that occurs when stomach acid frequently flows back into the oesophagus (the tube connecting your mouth and stomach). This backflow, called acid reflux, irritates the oesophageal lining and causes uncomfortable symptoms. Unlike occasional heartburn that many people experience after a large meal, GERD involves persistent acid reflux occurring regularly. The condition develops when the lower oesophageal sphincter (a ring of muscle at the bottom of your oesophagus) becomes weakened or relaxes inappropriately, allowing stomach contents to reflux upward.
GERD (Gastroesophageal Reflux Disease) Treatment in Singapore
Living with chronic heartburn and acid reflux can impact daily activities, sleep quality, and overall well-being. GERD (Gastroesophageal Reflux Disease) affects many people, causing persistent discomfort that goes beyond occasional heartburn. In Singapore, where spicy cuisine and busy lifestyles are common, individuals may experience this digestive condition. Our gastroenterologist provides GERD treatment options in Singapore, utilising current medical approaches that may help provide relief from acid reflux symptoms.
*Individual results and treatment responses may vary.*
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is GERD?
Types of GERD
Non-Erosive Reflux Disease (NERD)
This common form of GERD involves patients experiencing typical reflux symptoms without visible damage to the oesophageal lining during endoscopy. Despite the absence of erosions, NERD can cause discomfort and may impact quality of life.
Barrett’s Oesophagus
A complication of long-standing GERD where the normal oesophageal lining changes to resemble intestinal tissue. This condition may require regular surveillance as it can increase cancer risk. Detection through endoscopy allows for appropriate monitoring and intervention.
Causes & Risk Factors
Causes
GERD occurs when the lower oesophageal sphincter (LES) stops working properly. Several mechanisms may contribute to this dysfunction:
- Transient LES relaxations: Brief episodes where the sphincter relaxes inappropriately
- Permanently low LES pressure: Chronic weakness of the sphincter muscle
- Hiatal hernia: When part of the stomach pushes through the diaphragm
- Delayed gastric emptying: Slow movement of food from the stomach to the intestines
- Increased abdominal pressure: Physical pressure forcing stomach contents upward
Risk Factors
Several factors may increase the likelihood of developing GERD:
- Obesity: Excess weight can increase abdominal pressure
- Pregnancy: Hormonal changes and physical pressure can affect LES function
- Smoking: Nicotine may relax the LES and reduce saliva production
- Dietary triggers: Spicy foods, citrus, tomatoes, chocolate, caffeine, alcohol
- Medications: Certain blood pressure medications, sedatives, antidepressants
- Age: LES function may naturally decrease with ageing
- Genetics: Family history of GERD or hiatal hernia
- Eating habits: Large meals, lying down after eating, late-night dining
- Medical conditions: Diabetes, connective tissue disorders, delayed stomach emptying
Signs & Symptoms
Mild Symptoms
- Heartburn occurring occasionally
- Mild chest discomfort after meals
- Occasional sour taste in the mouth
- Minor difficulty swallowing
- Slight morning hoarseness
- Need for occasional antacids
Moderate Symptoms
- Heartburn occurring regularly
- Regurgitation of food or liquid
- Persistent cough, especially at night
- Disrupted sleep due to reflux
- Chronic throat clearing
- Feeling of lump in throat
- Worsening dental enamel erosion
- Increased belching and bloating
Severe Symptoms
- Daily heartburn affecting quality of life
- Chest pain mimicking heart problems
- Difficulty swallowing solid foods
- Unintentional weight loss
- Persistent nausea or vomiting
- Blood in vomit or stool
- Severe nighttime reflux causing choking
- Recurrent respiratory infections
GERD symptoms typically worsen after meals, when lying down, or bending over. Patients may notice symptom patterns related to specific triggers or times of day.
Experiencing these symptoms? Consider seeking medical evaluation.
Consult with a gastroenterologist for an accurate diagnosis and treatment plan.
When to See a Doctor
Seek medical attention if you experience heartburn more than twice weekly or if over-the-counter medications provide insufficient relief. Immediate medical evaluation is necessary for alarming symptoms, including difficulty swallowing, unexplained weight loss, persistent vomiting, or signs of bleeding such as black stools or blood in vomit. Chest pain requires urgent assessment to rule out cardiac causes.
During your consultation, a gastroenterologist will review your symptom history, dietary habits, and medication use. The evaluation includes a physical examination and discussion of diagnostic options. Treatment options are available once a proper diagnosis is established. Early intervention may help prevent progression to more serious complications like oesophageal strictures or Barrett’s oesophagus.
The consultation provides an opportunity to discuss lifestyle factors contributing to your symptoms. A healthcare professional can explain how food culture and lifestyle patterns may affect your condition, helping you make informed decisions about dietary modifications and treatment options.
Diagnosis & Testing Methods
Clinical Assessment
Initial diagnosis often relies on symptom evaluation and response to acid-suppressing medication. Your gastroenterologist will conduct a detailed medical history focusing on symptom frequency, severity, and triggers. A therapeutic trial with proton pump inhibitors may help confirm the diagnosis if symptoms improve.
Upper Endoscopy
This examination allows direct visualisation of the oesophagus, stomach, and upper small intestine. The procedure is performed under light sedation. Endoscopy can reveal inflammation, erosions, strictures, or Barrett’s oesophagus. Tissue samples can be collected for microscopic examination if abnormalities are detected.
24-Hour pH Monitoring
This test measures acid exposure in your oesophagus over a full day. A thin probe placed through your nose records pH levels whilst you maintain normal activities. The data correlates symptoms with acid reflux episodes, particularly useful for patients with atypical symptoms or those not responding to treatment.
Oesophageal Manometry
This test evaluates oesophageal muscle contractions and LES function. A pressure-sensitive tube measures coordination and strength of oesophageal contractions when you swallow. Results guide treatment decisions, especially when considering anti-reflux surgery.
Barium Swallow Study
This X-ray examination visualises the upper digestive tract after swallowing barium contrast. It can identify structural abnormalities like hiatal hernias, strictures, or tumours that may contribute to reflux symptoms.
Treatment Options Overview
Dietary Modifcations
Dietary changes form the foundation of GERD management. Identifying and avoiding personal trigger foods may help reduce symptom frequency. Common triggers include spicy dishes, citrus fruits, tomatoes, chocolate, mint, fatty foods, coffee, and alcohol. Eating smaller, more frequent meals may reduce stomach distension and pressure on the LES. Finishing meals at least three hours before bedtime allows proper digestion before lying down.
Lifestyle Interventions
Weight loss in overweight individuals may help improve GERD symptoms by reducing abdominal pressure. Elevating the head of your bed can use gravity to help prevent nighttime reflux. Smoking cessation may strengthen LES function and reduce acid production. Loose-fitting clothing around the waist prevents additional pressure on the stomach.
Proton Pump Inhibitors (PPIs)
PPIs represent an effective medical therapy for GERD, reducing stomach acid production by blocking the enzyme system responsible for acid secretion. Common options include omeprazole, esomeprazole, lansoprazole, and pantoprazole. Treatment typically starts with once-daily dosing before breakfast. Patients may experience symptom relief with appropriate use. Long-term PPI therapy may be necessary for erosive oesophagitis or severe symptoms.
*Individual results and timelines may vary.*
H2 Receptor Blockers
These medications reduce acid production through a different mechanism than PPIs. Famotidine and ranitidine provide moderate acid suppression suitable for mild-to-moderate GERD. They work faster than PPIs for acute symptom relief but offer less complete acid control. H2 blockers serve as step-down therapy after PPI treatment or for breakthrough symptoms.
Antacids and Alginate-Based Medications
Over-the-counter antacids neutralise existing stomach acid, providing rapid but short-lived relief. Alginate-based formulations create a protective foam barrier that may help prevent reflux. These medications suit occasional symptoms or supplement other treatments for breakthrough discomfort.
Prokinetic Agents
These medications enhance gastric emptying and strengthen LES pressure. Domperidone and metoclopramide may help patients with delayed gastric emptying contributing to reflux. Side effects limit long-term use, making them second-line options for selected patients.
Endoscopic Procedures
Contemporary endoscopic therapies offer alternatives to surgery for selected patients. Radiofrequency ablation (Stretta procedure) delivers controlled energy to the LES, aiming to improve muscle function. Transoral incisionless fundoplication creates an anti-reflux valve using specialised devices. These minimally invasive options suit patients seeking procedural intervention without traditional surgery.
Anti-Reflux Surgery (Fundoplication)
Laparoscopic fundoplication creates a new valve mechanism by wrapping the upper stomach around the lower oesophagus. This procedure can help control reflux in properly selected patients, particularly those with large hiatal hernias or severe symptoms despite medical therapy. Modern laparoscopic techniques may reduce recovery time compared to traditional open surgery.
*Individual results and timelines may vary.*
Every patient’s condition is unique.
Our gastroenterologist will assess your specific situation and recommend the most suitable treatment approach for you.
Complications if Left Untreated
Untreated GERD may progressively damage the oesophageal lining, potentially leading to complications. Chronic inflammation can cause oesophageal strictures (narrowing) that may create swallowing difficulties requiring dilation procedures. Erosive oesophagitis may result in bleeding or oesophageal ulcers.
Barrett’s oesophagus may develop in some chronic GERD patients, replacing normal oesophageal cells with intestinal-type cells. This condition can increase oesophageal cancer risk and may require regular surveillance endoscopy. Early detection of dysplastic changes allows intervention before cancer development.
Respiratory complications may include chronic cough, asthma exacerbations, and recurrent pneumonia from aspiration of refluxed contents. Dental erosions can result from repeated acid exposure, whilst chronic laryngitis may cause persistent hoarseness. Quality of life can deteriorate with sleep disruption, dietary restrictions, and social limitations from unpredictable symptoms.
*Individual outcomes and progression may vary.*
Prevention
Maintaining a healthy weight through a balanced diet and regular exercise may help reduce GERD risk. Singapore’s hawker culture offers both challenges and opportunities – choose steamed over fried options, request less spicy preparations, and avoid late-night supper sessions to help prevent symptoms.
Eating habits can play important roles in prevention. Eat smaller portions throughout the day rather than large meals. Chew food thoroughly and eat slowly to aid digestion. Stay upright for at least three hours after meals, avoiding the temptation to lie down immediately after dinner.
Stress management through regular exercise, adequate sleep, and relaxation techniques may help reduce GERD occurrence. Identify and avoid personal trigger foods through a symptom diary. Limit alcohol consumption and quit smoking to support your body’s natural anti-reflux mechanisms. Wear loose-fitting clothing and maintain good posture to minimise abdominal pressure.
*Individual results and responses to lifestyle modifications may vary.*
For Singaporeans & Singapore Permanent Residents
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
Can GERD be cured permanently, or will I need lifelong treatment?
GERD management varies by individual. Some patients may achieve long-term remission through lifestyle modifications and temporary medication use. Others with structural abnormalities like hiatal hernias or severe oesophagitis may require ongoing treatment. Surgical options like fundoplication can help provide relief for appropriate candidates. Your gastroenterologist will develop a personalised strategy based on your condition severity, response to treatment, and individual circumstances.
*Individual results and treatment outcomes may vary.*
Are PPIs safe for long-term use, and what are the potential side effects?
PPIs have an established safety profile. Studies have raised concerns about potential associations with kidney disease, bone fractures, and nutritional deficiencies with very long-term use. These risks must be balanced against the benefits of controlling GERD and preventing complications. Your gastroenterologist will monitor your treatment, using the lowest effective dose and considering periodic medication holidays when appropriate.
Can I still enjoy Singapore’s local food if I have GERD?
You may still enjoy local cuisine with some modifications. Request less spicy versions of your favourite dishes, avoid deep-fried options, and choose clear soups over coconut-based curries. Timing matters too – enjoy heavier meals at lunch rather than dinner. Patients may manage GERD whilst maintaining their food culture by identifying personal triggers and making smart substitutions.
*Individual tolerance to foods may vary.*
How quickly can I expect symptom relief after starting treatment?
Antacids may provide relief within minutes but last only hours. H2 blockers may work within 1-2 hours with effects lasting up to 12 hours. PPIs may require 2-4 days for initial improvement, with maximum benefit achieved after 1-2 weeks of consistent use. Lifestyle modifications may show gradual improvement over several weeks. Patients may experience relief within one month of starting comprehensive treatment.
*Individual response times and treatment outcomes may vary.*
When is surgery recommended for GERD?
Surgery may be considered for patients with severe symptoms uncontrolled by medication, those who cannot tolerate long-term medication, or when complications like large hiatal hernias are present. Young patients requiring lifelong high-dose PPIs may benefit from surgical intervention. The decision involves careful evaluation, including specialised testing to ensure you’re an appropriate surgical candidate.
What’s the difference between heartburn and GERD?
Heartburn is a symptom – the burning sensation in your chest from acid reflux. GERD is a chronic disease where frequent acid reflux causes troublesome symptoms or complications. Occasional heartburn after a large meal is normal; persistent symptoms affecting your quality of life may indicate GERD requiring medical evaluation.
Conclusion
GERD is a manageable condition with treatment options available. From lifestyle modifications and medications to procedures, our gastroenterologist will work with you to develop a personalised treatment plan addressing your specific symptoms and circumstances. Early intervention may help prevent complications and support your quality of life, potentially allowing you to enjoy meals and activities with reduced concern about reflux symptoms. Understanding your condition can help you make informed decisions about your digestive health.
Take the First Step Towards Better Ear Health
Living with GERD can be challenging, but you don’t have to face it alone. Our gastroenterologist has experience diagnosing and treating GERD using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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