Acid Reflux, Gastric Reflux & GERD Singapore

A gastroscopy is one of the most common diagnostic tools used to evaluate reflux symptoms. During this procedure, a thin, flexible tube with a camera (endoscope) is inserted through the mouth into the esophagus, stomach, and upper small intestine. This allows the doctor to visually inspect the lining for signs of inflammation, ulcers, or damage caused by stomach acid. This procedure is routinely performed often as a day surgery under sedation.

Ambulatory pH monitoring measures the amount of acid that flows into the oesophagus over a 24 to 48-hour period. This test involves inserting a small probe through the nose into the oesophagus, which records acid levels while the patient goes about their normal activities. Alternatively, a capsule-based system may be used, which attaches to the esophageal lining and wirelessly transmits data. This test helps confirm the frequency and duration of acid reflux episodes, especially in patients with atypical symptoms like chronic cough, chest pain, or throat irritation.

Esophageal manometry evaluates the muscle function of the oesophagus and the lower esophageal sphincter. A thin, pressure-sensitive tube is passed through the nose into the oesophagus to measure how well the muscles contract during swallowing. This test is particularly useful for identifying motility disorders that may mimic or contribute to reflux symptoms, such as achalasia or esophageal spasms. Manometry is often performed before surgery to ensure that the esophageal muscles are functioning well enough to support procedures like fundoplication or the LINX implant.

• Dietary Changes: Avoiding trigger foods such as spicy dishes, citrus fruits, chocolate, caffeine, and alcohol.
• Eating Habits: Consuming smaller, more frequent meals and avoiding lying down immediately after eating.
• Weight Management: Achieving a healthy weight to reduce abdominal pressure.
• Smoking Cessation: Quitting smoking to improve lower esophageal sphincter (LES) function.
• Elevating the Head During Sleep: Raising the head of the bed to prevent nighttime reflux.

The management of acid reflux and gastroesophageal reflux disease (GERD) is supported by a variety of medications, depending on the severity and frequency of the condition.

• Antacids: These are typically the first line of defense for individuals experiencing occasional heartburn or mild acid reflux. These over-the-counter remedies work by neutralizing stomach acid on contact, offering quick relief. While they are not suitable for long-term management, they are effective for intermittent symptoms or as a supplement to other treatments.
• H2 Blockers: These act by reducing acid production in the stomach. They are useful for moderate symptoms and offer longer-lasting relief than antacids. These are available both over-the-counter and in prescription strengths in Singapore, often recommended when lifestyle changes alone aren’t enough.
• Proton Pump Inhibitors (PPIs): These are among the most commonly prescribed medications for GERD in Singapore. PPIs are particularly effective for more severe or persistent symptoms, as they block the enzyme in the stomach lining responsible for acid production. They not only relieve discomfort but also promote the healing of inflamed or damaged esophageal tissue.
• Prokinetic Agents: Thesemay be prescribed when acid reflux is accompanied by delayed gastric emptying or motility issues. These medications help strengthen the lower esophageal sphincter and facilitate quicker movement of food through the stomach, reducing the likelihood of reflux.

For people who experience chronic or severe GERD symptoms that do not respond well to medication or lifestyle changes, surgical intervention may be considered. Surgery is typically recommended when patients suffer from frequent regurgitation, esophageal damage, or when long-term medication use is not desirable or effective.

• Fundoplication: This is the most established surgical procedure for GERD. In this minimally invasive surgery, the upper part of the stomach (fundus) is wrapped around the lower esophagus and stitched into place to reinforce the LES and prevent acid reflux. The most common version, Nissen fundoplication, creates a 360-degree wrap, but partial wraps (such as Toupet fundoplication) may be used depending on the patient's condition. Laparoscopic techniques ensure smaller incisions, reduced pain, and quicker recovery times, making this a viable option for many GERD patients.
• LINX Procedure: This is a newer, less invasive alternative that is gaining traction in Singapore for select patients. This technique involves the laparoscopic implantation of a small, flexible ring of magnetic beads around the LES. The magnetic attraction keeps the sphincter closed to prevent acid reflux but still allows food and liquids to pass through when swallowing. LINX is particularly appealing because it preserves the natural anatomy and function of the esophagus, and recovery is typically faster than traditional fundoplication.