More Than Just Heartburn: When Acid Reflux Becomes a Medical Concern

We’ve all been there—that uncomfortable burning sensation in the chest after a spicy meal or a late-night supper. In most cases, occasional acid reflux is a normal, albeit annoying, part of the human experience.

However, as a physician, I often see patients who have been "powering through" symptoms for months or even years, not realizing that their occasional heartburn has crossed the line into Gastroesophageal Reflux Disease (GERD) .

Knowing when to stop reaching for the over-the-counter antacids and start seeking medical advice is crucial for preventing long-term damage to your oesophagus.

When Does Reflux Become "Significant"?

The occasional splash-back of stomach acid is usually triggered by specific behaviours: overeating, lying down immediately after a meal, or consuming known irritants like curry, caffeine or alcohol.

We generally consider reflux to be "significant" or suggestive of GERD when:

• Frequency: Symptoms occur two or more times per week.
• Severity: The symptoms interfere with your daily life or quality of sleep.
• Persistence: You find yourself needing over-the-counter medications for more than two consecutive weeks.

When reflux becomes chronic, it isn't just about discomfort; it’s about the constant irritation of the oesophageal lining, which can lead to inflammation (esophagitis), ulcers, scarring, or even cellular changes such as Barrett’s oesophagus.

The "Red Flags": When to See a Doctor Immediately

While GERD is common, certain symptoms suggest that something more serious—such as a blockage, severe ulceration, or even malignancy—could be occurring. If you experience any of the following red flag symptoms, you should book an appointment promptly:

• Dysphagia: A feeling that food is getting "stuck" in your chest or throat.
• Unexplained Weight Loss: Losing weight without trying can be a sign of underlying systemic issues.
• Anaemia or Bleeding: If you are vomiting blood (which may look like coffee grounds) or have black, tarry stools, this is an emergency.
• Persistent Choking: Waking up coughing or feeling like you are gasping for air at night.
• New Symptoms After Age 50: Developing reflux for the first time later in life warrants a closer look.

A Note on Chest Pain: It is vital to remember that "heartburn" can sometimes mimic a heart attack. If you have chest pain that radiates to your arm or jaw, or is accompanied by shortness of breath and sweating, seek emergency care immediately. We must always rule out the heart before blaming the stomach.

Investigating the Root Cause

When you come to the clinic with chronic symptoms, our goal is two-fold: confirm the diagnosis of GERD and rule out other "copycat" conditions like gallstones, stomach ulcers, or functional dyspepsia.

Here are the primary tools we use to get to the bottom of the issue:

• Gastroscopy (Upper GI Endoscopy)

  This is the gold standard. A small, flexible camera is passed down the esophagus while you are sedated. It allows us to see the physical state of the tissue, check for a hiatal hernia (where the stomach slides into the chest), and take biopsies to rule out Barrett’s Esophagus (a precancerous condition).

• pH Monitoring

  If your endoscopy looks normal but your symptoms persist, we may use a pH probe. This involves a tiny sensor that measures how much acid enters your esophagus. It helps us correlate your symptoms directly with acid events.

• Esophageal Manometry

  This test measures the rhythmic muscle contractions in your esophagus when you swallow. It also measures the coordination and force exerted by the muscles, specifically the Lower Esophageal Sphincter (LES)—the "valve" that is supposed to keep acid down.

• Barium studies

  You may be asked to drink a contrast agent while X-rays are taken. This is a dynamic test to assess esophageal swallowing and stomach emptying. It provides a “road-map” to identify the size of hiatal hernia and the extent of reflux.

• Ruling Out Other Problems

  To ensure the pain isn't coming from elsewhere, we may also order:

  • Abdominal Ultrasound: To check for gallstones, which can cause similar upper-abdominal pain, bloating and heartburn.
  • Chest X-ray/ECG/Cardiac Tests: To ensure the symptoms aren't related to lung or heart problems.

Take the First Step to Recovery with Digestive Centre

If you have to plan your life around your "gastric” or “reflux” problem, it is probably time to stop self-medicating. Chronic reflux is highly treatable, and the first step is a clear diagnosis. For a detailed assessment, contact us to make an appointment with Dr Shanker at Digestive Centre today.