The Telegraph
Since 1st March, 1999
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Heartburn on acid test route

Sourav Sengupta had put up with the stubborn respiratory distress and heartburn all through the evening, trying to ignore the nagging discomfort. But the breathlessness got worse by the minute and shortly after midnight, he felt completely winded. His wife raised an alarm and neighbours rushed a gasping Sourav to the nearest nursing home around 2 in the morning.

The travel agent, in his mid-thirties, was treated for asthma and released next morning. However, the symptoms returned with a vengeance and he was back at the doctor’s door three days later. After ricocheting off several dead walls, he was finally diagnosed with gastro-oesophageal riflux disease (Gerd), caused by a malfunctioning of the food-pipe valve mechanism.

Sourav was lucky. With most patients, the problem is not recognised at the onset, and often misread as asthma, since manifestation is not always obvious. “Between 50 and 80 per cent of asthma may actually be caused by Gerd, also known as non-oesophagitis riflux disease, where the lower oesophageal sphincter or valve doesn’t do its designated job properly, allowing acid to come up into the food-pipe,” says consultant gastroenterologist and endoscopist Mahesh K. Goenka.

The valve, supposed to allow only forward movement of food and fluids consumed, and prevent back-flow from the stomach upwards, often relaxes due to stress, excessive intake of alcohol, smoking and even by consumption of chocolates or peppermint. The weakened pumping action of the food-pipe allows stomach acids to come up to the oesophagus, causing the all-too-familiar heartburn, or the feeling of food in the mouth.

“Drops of this acid can seep into the lungs through micro-aspiration – usually during sleep when the patient is in a prone position – leading to a respiratory problem,” explains Goenka. A recent study undertaken by Mumbai’s KGM Hospital reveals that more than 20 per cent of our population has the riflux disease, making it the second commonest condition in the country after flu.

Practising gastroenterologists in the city say nearly one-fourth of their total volume of patients are afflicted with the riflux disease, also a common cause for hoarseness of voice. The count keeps growing by the day, thanks to mounting stress in urban life and faulty eating habits, maintain the doctors. “It’s the recognition of the condition that is often elusive, but the treatment is fairly simple once you identify Gerd in a patient,” observes Goenka.

A 24-hour ambulatory ph-metry is the foolproof diagnostic procedure, where an electrode is passed into the oesophagus to monitor the acid content. Doctors can then co-relate the reading of the recorded episodes with the clinical symptoms of the patient and arrive at a conclusion.

The good news is that 90-95 per cent of riflux disease patients respond to oral medication, even though the treatment could be a life-long affair. The medicines are either proton pump inhibitors to reduce acid formation, or motility-enhancing (prokinetic) agents to help pump the acid back into the stomach and tighten the relaxed sphincter. “Only a small percentage of patients need surgery to correct the defective sphincter,” says Goenka.

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