“Any time I was invited out with friends, I avoided eating too much and avoided many foods, which is strange and challenging,” says Dubai resident Paula Louro, 49, from Portugal, who suffered from a condition known collectively as gastroesophageal reflux disease (GORD) for about 20 years.
Living with GORD, which causes heartburn, indigestion or acid reflux, can be not only painful and frightening, but also a socially challenging condition for some sufferers such as Louro, who feel embarrassed to eat in public.
“When you are in your own home, you can eat at the times you want, but when it came to socialising, I felt uncomfortable because I always bloat after food and felt very bad,” she says, adding that her friends, too, were able to notice the visible inflammation in her tummy.
Dr Emad Fayyad, gastroenterology specialist at Medcare Al Safa Hospital, says the UAE has seen a rise in chronic cases of GORD over the last decade, with as much as 30 per cent of the population living with the condition, according to the Scientific and Research Committee of The Emirates Gastroenterology & Hepatology Society.
“I believe this figure is the tip of the iceberg, representing those patients who have sought medical care, but there is still a huge number of GORD patients who are misdiagnosed as having viral or bacterial infections in the throat or respiratory tract, which actually represents atypical reflux,” Fayyad says.
The UAE’s high obesity rates compound the prevalence of the condition. “The concurrent rise in obesity rates has contributed the most to the alarming rise in GORD,” says Fayyad, citing that about 31 per cent men and 42 per cent women living in the UAE are obese or overweight, according to the latest data from the World Obesity Federation.
Causes and consequences
So what causes gastric issues? To put it simply, the stomach and oesophagus are connected by a valve called the lower oesophageal sphincter, which opens when people swallow, to allow food down into the stomach, and then prevents acid from coming back up. Reflux is caused by a poorly functioning valve.
Dr John Rodriguez from Cleveland Clinic Abu Dhabi’s Digestive Disease Institute, explains there are many who are vulnerable to the condition including people who are obese, pregnant or suffer from certain medical conditions such as connective tissue disorders or delayed stomach emptying. Additionally, once the condition develops, it can be aggravated by smoking, certain foods or eating large meals late at night.
Some trigger foods include fatty and fried dishes, alcohol, salt, coffee, carbonated beverages such as soda, chocolate, garlic, onions, citrus fruits, peppermint and tomato sauce.
Dr Jayakumar B Kannan, consultant gastroenterologist at Aster Clinic, Al Muteena, says in addition to common causes such as caffeinated drinks, reactions to medication, and eating late and other unhealthy eating habits, there can be other underlying causes of GORD. These include allergies to milk and other dairy products, and fructose intolerance causing reactions to sweets, pizza, alcohol and carbonated drinks.
Fayyad says that while symptoms that feel like acid reflux, such as indigestion, belching, gas and heartburn, can be caused by an intolerance to certain foods, they are not always easy to identify. “Patients may have a list of foods to avoid because they have noticed that acid reflux disease occurs after eating these, but in many cases, it is not one specific dish or ingredient that is causing the problem, but an entire food group,” he explains.
“Dairy products can cause acid reflux symptoms, which is sometimes attributed to the high-fat content of milk, cream or cheese, but it may actually be due to lactose intolerance caused by a lack of enzymes in the gut, which the body needs to break down such products.”
Either way, as Rodriguez puts it: “Chronic acid reflux can have a tremendous impact on a person’s quality of life, particularly if medication isn’t effective or poorly tolerated.”
As of last month, however, a non-invasive procedure introduced by Cleveland Clinic Abu Dhabi claims it can offer a longer-term solution. Eliminating the need for lifelong medication, the treatment helps strengthen the lower oesophageal sphincter valve and thereby hopes to offer patients an alternative to alleviate a condition that can cause havoc for its sufferers, from social anxiety to eating disorders.
Doctors use a specialised device to restore and support the valve’s function by creating a ring of tissue around it and anchoring it in place with small fasteners, with no incisions required.
Rodriguez says the treatment is a 40 to 60-minute outpatient procedure, which means patients can return to regular life in a day or two, alleviating the need to depend on medications that include everything from over-the-counter antacids for mild symptoms, all the way to prescription treatments such as H2 receptor blockers, which reduce the amount of acid the stomach can produce; and Proton-pump inhibitors (PPIs), which are responsible for the long-term reduction of acid in the stomach. Cleveland Clinic claims the results of the new treatment are on a par with more invasive methods.
Surgery may, however, be beneficial in severe cases such as Louro’s, who says she used to suffer from heartburn and severe bloating even hours after eating. Even having dinner at 8pm and waiting until midnight to go to bed was often uncomfortable.
So last month, she opted for a procedure at Medcare Hospital – one that required her to recover at home on a liquid diet for a week – after an endoscopy showed that the connection between her oesophagus and stomach was always open.
“I had two options, medication for life or surgery, so I chose the latter,” she explains. “It changed my life. The connection isn’t completely closed because if it were, I would not be able to eat at all, but I feel so much better now.”
Tips for preventing indigestion
• Elevate the head of the bed by six to eight inches, as gravity helps keep stomach acid from rising up the oesophagus.
• Avoid laying down immediately after meals
• Avoid food that decreases the pressure of the lower oesophageal sphincter such as lemon, orange, fat-rich foods, plus medicines such as beta-blockers and calcium channel blockers
• Avoid smoking and alcohol, especially wine
• Lose excess weight, regulate body-mass index, and exercise regularly
• Eat smaller meals more frequently throughout the day
• Wear loose-fitting clothing to avoid putting pressure on the abdomen