Who’s Up For Breakfast?

Breakfast is one important component to kick start the day. Some people find themselves having a burning chest pain and bitter taste in their mouth sometime after skipping breakfast. Some experience stomach ache as well. No joke, that is the reflux of the gastric juice from your stomach. So, what actually happens inside your body?

This condition is called gastro-oesophageal reflux disease (GERD). The gastric acid produced in the stomach refluxes back into the oesophagus and sometimes even through your throat to your mouth, causing the bitter taste in the mouth. The reason behind this is because the lower oesophageal sphincter (LES) which usually acts as the lock to prevent the reflux of gastric juice is loosened, in other words, the tone of the muscle is decreased or lost, thus no more locking the juice in the stomach. 

Photo courtesy of epgpatientdirect.org

One magical function of our body is that it has its own biological clock inside. During breakfast time, our biological clock reminds the stomach to produce more acid in case we had breakfast so that digestion happens smoothly. However, in the absence of breakfast, the acid is retained in the stomach. With the loosened lower oesophageal sphincter, the reflux of gastric juice from your stomach up to your throat could happen.

Photo courtesy of houstonheartburn.com

Here comes the root of the problem: the reason why the lower oesophageal sphincter is loosened.

Increased intra-abdominal pressure

Pregnancy and obesity increase the pressure in the abdomen, forcing the gastric juice up to a lower pressure region in the oesophagus.

Diet

Certain foods will cause the lower oesophageal sphincter to relax, such as excessive consumption of coffee, alcohol, chocolate, tea, and dietary fat. The foods that trigger symptoms vary widely among affected individuals.

Delayed gastric emptying time

It is the lengthening of the period where food moves from stomach to the intestine. Diabetes is the most common cause. Fatty food and carb-rich food may cause symptoms of dyspepsia, the difficulty in digestion.

Smoking

Nicotine found in tobacco has the effect of relaxing the muscles around the lower oesophageal sphincter, thus loosening the ring and increasing the possibility of gastric juice reflux.

Hiatus hernia

It is the protrusion of part of the stomach through the diaphragm into part of the chest cavity. This is thought to cause reflux because the pressure gradient which usually pinches the hiatus, is lost.

Photo Courtesy of tfd.com

Long-term effect of GERD/heartburn

• Oesophagitis

Frequent irritation of the oesophagus by the gastric juice can cause inflammation of the oesophagus. Individuals might suffer from difficulty or pain during swallowing, lack of appetite, sore throat, hoarse voice and chest pain which worsens with eating. In more severe case, esophagitis may cause ulcer and bleeding, and eventually scarring, which narrows the tract diameter.

• Barrett’s oesophagus

It is a pre-malignant condition where there is a transformation of the cells lining the oesophagus after long term wash up by the gastric juice. This is an adaptive response of our body and is more commonly seen in men (especially white), the obese and those over 50 years of age.

Photo Courtesy of Davidsons Principles and Practice of Medicine

• Oesophageal cancer

Investigations

The gold standard of investigation is endoscopy. This is performed to rule out other disease and to identify complications. A flexible tube with light and camera will be inserted into the stomach through the mouth and oesophagus. The view will be projected on a screen for better observation.

Photo Courtesy of Bailey and Love

24-hour pH monitoring is indicated if the diagnosis is unclear. It also involves a tube passing through the oesophagus into the stomach, and a monitor attached to the tube will function to detect the change in pH. A pH of less than 4 for more than 6-7% of the study time is diagnostic of reflux disease.

Barium swallow is an X-ray imaging test which captures the image of the structures when the person in swallowing liquid barium.

A measure for every scenario

I don’t have time to visit the doctor! 

Most people with reflux disease do not consult a doctor and do not need to do so. There are a few over-the-counter treatments for heartburn and regurgitation such as antacids, H2 blockers and proton pump inhibitors (PPI).

I shall skip my breakfast and lunch for I need to lose some weight!

Some may think skipping meals would be the best option to lose weight but in fact no, this will only bring more harm and complications! You might not notice this but skipping meals make you prone to overeat later and a full stomach can aggravate the symptoms too.

I can’t live without coffee!

A coffee a day is of no harm. Same goes to alcohol and tea. Not too much.

I have reflux when I sleep at night.

Individuals can also try to have a modest degree of head-up tilt of the bed while sleeping. Avoidance of large meals late at night can be effective too.

My symptoms are getting out of control

Consultation and surgery are usually only needed when the symptoms become severe and when the medicines have no effect anymore.

“I know for sure that taking care of your body, no matter what, is an investment, and the return is priceless.” – Oprah Winfrey

So what do you do – skip breakfast or eat it religiously every single day? Do let us know!

(Originally Published on GetDoc)