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SINGAPORE – The hot days of April have been especially uncomfortable for Mr Ow Sing Fuak. “I got heartburn,” says the 57-year-old, who works part-time at jobs such as estate maintenance.
While there is no scientifically proven link between hot weather and increased cases of heartburn, Mr Ow finds that his stomach acid-related discomfort can be triggered by stress, including when the weather is too hot or cold.
More people in Singapore are suffering from acid reflux or heartburn, doctors say, warning that the condition could signal or lead to more serious complications.
Dr Edward Cheong, a general surgeon with a speciality in upper gastrointestinal surgery, recalls the case of a 67-year-old man who had chronic acid reflux for 40 years without seeking professional help.
By the time the patient consulted Dr Cheong, he had developed a precancerous condition known as Barrett’s oesophagus. The cells lining the oesophagus had been damaged by chronic backflow of stomach acid.
“Many examples like this occur every day because patients ignore the symptoms for decades before seeking help,” says Dr Cheong, who practises at PanAsia Surgery Group. His patient was eventually treated successfully with anti-reflux medication, as well as through changing his lifestyle to address risk factors such as stress and obesity.
Dr Cheong estimates that about 20 per cent of the population suffers from heartburn or Gastroesophageal Reflux Disease (Gerd). “This condition is often overlooked. But it can carry very sinister consequences,” he adds.
Acid reflux and Gerd
The stomach produces a highly acidic liquid to aid in digestion, says Dr Toh Bin Chet, a general surgeon with a speciality in upper gastrointestinal surgery.
“The acid and stomach contents are supposed to travel only in one direction – down the digestive tract. When gastric acid from the stomach flows backward and up into the oesophagus and throat, it’s called acid reflux,” adds Dr Toh, who is senior consultant at Nexus Surgical, a subsidiary of Foundation Healthcare Holdings.
While many people experience the occasional episode of acid reflux, some suffer from constant heartburn (a burning sensation in the chest) or a burning gastric pain after eating, says Dr Toh. Some may even have difficulty swallowing, or dysphagia.
When acid reflux occurs at least twice a week for several weeks, a patient may have Gerd.
Dr Kenny Sze Ching Pan, senior consultant and head of Khoo Teck Puat Hospital’s Division of Gastroenterology, Department of General Medicine, says: “Risk factors for Gerd include anything that increases our intra-abdominal pressure, such as being overweight or heavily pregnant.”
Other risk factors include smoking, drinking alcohol, overeating, eating heavy meals before vigorous physical activity or lying down soon after eating, he adds.
Acid reflux may also be triggered by spicy food, caffeine and carbonated drinks, says Dr Sze.
Gerd is thought to be increasingly prevalent in Asia, he adds, because of higher rates of obesity, as well as an ageing population, among other factors.
Why acid reflux is on the rise
While the incidence of acid reflux and Gerd in Singapore has not been recently studied, doctors told The Straits Times that the number of cases has been climbing.
Dr Ng Tay Meng, gastroenterologist at Asian Healthcare Specialists, says half his patients have Gerd. They typically experience heartburn or acid regurgitation.
Some less common symptoms include frequent coughing and chronic sore throat, he adds.
Like Dr Cheong, he estimates the prevalence of Gerd at up to 20 per cent in Singapore.
“Gastroenterologists have been encountering an increasing number of patients with Gerd in the last 20 years,” says Dr Ng.
Part of the reason may be greater awareness of the condition, so more are seeking help.
Changes in Singapore society have also contributed to the rise, he adds. Contributing factors include increased stress; more consumption of caffeinated or carbonated beverages and alcohol; and more eating diets high in calories and fat.
Doctors say that hotter weather may indirectly cause acid reflux and Gerd. For example, hot weather may disrupt sleep cycles and lead to reduced exercise and weight gain, which can trigger episodes of acid reflux and Gerd, says Dr Asim Shabbir, senior consultant, upper gastrointestinal surgery, at Alexandra Hospital and National University Hospital (NUH).
Dr Kewin Siah, senior consultant at NUH’s Division of Gastroenterology & Hepatology, Department of Medicine, says heat stress or higher temperatures may exacerbate symptoms of acid reflux or Gerd in susceptible individuals, possibly due to increased perspiration and dehydration.
“To address this, individuals can stay hydrated, avoid large meals before outdoor activities in hot weather, and manage stress levels, which can worsen Gerd symptoms.”
Demand for heartburn-relief medications spikes during festive seasons, pointing to overeating as a major culprit.
A new online pharmacy service, Glovida-Rx Pharmacy, which started operations in October 2023, has seen demand for antacid medications rise in the first quarter of 2024. Its director Winthrop Wong says that demand for a class of medications known as proton pump inhibitors – which reduce stomach acid production – has risen 30 per cent month on month from January to March.
He attributes this to the festive celebrations during these months. “Certain foods and drinks – especially acidic, fatty, oily or spicy foods – can cause acid-reflux symptoms, and during festive periods, people tend to consume more of these foods.”
A spokesman for Watsons Singapore says that demand for heartburn-relief medications “typically surges during festive seasons, characterised by increased social gatherings and overeating tendencies”.
“There is a notable uptick in demand during the fasting month of Ramadan, attributable to shifts in eating habits and timings. This trend mirrors past festive and holiday periods,” the spokesman adds.
An ageing population may also lead to increased incidence of acid reflux and Gerd.
Dr Shabbir says changes in muscle tone with age may weaken the lower oesophageal sphincter valve, making it easier for stomach acid to flow back.
Another condition that increases the risk of acid reflux is a hiatal hernia, he adds. This is when a portion of the stomach protrudes through the diaphragm into the centre of the chest, weakening the same valve.
American actress Emma Stone suffers from this condition, according to an interview with Rolling Stone magazine in 2019. She controls her acid reflux by not taking spicy food.
Lifestyle changes help with acid reflux
Lifestyle changes and watching one’s diet are key to preventing or controlling acid reflux and Gerd, doctors say.
However, Dr Bhavesh Kishor Doshi, gastroenterologist at Gleneagles Hospital, says: “All patients suffering from Gerd should consult a doctor to get a formal assessment. In addition, symptoms such as difficulty swallowing, vomiting, unexplained weight loss and loss of appetite should be thoroughly assessed by the doctor.”
Lifestyle changes that can help include cutting out triggers such as caffeinated, citrus or acidic, spicy and fatty foods, he adds.
Having a longer gap between mealtime and bedtime is also helpful, as is using an extra pillow at night, he says.
Doctors also recommend maintaining a healthy weight, avoiding alcohol and stopping smoking.
Dr Sze says: “If lifestyle changes and dietary care cannot control symptoms, then reflux medications can be used. These either neutralise acid – antacids – or suppress acid secretion by the stomach.”
He adds that for those whose symptoms do not respond to medication, endoscopic or surgical procedures may be required. “These are usually reserved for patients with refractory, severe or disabling symptoms.”
Dr Shabbir says surgery can be recommended for patients with mechanical issues such as a lax sphincter and hiatal hernia. “This would involve tightening the loose hiatus muscles and either wrapping the stomach around the lower oesophagus to strengthen the weakened lower oesophageal sphincter or implanting a small magnetic device around the sphincter to reinforce its function and prevent reflux.”
He adds that stress-reduction techniques may help people manage acid reflux and Gerd. Such techniques include yoga, meditation, deep breathing exercises and even engaging in enjoyable hobbies and activities.
Mr Ow manages his heartburn through prescribed medications and lifestyle modifications. He gave up coffee several years ago, when the acid reflux started. In 2018, his condition was at its worst. He felt breathless and as if there were “no power” in his body. He was also overweight, at 80kg with a height of 1.71m.
Referred to Dr Siah at NUH in 2019, he had an endoscopy which revealed that his oesophagus had been damaged by chronic acid reflux, and he also had a small hiatal hernia.
He now takes strong proton pump inhibitors and over-the-counter antacids to manage the symptoms. He avoids caffeine, alcohol and spicy foods.
He limits exertion since suffering a heart attack and heart failure in 2010, which led to him getting a pacemaker inserted. When he is up to it, he walks on the treadmill at home.
He saw a nutritionist to help with his diet, switched heavy meals for smaller, more frequent ones, and is now a healthier 65kg.
“I feel better now and have more stamina,” says the married father of two adult children.
“When I was younger, I didn’t have discipline,” he adds. “I want people with this sickness to know that they need to take care of themselves.”
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