Acid Reflux

Acid reflux, or Gastroesophageal Reflux Disease (GERD), is a condition where stomach acid flows back up into the oesophagus, causing a burning sensation in the chest, sour burps, or a bitter taste in the mouth. Unlike the stomach, the oesophagus isn't built to handle acid, so this backflow causes irritation and inflammation.

Normally, a ring of muscle at the bottom of the oesophagus called the Lower Esophageal Sphincter (LES) acts as a valve to keep acid from rising. When this muscle weakens or relaxes at the wrong time, acid escapes upward — and that's when the discomfort begins.

Acid reflux isn't just about heartburn. There are several symptoms to watch for.

🔥 Common symptoms — Heartburn (burning sensation in the chest), especially after eating or when lying down / sour or bitter-tasting burps / bloating and trapped wind / difficulty swallowing or feeling like something is stuck in the throat

😮 Less obvious symptoms many people don't associate with acid reflux — Chronic dry cough, especially at night / frequent sore throat or hoarseness / chest pain (similar to heart disease — see a doctor to rule it out) / unusual tooth erosion from acid

If you experience these symptoms more than twice a week, it's time to start treatment and make some lifestyle adjustments.

Multiple factors can contribute to acid reflux.

Behavioural factors — Eating large meals and lying down immediately / spicy, fatty, or acidic foods / excessive coffee, tea, carbonated drinks, or alcohol / smoking / chronic stress

Physical factors — Being overweight or obese / pregnancy / hiatal hernia / weakened lower oesophageal sphincter

Medication-related factors — NSAIDs (such as Ibuprofen and Aspirin), certain blood pressure medications, and sedatives can all worsen acid reflux symptoms

Treatment follows three main approaches.

1. Lifestyle changes — Reduce fatty, spicy, and acidic foods / don't lie down right after eating (wait at least 2-3 hours) / elevate the head of your bed by 6-8 inches / lose weight if overweight / avoid coffee, alcohol, and cigarettes

2. Medication — PPIs are the most effective medication class for treating acid reflux. They work by blocking acid production at the source, allowing the inflamed oesophagus to heal.

3. Surgery — In severe cases where medication fails, doctors may consider surgery to reinforce the oesophageal sphincter. However, this is very rare.

For most people, a combination of lifestyle changes and PPI medication controls symptoms very effectively.

Both belong to the PPI class, but they have some key differences.

Omeprazole — The first PPI to be widely used, with over 30 years of proven track record. Affordable and effective for most people. Take once daily, 30 minutes before breakfast. At Intimo Life, we offer Omeprazole GPO, manufactured by Thailand's Government Pharmaceutical Organization at an accessible price point.

Esomeprazole — A newer-generation PPI developed from Omeprazole, using only the most active component (S-isomer). This means more consistent absorption and better efficacy for some people. Ideal if Omeprazole hasn't worked well enough. At Intimo Life, we offer Nexium, the original brand of Esomeprazole.

In short: Start with Omeprazole — it works well for most people. If symptoms persist, switching to Esomeprazole may help.

Taking PPIs correctly makes a real difference in how well they work.

⏰ Timing — Take 30 minutes before a meal, ideally before breakfast. PPIs work best when the stomach is about to start producing acid.

💊 How to take — Swallow whole with water. Do not crush, break, or chew — the coating protects the medication from being broken down before it reaches the intestines.

📅 Duration — For typical acid reflux, take for 4-8 weeks. Do not use continuously for more than 8 weeks without consulting a pharmacist.

⚡ Important to know — PPIs don't provide instant relief like liquid antacids. It may take 2-3 days to feel the full effect, so take them consistently every day.

PPIs are generally very safe medications, but some side effects can occur.

Common side effects — Headache, bloating, nausea, diarrhoea or constipation. These are usually mild and resolve once you stop the medication.

Long-term use considerations — Using PPIs continuously for over a year may slightly increase the risk of vitamin B12 and magnesium deficiency, and may marginally raise fracture risk in elderly patients. For this reason, it's recommended to use the lowest effective dose for the shortest necessary duration.

If you need to use PPIs for longer than 8 weeks, consult a doctor to assess whether continued use is appropriate.

Many people confuse these two conditions. While they share some symptoms, they are different problems.

Acid Reflux (GERD) — Acid flows from the stomach up into the oesophagus. Main symptoms include heartburn and sour burps. Typically worsens when lying down or bending over.

Gastritis / Peptic Ulcer — Inflammation or ulcers in the stomach lining itself. Main symptoms include a dull or burning pain in the upper abdomen. Typically worsens on an empty stomach.

Both conditions can be treated with PPIs. However, if you experience severe abdominal pain, vomiting blood, or unexplained weight loss, see a doctor for further investigation.

Medication alone may not be enough. Combining it with these habits can provide much more lasting relief.

🍽️ Diet — Avoid fatty, spicy, and highly acidic foods, chocolate, and mint / reduce coffee, tea, carbonated drinks, and alcohol / eat smaller, more frequent meals instead of three large ones / don't eat 2-3 hours before bedtime

🛏️ Sleep — Elevate the head of your bed by 6-8 inches (not just more pillows) / sleeping on your left side reduces reflux more effectively than sleeping on your right

⚖️ Weight — Lose weight if overweight. Abdominal fat puts pressure on the stomach, making reflux more likely.

🚭 Smoking — Quit smoking. Nicotine weakens the lower oesophageal sphincter, making it easier for acid to escape.

Most acid reflux cases respond well to medication and lifestyle changes. However, see a doctor if you experience any of the following:

🚨 Symptoms don't improve after 2 weeks of PPI use / difficulty or pain when swallowing / vomiting blood or black stools / unexplained weight loss / severe chest pain (to rule out heart disease) / symptoms persisting for more than 8 weeks despite treatment

These could indicate complications that require further investigation, such as severe oesophagitis, oesophageal stricture, or Barrett's Oesophagus.