本港大約有10%、即逾70萬人有俗稱胃酸倒流的胃食道反流病。當下食道括約肌出現鬆弛,胃酸便有機會反流至食道,上湧至食道的胃酸會刺激食道內壁黏膜,引致胸口灼痛(火燒心)、胃酸上湧及胃氣胃脹等常見不適,少數病人更因胃酸湧入口腔、咽喉、聲帶,有機會引起聲沙、咳嗽、牙周病及口臭等看似不相關的徵狀。

病人經常忽略病情

試過有一名病人,本身是中港貿易的商人,經常兩邊走,食無定時,而且多應酬,經常大吃大喝,因此患上了胃酸倒流。他經常出現火燒心及胃酸上湧等症狀,尤其夜間睡眠時,經常痛醒,需要坐直身體,讓胃氣噯出,症狀才會舒緩一點。胃酸更加刺激病人的咽喉,令病人出現咳嗽、聲沙、口臭等徵狀,影響了病人社交生活。

然而,不少病人卻未有正視症狀,認為工作忙,壓力大,胃部不適是正常不過的事情,故此強行忍受病情,未有及早求醫。

我的經驗顯示,病人通常在症狀出現長達五年後,症狀變得嚴重才求醫。其中有些病人使用家庭醫生處方的藥物後,但控病效果仍未理想,故需要轉介專科醫生處理。

適當檢查助正確診斷

正確的診斷對於治療胃酸倒流十分重要,一般醫生會處方有症狀的患者四至八星期的質子泵抑制劑,如症狀有明顯改善,病人很大機會就是患上胃酸倒流。較嚴重的病人可能需要使用較高劑量,或一些較新的長效藥物,以有效控制胃酸問題,避免胸口灼痛、口臭等症狀繼續影響日常作息,使患者可以恢復正常的生活。

若果用藥後,症狀未能改善或出現一些較嚴重的紅旗症狀,如體重急降、吞嚥困難、貧血及持續嘔吐,會建議患者進行胃鏡檢查,進一步檢查食道、胃及十二指腸是否因為胃酸倒流而出現症狀及併發症,例如食道有紅腫發炎、損傷潰瘍,又或發生胃下垂、賁門鬆弛等結構變化情況,以及糜爛性食道炎、巴洛氏食道症及評估癌症風險等、以便制定適當的治療策略。

如果藥物治療未能控制病情的病人,或不想長期服藥的病人,可考慮進行手術治療。食道胃酸監測有助檢測病人的症狀是否由胃酸倒流引起,有助評估手術的預後成果,而配合個人飲食及生活記錄則能知道哪些食物或活動會激發胃酸,例如坊間有傳言吃香蕉可助控胃酸,曾經有患者每次進食香蕉後症狀特別劇烈,覆查胃酸監測資料確認香蕉刺激其胃酸分泌,患者便可透過減少進食某種食物舒緩症狀。

最後提醒大家,胃酸問題的成因因人而異,有懷疑不應自行處理,宜及早求醫以解決困擾。

胃酸倒流常見症狀

食管症狀
胸口灼痛(火燒心)、胃酸上湧、胃氣、胃脹、口有酸氣
非食管症狀
聲沙、咳嗽、牙周病、口臭
參考資料:
  1. Wong CY. Gastro-esophageal reflux disease: Optimizing proton pump inhibitor therapy to improve symptom control. JSPHK.2014;6:1-2.
  2. Mayo Foundation for Medical Education and Research. Definition. Available at:http://www.mayoclinic.org/ diseases-conditions/gerd/basics/definition/con-20025201 (Accessed on 09 Mar 2015).
  3. Mayo Foundation for Medical Education and Research. Symptoms . Available at: http://www.mayoclinic.org/diseases-conditions/gerd/basics/symptoms/ con-20025201(Accessed on 09 Mar 2015).
  4. American Academy of Family Physicians. Atypical Presentations of Gastroesophageal Reflux Disease.Available at: http://www.aafp.org/afp/2008/0815/ p483.html#afp20080815p483-t1 (Accessed on 25 Mar 2015).
  5. Mayo Foundation for Medical Education and Research. Causes. Available at: http://www.mayoclinic.org/diseases-conditions/gerd/ basics/causes/con-20025201(Accessed on 09 Mar 2015).
  6. MedlinePlus. Gastroesophagal reflux disease. Available at: https://medlineplus.gov/ency/article/000265.htm (Accessed on 5 Dec 2017)
  7. Mayo Foundation for Medical Education and Research. Risk factors. Available at: http://www.mayoclinic.org/ diseases-conditions/gerd/basics/risk-factors/con-20025201(Accessed on 09 Mar 2015).
  8. Healthline. Can Stress Cause Acid Reflux? Available at: https://www.healthline.com/health/gerd/stress#1 (Accessed on 5 Dec 2017)
  9. Mayo Foundation for Medical Education and Research . GERD: Can certain medications increase serverity? Available at: https://www.mayoclinic.org/diseases-conditions/gerd/expert-answers/heartburn-gerd/faq-20058535 )(Accessed 5 Dec 2017)
  10. GI Motility online. Medical management of gastroesophageal reflux disease. Available at: https://www.nature.com/gimo/contents/pt1/full/gimo54.html (Accessed 5 Dec 2017)
  11. Mayo Foundation for Medical Education and Research. Complications. Available at: http://www.mayoclinic.org/diseases-conditions/ gerd/basics/complications/ con-20025201(Accessed on 09 Mar 2015).
  12. American College of Gastroenterology. Diagnosis and Management of Gastroesophageal Reflux Disease. Available at:http://gi.org/guideline/diagnosis-and-managemen-of-gastroesophageal-reflux-disease/(Accessed on 25 Mar 2015).
  13. 香港專科醫護基金. 胃酸倒流引致胸痛 嚴重影響生活質素Available at http://www.hkscf.org/cn/index/headline/?newsid=109 (Accessed on 13 Mar 2015).
  14. WebMD. GERD. Controlling Heartburn by changing your habits. Available at: https://www.webmd.com/heartburn-gerd/lifestyle-modifications-for-gastroesophageal-reflux-disease (Accessed on 5 Dec 2017)
  15. MedlinePlus National Institutes of Health. Heartburn. Available at: https://medlineplus.gov/ency/article/003114.htm (Accessed on 04 Jan 2018)
  16. Fass R, et al. The Effect of Dexlansoprazole MR on Nocturnal Heartburn and GERD-Related Sleep Disturbances in Patients With Symptomatic GERD. Am J Gastroenterol 2011; 106:421-31.
  17. Hunt R, et al. World Gastroenterology Organisation Global Guidelines . GERD Global Perspective on Gastroesophageal Reflux Disease. J Clin Gastroenterol Volume 51., Number 6, July 2017
  18. Mayo Clinic. Histamine H2 Antagonist (Oral Route, Injection Route, Intravenous Route). Available at: https://www.mayoclinic.org/drugs-supplements/histamine-h2-antagonist-oral-route-injection-route-intravenous-route/proper-use/drg-20068584 (Accessed on 27 Dec 2017)
  19. Kwong MF, et al. Asia-Pacific consensus on the management of gastroesophageal reflux disease: Update. Journal of Gastroenterology and Hepatology 23 (2008) 8-22. doi:10,1111/j.1440-1746.2007.05249.x.
  20. Abdel-Hamid H. Modified PPIs (a search for the better). Al-Azhar Assiut Med J 2016;14:8-10
  21. Medscape. Laparoscopic Nissen Fundoplication. Indications. Available at: https://emedicine.medscape.com/article/1892517-overview#a2 (Accessed on 5 Dec 2017)
  22. David Armstrong, et al. Validation of a short questionnaire in English and French for use in patients with persistent upper gastrointestinal symptoms despite proton pump inhibitor therapy: The PASS (Proton pump inhibitor Acid Suppression Symptom) test. Can J Gastroenterol Vol 19 No 6 June 2005
HK/GI/2018-00034