Reflux (GERD) and functional dyspepsia — recognising it, testing smartly, treating properly

In brief

• Reflux (GERD) and functional dyspepsia are common, and can show up as chronic cough, hoarseness, throat clearing or chest pressure as well as heartburn and early fullness.
• H. pylori is a curable cause, and we test for it with the urea breath test or stool antigen test, not blood antibody tests.
• Losing 5–10% of body weight if you carry extra, smaller meals and not lying down within 3 hours of eating often improve reflux substantially.
• PPIs are effective, but many people can step down once the reason for taking them has passed.
• See us promptly for difficulty or pain swallowing, weight loss, vomiting blood, black stools, persistent vomiting, or new indigestion at age 45 or above.

We assess reflux and indigestion, with H. pylori breath and stool testing, at our Punggol clinic. Book a chronic-care appointment.

Do any of these sound familiar?

Many patients don’t connect their symptoms to reflux or dyspepsia until someone asks. Some common stories:

“I get a burning feeling behind my breastbone after dinner. Sometimes I wake at night with a sour taste in my throat.”

“I’ve been coughing for months. Two courses of antibiotics didn’t help, and my chest X-ray is clear. It’s worse after dinner and lying down.”

“I feel full after a few bites, then bloated for an hour or two. I’ve started avoiding lunch out with colleagues.”

“I keep clearing my throat, and I’m hoarse by evening. The ENT said my vocal cords look irritated, but there’s no infection.”

“Some mornings I wake with pressure behind my breastbone. My stress test and ECG were fine, but it keeps coming back.”

The common thread is stomach contents (acid, bile or both) going where they shouldn’t. They may rise into the oesophagus (reflux), irritate the stomach lining, or cause fullness and pain out of proportion to what you’ve eaten.

GERD and functional dyspepsia — related, but different

The two often get lumped together, and many patients have elements of both. But they are investigated and treated differently.

Gastro-oesophageal reflux disease (GERD)

GERD is reflux of stomach contents up into the oesophagus, causing symptoms or damage. The hallmark symptoms are:

• Heartburn: burning behind the breastbone, classically after meals or when lying down.
• Acid regurgitation: a sour or bitter taste in the mouth, sometimes with small amounts of food coming back up.
• Water brash: excess watery saliva, often with a sour taste.

GERD also has atypical and extra-oesophageal forms that are easy to miss:

• chronic cough, particularly at night or after meals
• hoarseness, throat clearing or globus (a feeling of something stuck in the throat), often called laryngopharyngeal reflux (LPR) or “silent reflux”, sometimes with little or no heartburn
• non-cardiac chest pain: pressure or pain behind the breastbone that mimics heart symptoms, often prompting repeated heart tests
• dental erosion, particularly on the inner surfaces of the teeth
• sleep disturbance: waking at night with cough, throat irritation or sour regurgitation
• asthma that is severe or hard to control, which is sometimes partly driven by reflux

Usually the lower oesophageal sphincter (LOS), the ring of muscle between stomach and oesophagus, relaxes when it shouldn’t. Raised pressure in the abdomen, a hiatal hernia (part of the stomach pushing up through the diaphragm) or delayed stomach emptying often add to this.

Functional dyspepsia

Functional dyspepsia is a cluster of chronic upper abdominal symptoms without a structural disease to explain them. “Functional” means tests (endoscopy, ultrasound, blood tests) usually find no specific abnormality. The symptoms are still very real.

The internationally used Rome IV criteria require at least one of:

• Bothersome postprandial fullness: feeling uncomfortably full for longer than expected after normal-sized meals.
• Early satiety: feeling full after only a few bites.
• Epigastric pain: pain or ache in the upper middle abdomen.
• Epigastric burning in the same area, without the behind-the-breastbone character of heartburn.

These must be present for at least 3 months, starting at least 6 months before diagnosis, with no evidence of structural disease on investigation.

There are two patterns, and patients often have both:

• postprandial distress syndrome (PDS): mainly postprandial fullness and early satiety
• epigastric pain syndrome (EPS): mainly epigastric pain and burning

Functional dyspepsia and GERD can coexist, and their treatment overlaps a lot, though some treatments suit one more than the other.

Red flags — when we look further

Most reflux and dyspepsia is straightforward. These features change the approach and call for earlier investigation:

• New dyspepsia at age 45 or above, particularly in people of East or Southeast Asian background
• Progressive difficulty swallowing (dysphagia): food or liquid getting “stuck”
• Pain on swallowing (odynophagia)
• Unintentional weight loss of more than about 5% of body weight over 6 months
• Iron deficiency anaemia on blood tests
• Vomiting blood, coffee-ground vomit, black tarry stools, or any visible bleeding from the gut
• Persistent vomiting
• A lump you can feel in the upper abdomen
• A first-degree relative (parent, sibling or child) with stomach or oesophageal cancer
• A previous stomach ulcer or stomach surgery
• Severe or rapidly worsening symptoms despite standard treatment

Any of these lowers our threshold for further tests, usually an upper endoscopy (gastroscopy, “OGD”).

When we’d refer for endoscopy

Singapore has a higher background rate of gastric cancer than Western benchmarks, particularly among Chinese people and older adults. So while Western guidelines often reserve endoscopy for people over 55–60 with alarm features, local practice typically has a lower threshold.

We usually discuss referral to a gastroenterologist or general surgeon for endoscopy if you have:

• any alarm feature from the list above, at any age
• new dyspepsia over age 45 (some doctors use 40) without a clear trigger
• a strong family history of gastric cancer or Barrett’s oesophagus
• persistent symptoms despite 4–8 weeks of appropriate treatment, such as a PPI trial or H. pylori eradication
• a positive H. pylori test, and we want to check for ulcers, gastric atrophy or intestinal metaplasia while treating
• long-standing reflux (more than 5 years), for a one-time check for Barrett’s oesophagus, a precancerous change that needs surveillance if found

Endoscopy isn’t a minor test, but it is the most useful way to see whether the upper gut looks normal, whether H. pylori is present, and whether anything more concerning is going on. We always make it a shared decision, not a default.

Our usual pathway: we recommend a specific gastroenterologist or general surgeon (both our Punggol and Joo Chiat clinics have preferred referral partners). We write a referral letter stating the reason, and follow up after the report to plan next steps together.

Helicobacter pylori — the one reversible cause worth ruling out

Helicobacter pylori (H. pylori) is a bacterium that lives in the stomach lining. It is curable with antibiotics, and clearing it can:

• cure a large proportion of dyspepsia in people who carry it
• heal stomach and duodenal ulcers and prevent their return
• reduce the long-term risk of gastric cancer, MALT lymphoma and iron-deficiency anaemia

Local prevalence has fallen over recent decades, from well over half of adults to about 20–30%, depending on the population. Testing is still usually worthwhile in dyspepsia, ulcer-type pain, or recurrent reflux that isn’t settling.

Testing for H. pylori — why the method matters

Patients are often tested the wrong way, because the available tests are not interchangeable.

What we offer at KTMC — Urea Breath Test and stool antigen test

International consensus (Maastricht VI / Florence Report 2022, ACG 2024, Asian-Pacific Consensus) treats the Urea Breath Test (UBT) and stool antigen test as equivalent first-line non-invasive tests, for diagnosis and test-of-cure, and local Singapore validation agrees. Both detect active, current infection (not past exposure), with sensitivity and specificity around 95%. Blood antibody testing (serology) performs substantially worse.

Urea Breath Test. You swallow a small amount of urea labelled with a harmless carbon isotope. If H. pylori is present, its enzyme (urease) breaks down the urea and releases labelled carbon dioxide, which you breathe out and we measure. It takes around 30 minutes in clinic: two breath samples, with a small drink in between.

Stool antigen test. You collect a single stool sample, usually at home, and drop it at the clinic. No clinic time is needed for the test itself.

Which to choose is a practical decision, as the two tests are equally valid. The UBT suits people who want everything done in one visit with a same-day result. The stool test suits children, people with swallowing difficulty, travellers, and anyone who can’t easily come in or would rather avoid the in-clinic procedure.

Preparation is the same for both tests. Acid-suppressing medicines and antibiotics suppress the bacterium and can cause a false-negative result, so:

• Stop PPIs for at least 2 weeks before the test.
• Stop antibiotics and bismuth-containing medicines for at least 4 weeks.
• Stop H2 blockers (e.g. famotidine) for 24 hours before the test.
• Fast for at least 4–6 hours before a UBT (small sips of water are fine). No fasting is needed for the stool test.

If stopping your PPI is difficult, we discuss the trade-off. A short stop is usually fine, but we plan it rather than just pause the medicine.

Testing done at endoscopy — rapid urease test and histology

If you are having an endoscopy for another reason, the gastroenterologist usually takes small biopsies of the stomach lining and tests them in two ways:

• Rapid urease test (CLO test): the same principle as the UBT, with a result within hours.
• Histology: the biopsy is examined under the microscope, which also checks for gastritis, atrophy, intestinal metaplasia, ulcers or cancer.

What we don’t use — serology and “rapid antibody” tests

Blood tests for H. pylori antibodies are no longer recommended for routine clinical use, whether in a wellness panel or as a “rapid antibody test” (ART) with an answer in minutes. International consensus groups (Maastricht VI, ACG, Asian-Pacific) all agree, for two reasons:

1. They can’t tell active infection from past infection. IgG antibodies stay positive for years, sometimes for life, even after successful eradication. A positive result does not mean you need treatment. A negative result in someone who has had H. pylori before is also hard to interpret.
2. A positive result means less as prevalence falls. As local prevalence has come down, so has the chance that a positive antibody test reflects a current, treatable infection. Antibody tests make sense in research and epidemiology, but rarely for day-to-day clinical decisions.

In practice: if you were told you have H. pylori from a blood antibody test, and were never treated or were treated long ago, you need a proper active-infection test (UBT or stool antigen) before starting antibiotics. Equally, if a blood antibody test stays positive after treatment, that is expected and does not mean treatment failed.

The test-of-cure — 4 weeks after treatment

Successful eradication must be confirmed. The standard is to repeat the UBT or stool antigen test at least 4 weeks after finishing antibiotics, and 2 weeks off any PPI. Testing earlier risks a false-negative result. We routinely schedule this.

Treating H. pylori

Treatment needs a combination of antibiotics plus acid suppression. Single drugs don’t work, and nor do short courses.

What you’ll typically be prescribed

The current options, adjusted for local availability and resistance patterns:

• Concomitant therapy (10–14 days): a PPI + amoxicillin + clarithromycin + metronidazole, all taken together. This is our usual first-line choice in Singapore. It works well against most local strains and doesn’t depend on bismuth.
• Triple therapy (14 days): a PPI + amoxicillin + clarithromycin. Still used in selected patients with no previous macrolide exposure, but rising local clarithromycin resistance influences the choice.
• Bismuth quadruple therapy (10–14 days): a PPI + bismuth + metronidazole + tetracycline. It works well even where clarithromycin resistance is suspected, and is standard first-line in several countries. In Singapore it is mainly used second-line, and is usually arranged by specialists or hospitals, typically after first-line failure or for specific resistance concerns.
• Levofloxacin-based therapy: a PPI + amoxicillin + levofloxacin, usually reserved as second-line after a failed concomitant or triple course.

During the course:

• Complete the full course. Eradication rates fall substantially if even a day or two is missed; set reminders if needed.
• Take each medicine at the right time. Some go with food, others on an empty stomach, so follow the pharmacy labels precisely.
• Side effects are common: a metallic taste (from metronidazole), nausea, loose stools, occasionally a rash. Adjusting dose timing almost always helps. On a bismuth regimen, dark stools and a dark tongue are expected and harmless.
• No alcohol during treatment, because metronidazole reacts unpleasantly with it.
• Probiotics during and after the course may reduce gut side effects and slightly improve eradication rates.

If a first-line course fails (about 10–15% do), we switch to a different antibiotic combination rather than repeat the same one. That is why confirming the bacterium is still present, by UBT or stool antigen and not serology, is essential.

Managing GERD — lifestyle foundation

Lifestyle measures help most patients, even before medication, and reduce how much long-term medication you need.

Weight

If you carry extra weight, particularly around the abdomen, losing even 5–10% often improves reflux substantially. Abdominal (visceral) fat raises the pressure inside the abdomen and pushes stomach contents upward. See our medical weight management guide.

Meal size and timing

• Smaller, more frequent meals are generally easier on the lower oesophageal sphincter than large, infrequent ones.
• Don’t lie down within 3 hours of a meal. Gravity helps keep stomach contents where they belong.
• Avoid late-night dinners if reflux is worse at night.
• Eat slowly and chew thoroughly, which improves fullness and reduces swallowed air.

Trigger foods

Triggers vary, so notice which apply to you rather than follow a blanket list. The usual suspects:

• fatty and fried foods, which delay stomach emptying
• spicy food, particularly chilli-based
• tomato-based foods and citrus
• chocolate and mint (including peppermint tea), which relax the lower oesophageal sphincter
• coffee (caffeinated, and sometimes decaffeinated)
• carbonated drinks
• alcohol, particularly beer and wine
• very hot or very cold foods

If your triggers aren’t obvious, keep a short food and symptom diary for 2–3 weeks. Rather than cut out everything, identify the 2–3 things that reliably trigger you.

Sleep position

For night-time reflux:

• Raise the head of the bed by 15–20 cm, using blocks under the bed legs. Extra pillows are not the same; they bend the body and can worsen reflux.
• Sleep on your left side, which anatomy favours for less reflux.

Smoking

Smoking weakens the lower oesophageal sphincter and reduces the protective effect of saliva. Stopping helps meaningfully. Our asthma guide lists local smoking-cessation services, which apply equally here.

Tight clothing

Tight high-waisted clothing, shapewear and heavy belts can worsen reflux by raising pressure in the abdomen.

Exercise — helpful overall, but timing and technique matter

• Regular moderate activity helps, mainly through weight control and general metabolic benefit. Walking, cycling on flat ground, swimming and general aerobic exercise usually don’t provoke reflux.
• Intense exercise within 2–3 hours of a meal (running, hard cycling, vigorous gym work) often worsens reflux in the short term. Leave a gap after eating.
• Movements that raise abdominal pressure can trigger reflux: heavy lifts done holding your breath (squats, deadlifts), crunches and sit-ups, and yoga inversions (shoulder stands, headstands, long holds in downward dog). If your reflux is significant, swap heavy deadlifts for goblet squats, sit-ups for planks and dead bugs, and inversions for gentler hip-opening poses.
• Conventional “core strengthening” that compresses the abdomen isn’t the useful part.

The exercise that does help is diaphragmatic breathing. Randomised trial evidence (Eherer 2012 in Am J Gastroenterol, and later studies) supports it as a real add-on treatment for GERD. It is thought to strengthen the crural diaphragm, which wraps around the lower oesophagus and reinforces the sphincter from outside.

The technique, 5–10 minutes daily:

1. Lie on your back or sit comfortably.
2. Place one hand on your chest and one on your abdomen just below the ribs.
3. Breathe in slowly through the nose, so that the hand on your abdomen rises while the chest hand stays fairly still.
4. Breathe out slowly through the mouth or nose.
5. Aim for around 6 breaths per minute, slower than your usual rate.

Consistency matters more than duration. Most people who benefit notice fewer reflux episodes over 4–8 weeks, sometimes allowing a PPI step-down. It won’t work for everyone, but it is free, low-risk and evidence-based.

GERD medications

A stepped approach usually works well.

Antacids — for occasional symptoms

Simple antacids neutralise acid for short periods (30–60 minutes). They include calcium carbonate (e.g. Rennie), sodium bicarbonate (e.g. Eno) and aluminium or magnesium hydroxide mixtures. They are useful for occasional breakthrough symptoms, but not effective as main long-term treatment.

Alginates — a useful adjunct

Alginate-containing preparations (Gaviscon Double Action, Gaviscon Advance) form a physical “raft” on top of the stomach contents, which suppresses reflux for 3–4 hours. They are especially useful:

• after meals, particularly dinner, if you have night-time reflux
• in pregnancy, where other options are limited
• alongside a PPI when breakthrough symptoms remain

The main caveat with alginates is their sodium content, if you have significant heart failure or are on strict sodium restriction.

H2 blockers — a useful middle step

Famotidine and similar H2 blockers reduce acid production, working within an hour for several hours. They are useful for:

• mild-to-moderate GERD
• occasional breakthrough symptoms on a PPI
• night-time reflux, taken before bed in addition to a morning PPI
• people who prefer not to take a daily PPI

Ranitidine (Zantac), formerly the most widely used H2 blocker, was recalled in Singapore in September 2019 over contamination with N-nitrosodimethylamine (NDMA). The US FDA asked for its withdrawal from the market in April 2020. Famotidine is the current alternative.

Proton pump inhibitors (PPIs) — effective, sometimes overused

PPIs are the most effective acid-suppressing medicines. They include:

• omeprazole (Losec, generic)
• esomeprazole (Nexium)
• pantoprazole
• rabeprazole (Pariet)
• lansoprazole

PPIs are appropriate for:

• moderate-to-severe reflux, including erosive oesophagitis
• peptic ulcer disease
• H. pylori eradication (as part of the combination)
• Barrett’s oesophagus
• long-term high-dose NSAID or steroid use (gastroprotection)
• severe gastritis
• high bleeding risk on antiplatelet medicines

Points worth knowing:

• Take PPIs 30–60 minutes before breakfast (once daily) or before meals (twice daily). They work best when eating switches on the stomach’s proton pumps; taking them at bedtime or at random times substantially reduces the effect.
• The effect is not instant. PPIs reach full effect over about 4–5 days of regular use.
• Agents differ slightly. If one isn’t working, try another before concluding PPIs don’t suit you.

Long-term safety. PPIs are broadly safe, but long-term use (years rather than weeks) has been linked with modest increases in several risks:

• vitamin B12 deficiency (screening is worthwhile after several years of continuous use)
• low magnesium, occasionally significant, particularly with diuretics
• bone fracture: a small but real signal in observational studies, particularly in older adults and with long use
• kidney problems: an uncommon but recognised risk of acute interstitial nephritis, and a modest signal for chronic kidney disease progression
• Clostridioides difficile infection: a modest increase in risk
• pneumonia: a small signal in some populations
• rebound acid hypersecretion: symptoms rise for 2–4 weeks after stopping a long-term PPI, which can be mistaken for reflux returning and prompt an unnecessary restart

For most people taking a PPI for a clear clinical reason, these risks are modest. They are a reason not to stay on a PPI without one.

The “when can I stop my PPI?” conversation

We want to have this conversation more often:

• If you started a PPI for a short-term reason (an NSAID course, ulcer healing, an H. pylori course) and that reason has passed, stepping down is usually appropriate: to on-demand use, to an H2 blocker, or stopping entirely.
• If you take a PPI for long-standing reflux, a step-down trial is reasonable. Halve the dose for 2–4 weeks, then take it on alternate days, then as needed. Expect some rebound, and ride it out with an alginate or H2 blocker.
• If you have Barrett’s oesophagus, erosive oesophagitis on endoscopy, or severe symptoms that reliably return on stopping, long-term PPI is the right plan, with periodic review of the dose and the reason.

A lifelong PPI that no one reviews is usually not the right plan. If we haven’t discussed it, please raise it at your next visit.

Managing functional dyspepsia

Functional dyspepsia is often harder to treat than GERD, because there is rarely a single structural fix. A stepped approach usually works.

Test and treat for H. pylori first

Given how common H. pylori is in Singapore, this is a worthwhile first step for anyone with dyspepsia and no alarm features. Some patients’ symptoms resolve entirely after successful eradication.

A PPI trial

A 4–8 week PPI trial helps a meaningful proportion of patients, particularly those with epigastric pain or burning. If symptoms settle, we usually try stepping down. If there’s no response after 8 weeks, a PPI is probably not the answer, and we move on rather than continue indefinitely.

A prokinetic

For postprandial distress (fullness, early satiety, bloating), where slow stomach emptying is often the driver, a prokinetic is sometimes useful:

• Domperidone: used short-term. HSA has noted heart rhythm concerns with prolonged use at higher doses, so we review it regularly.
• Metoclopramide: used for acute episodes. Long-term use is limited by the risk of movement disorders (extrapyramidal side effects).

Prokinetics are usually add-ons, not a long-term solution for most patients.

Neuromodulation — low-dose antidepressants for dyspepsia

For persistent dyspepsia despite the above, low-dose amitriptyline (typically 10–25 mg at night) or mirtazapine (useful when appetite and weight are low) can meaningfully improve symptoms. At these doses, much lower than for depression, they are not acting as antidepressants. They calm the heightened gut sensitivity that often underlies functional dyspepsia.

Patients sometimes resist this (“I’m not depressed”), but it is well-evidenced and worth an open-minded discussion. Many patients report substantial improvement.

Dietary adjustment

• small, frequent meals rather than large ones
• chewing thoroughly and eating slowly
• identifying your own trigger foods, commonly fatty or spicy meals, too much tea or coffee, and alcohol
• STW-5 (Iberogast), a herbal prokinetic available locally, with some evidence in functional dyspepsia; a reasonable adjunct if you prefer a non-pharmacological option

Stress and sleep

Symptoms often fluctuate with stress, sleep quality and mood. This doesn’t mean “it’s in your head”; it reflects a real interplay between the nervous system and the gut. So we often review sleep and stress too.

A brief note on pregnancy

Reflux is very common in pregnancy, as hormones relax the LOS and the growing uterus adds pressure. The usual approach:

• Lifestyle first: small meals, no late eating, raise the head of the bed, identify triggers.
• Alginates (Gaviscon): generally considered safe throughout pregnancy and often enough on their own.
• Famotidine: the H2 blocker with the most reassuring pregnancy safety data.
• PPIs: omeprazole has the largest body of pregnancy safety data and is generally considered acceptable where symptoms warrant it.

Symptoms usually settle soon after delivery. H. pylori testing and treatment are usually deferred until after pregnancy, unless there is a specific reason.

The Singapore context

• Healthier SG: for enrolled chronic-disease patients, reflux and dyspepsia review can be built into the chronic-care plan, with regular planned reviews rather than one-off visits.
• CHAS and MediSave: reflux and dyspepsia are not on MOH’s Chronic Disease Management Programme list, so the chronic-condition MediSave and CHAS subsidies do not cover them. Other support, such as CHAS common-illness subsidies for CHAS Blue, CHAS Orange, Pioneer Generation and Merdeka Generation cardholders, may apply to some visits. Our staff can check what applies to you.
• H. pylori testing at KTMC: both the Urea Breath Test and the stool antigen test are available at our Punggol and Joo Chiat clinics. We discuss results on the day or at the next visit.
• Specialist referrals: we work with a small number of trusted gastroenterologists and general surgeons, and suggest the most appropriate match for your clinical picture and preference.

Get in touch

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Email — admin@ktmc.sg

References

Guidelines and consensus statements

• Katz PO, Dunbar KB, Schnoll-Sussman FH, et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27–56.
• Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI / Florence consensus report. Gut. 2022;71:1724–1762.
• Chey WD, Howden CW, Moss SF, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2024;119(9):1730–1753.
• Ford AC, Mahadeva S, Carbone MF, Lacy BE, Talley NJ. Functional dyspepsia. Lancet. 2020;396:1689–1702.
• Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380–1392. (Rome IV criteria)

Singapore context

• Ang TL, Fock KM, Dhamodaran S, Teo EK, Tan J. Evaluation of the Utility of Serology, Urea Breath Test, and Stool Antigen Test for the Detection of H. pylori in Singapore. J Gastroenterol Hepatol. — locally-adapted diagnostic recommendations.
• Ministry of Health, Singapore. Singapore Cancer Registry — annual reports on gastric cancer incidence.
• Ang TL, Ang D. Helicobacter pylori treatment strategies in Singapore. Gut Liver. 2021;15(1):13–18.

PPI safety

• Freedberg DE, Kim LS, Yang YX. The Risks and Benefits of Long-term Use of Proton Pump Inhibitors: Expert Review and Best Practice Advice From the American Gastroenterological Association. Gastroenterology. 2017;152(4):706–715.
• Targownik LE, Fisher DA, Saini SD. AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review. Gastroenterology. 2022;162(4):1334–1342.

Diaphragmatic breathing for GERD

• Eherer AJ, Netolitzky F, Högenauer C, et al. Positive effect of abdominal breathing exercise on gastroesophageal reflux disease: a randomized, controlled study. Am J Gastroenterol. 2012;107(3):372–378.
• Casale M, Sabatino L, Moffa A, et al. Breathing training on lower esophageal sphincter as a complementary treatment of gastroesophageal reflux disease (GERD): a systematic review. Eur Rev Med Pharmacol Sci. 2016;20(21):4547–4552.

Antacids and ranitidine

• National Drug Formulary (NDF), Singapore. Rennie tablet [SIN08733P]: product information (calcium carbonate and magnesium carbonate). ndf.gov.sg
• Health Sciences Authority (HSA). HSA stops supply of eight brands of ranitidine products in Singapore. 16 September 2019. hsa.gov.sg
• US Food and Drug Administration (FDA). FDA requests removal of all ranitidine products (Zantac) from the market. 1 April 2020. fda.gov

National programmes

• Ministry of Health, Singapore. Healthier SG and Chronic Tier information. healthiersg.gov.sg
• Community Health Assist Scheme. chas.sg
• Ministry of Health, Singapore. Chronic Disease Management Programme (CDMP) — list of covered conditions. 2026. moh.gov.sg
• Community Health Assist Scheme. Common illnesses. chas.sg

This information is for general education only and is not a substitute for medical advice. Reflux and dyspepsia management should be individualised based on your specific symptoms, risk factors, test results, and preferences — please speak with our team about what’s right for you. v1.1 · October 2026 (v1.0 April 2026) · Review due April 2028.