Fatty Liver Disease: The Diagnosis Everyone Ignores
Fatty liver is now found on roughly one in three routine ultrasounds. Most people are told it is 'nothing to worry about' — which is true only if something is done about it.
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Reaching for an antacid several times a week is not a solution — it is a symptom. Persistent reflux damages the oesophagus and occasionally hides something more serious.
What is actually happening
The valve between the oesophagus and the stomach normally stays closed except when swallowing. In gastro-oesophageal reflux disease it relaxes inappropriately, allowing acid to flow upward into a tube that has no protective lining against it.
The result is burning behind the breastbone, an acid or bitter taste, and sometimes a chronic cough, hoarseness, sore throat or a sensation of a lump in the throat — symptoms that frequently get treated as ENT or respiratory problems for months.
Lifestyle changes that work
- Do not lie down for three hours after eating — this is the single most effective change
- Raise the head end of the bed by 15–20 cm using blocks under the legs, not extra pillows, which bend the abdomen and worsen reflux
- Eat smaller, more frequent meals instead of large ones
- Lose weight if the abdomen is large — abdominal pressure drives reflux directly
- Stop smoking, which relaxes the valve
- Reduce alcohol, coffee, and very spicy or oily food if they clearly trigger symptoms
- Avoid tight belts and waistbands
- Do not exercise immediately after eating
Worth knowing
Late dinners are the most common cause we identify. Eating at 10 pm and lying down at 10:30 pm guarantees reflux regardless of what medication you take.
About long-term acid-suppressing medication
Proton pump inhibitors such as pantoprazole and omeprazole are highly effective, but they are extremely widely taken for years without review — often bought over the counter and never reassessed. Long-term use is associated with reduced absorption of vitamin B12, magnesium, calcium and iron, and with a higher rate of certain gut infections.
That does not mean they are dangerous or should be avoided when needed. It means the dose should be the lowest that controls symptoms, the need should be reviewed periodically, and lifestyle measures should do as much of the work as possible.
Alarm features requiring endoscopy
- Difficulty swallowing, or food sticking
- Painful swallowing
- Unintended weight loss
- Vomiting blood, or black tarry stools
- Persistent vomiting
- Anaemia found on a blood test
- New reflux symptoms starting after the age of 45
- Symptoms not responding to adequate treatment
- A family history of stomach or oesophageal cancer
Helicobacter pylori
This bacterium infects a large share of the Indian population and is a major cause of peptic ulcer and a risk factor for stomach cancer. It is tested for by a urea breath test, stool antigen test or a biopsy during endoscopy, and treated with a combination of antibiotics and acid suppression for two weeks.
Testing is worthwhile in anyone with ulcer disease, persistent unexplained dyspepsia, or a family history of stomach cancer. Confirming eradication after treatment matters, since resistance is increasingly common.
Key takeaways
- Not lying down for three hours after eating is the highest-impact single change.
- Raise the head of the bed with blocks rather than adding pillows.
- Long-term acid-suppressing medication should be reviewed, not taken indefinitely without reassessment.
- Difficulty swallowing, weight loss or bleeding require endoscopy without delay.
A note on medical advice
This article is general health education written and reviewed by the Department of Gastroenterology at SIMS. It is not a substitute for an examination, a diagnosis or the advice of your own treating doctor, and it cannot account for your history, medicines or reports. If a symptom is sudden or severe — chest pain, stroke symptoms, breathing difficulty, serious injury, seizures or heavy bleeding — call 9281862028 or come straight to the emergency department instead of reading further.
AcidityGERDRefluxGastroenterology
