Gastroesophageal Reflux Overview
Gastroesophageal reflux, also called acid reflux, occurs when stomach contents back up into the esophagus (food pipe) and/or mouth. Occasional reflux is normal and can happen in healthy people, most often after eating a large meal. Most episodes are brief and do not cause bothersome symptoms or complications. In contrast, people with gastroesophageal reflux disease (GERD) experience bothersome symptoms or damage to the esophagus as a result of acid reflux.

GERD Risk Factors
Certain factors increase a person’s risk of developing GERD, including:
• Hiatal Hernia — This occurs when part of the upper stomach pushes through the diaphragm into the chest. The diaphragm has an opening for the esophagus to pass through, which enlarges in people with a hiatal hernia, allowing the stomach to move upward. This shift increases acid reflux because the lower esophageal sphincter (the valve at the base of the esophagus) becomes less tight.

• Obesity — People who are obese or overweight have an increased risk of GERD and hiatal hernia. While the reasons for this are not completely understood, it is partly related to increased pressure in the abdomen.
• Lifestyle factors and medications — Certain foods (including fatty foods, chocolate, and peppermint), caffeine, alcohol, and cigarette smoking can all worsen acid reflux and GERD. Some medications may also increase the risk.

GERD Symptoms
The most common symptoms of GERD are:
• Heartburn — A burning sensation in the centre of the chest, which sometimes spreads to the throat. It most often happens after a large meal.
• Regurgitation — When stomach contents (acid mixed with bits of undigested food) flow back into your mouth or throat.

Other possible symptoms include:
• Stomach pain (upper abdominal pain)
• Chest pain
• Laryngitis or hoarseness (due to acid irritating the vocal cords)
• Sore throat or cough
• A sensation of a lump in the throat (called globus sensation)
• Nausea and/or vomiting

When to Seek Help
The following signs and symptoms may indicate a more serious problem (also known as alarm symptoms). Tell your healthcare provider right away if you:
• Have difficulty or pain when swallowing (e.g., feeling like food gets stuck in your throat)
• Have no appetite or lose weight without trying
• Experience severe chest pain
• Feel like you are choking
• Notice signs of gastrointestinal bleeding, such as blood in vomit, dark-coloured vomit that looks like coffee grounds, or black tarry stools
• Have persistent vomiting
• Experience any of the above symptoms and are over 60 years old

GERD Diagnosis
If you have the classic symptoms of GERD (heartburn and/or regurgitation), your healthcare provider may diagnose you based on symptoms alone. In such cases, they will likely recommend a trial of medication; if your symptoms improve, it is likely that GERD is the cause.

Additional testing may be needed if you:
• Do not improve after taking a proton pump inhibitor (PPI)
• Do not have the classic symptoms of GERD (heartburn or regurgitation)
• Have alarming symptoms
• Have symptoms that suggest another problem
• Have risk factors for complications such as Barrett’s esophagus or esophageal cancer

It is important to rule out life-threatening problems that can mimic GERD, such as heart disease, which can also cause chest pain and should be evaluated immediately.

If serious conditions are excluded and GERD remains uncertain, your provider may recommend one or more of the following tests:

Upper Endoscopy
An upper endoscopy allows the doctor to directly examine the upper gastrointestinal (GI) tract. A small, flexible tube is passed through the mouth into the esophagus, stomach, and small intestine. The tube has a light and camera that display magnified images on a monitor.

With severe reflux, ulceration or inflammation of the esophageal lining (esophagitis) may be seen. Tissue samples (biopsies) can be taken to evaluate the extent of damage.

Esophageal Manometry
Esophageal manometry measures muscle pressure and movement in the esophagus using a thin tube inserted through the nose. This test checks if the esophagus and lower esophageal sphincter are functioning normally. It may be performed when endoscopy results are normal but symptoms such as chest pain or swallowing difficulty persist.

Esophageal pH Study
An esophageal pH study directly measures acid levels in the esophagus. A thin tube with a sensor is inserted through the nose and left in place for 24 hours. The recorded data helps doctors assess reflux severity and symptom correlation. This test confirms GERD when symptoms exist without visible signs on endoscopy and can also monitor treatment effectiveness.

GERD Complications
Most people with GERD will not develop serious complications, especially with proper treatment. However, severe or long-standing GERD can lead to:
• Erosive esophagitis — Damage to the esophageal lining caused by prolonged acid exposure, which can lead to ulcers or bleeding.
• Esophageal stricture — Scarring and narrowing of the esophagus, causing food or pills to get stuck.
• Barrett’s Esophagus — A condition where the normal squamous cells lining the lower esophagus are replaced by intestinal-type cells due to chronic acid exposure. Barrett’s esophagus slightly increases the risk of esophageal cancer, so regular endoscopic monitoring is recommended.
• Lung and throat problems — Acid reflux into the throat can cause hoarseness, sore throat, or even pneumonia and asthma-like symptoms. Chronic acid exposure may cause lasting lung damage.
• Dental problems — Repeated acid reflux can erode tooth enamel over time.

GERD Treatment
Managing GERD involves both lifestyle changes and medications.
Lifestyle Modifications
• Maintain a healthy weight – Losing excess weight can help reduce reflux.
• Elevate your head during sleep – Raise the head of your bed to prevent acid from flowing upward.
• Sleep on your left side – This position helps keep stomach acid away from the esophagus.
• Eat wisely – Avoid trigger foods such as spicy foods, caffeine, alcohol, peppermint, and fatty meals.
• Quit smoking – Smoking lowers esophageal sphincter pressure and worsens reflux.
• Avoid late meals – Eat smaller, earlier meals and avoid eating close to bedtime.

Medications
• Alginate-containing antacids – These neutralise stomach acid and provide short-term relief in mild GERD. They also form a protective layer that prevents acid from reaching the esophagus.
• Proton Pump Inhibitors (PPIs) – These reduce acid production and promote healing of esophageal inflammation. Examples include dexlansoprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole. PPIs are typically prescribed for 4–8 weeks and may be continued long-term for complications such as strictures or Barrett’s esophagus.
• Potassium-Competitive Acid Blockers (PCABs) – These newer drugs provide rapid and long-lasting acid suppression and are used in patients who do not respond to PPIs or have severe inflammation or ulcers. Examples include vonoprazan and the recently launched tegoprazan.

Surgical Treatment
• Lifestyle modifications and medications are very effective in controlling symptoms in most cases. Therefore, surgery is considered only for severe or treatment-resistant (refractory) GERD.
• In general, antireflux surgery involves repairing any hiatal hernia (if present) and strengthening the lower esophageal sphincter.
• The most common surgical procedure is called laparoscopic Nissen fundoplication, which involves wrapping the upper part of the stomach around the lower end of the esophagus to reinforce the valve mechanism.
• However, preoperative manometry and pH studies are essential to confirm the presence and severity of acid reflux and to ensure normal esophageal motility. This helps minimise post-surgical complications such as difficulty swallowing.

Conclusion
GERD is a common condition caused by stomach acid flowing back into the esophagus, leading to symptoms like heartburn and regurgitation. It can usually be managed with lifestyle changes and medications such as alginate-containing antacids, PPIs, or PCABs.

If symptoms are frequent or severe, consult your doctor for proper diagnosis and treatment. Early management not only improves comfort but also prevents complications, helping you live a healthier, more comfortable life.

Dr. Ng has extensive clinical experience in the management of gastrointestinal and hepatological diseases, such as gastroesophageal reflux disease, peptic ulcer disease, functional gastrointestinal disorders, inflammatory bowel disease, hepatitis and liver cirrhosis. He performs both diagnostic and therapeutic gastrointestinal endoscopic procedures, including gastroscopy, colonoscopy and endoscopic ultrasound.

by Dr. Kiranjit Kaur Jugindar Singh
Consultant Obstetrician & Gynaecologist

When we speak about women’s health, most of the focus gravitates towards youth – puberty, fertility, pregnancy, and motherhood. We often celebrate milestones like weddings, births, and birthdays. But what often gets overlooked is the profound beauty, strength, and wisdom that emerge in the next chapter of a woman’s life: perimenopause.

A Season of Change and Growth
Perimenopause is the transition phase leading up to menopause, during which the ovaries gradually produce less estrogen. It can last several years, often starting in the 40s, and ends when you reach menopause.

Common symptoms include:
• Irregular or heavier menstrual periods
• Hot flushes or night sweats
• Mood changes
• Sleep disturbances
• Weight fluctuations
• Decreased libido
• Vaginal dryness

It can be challenging, but it’s also an opportunity. Your body isn’t betraying you; it’s guiding you towards balance and wisdom.

The Shift of Power
Perimenopause is a biological graduation. By this stage, most women have gained experience, emotional intelligence, and resilience. You have learned to navigate life’s complexities. Now, your body is shifting too—inviting you to slow down, reflect, and realign with what truly matters.

Rather than resisting the changes, embrace them and allow yourself to channel your energy into self-care, renewal, and strength.

Nourish and Thrive
Women are known for resilience, grace, and quiet strength. Now it’s time to turn that strength inwards. A few steps to help with perimenopause:
• EAT WELL. Have balanced, healthy, and nutritious meals. Load up on powerful allies – tofu, tempeh, soy, leafy greens, fish, and plenty of water to help support hormonal balance.
• MOVE WITH JOY. Try morning walks, yoga, Pilates, or even dancing.
• REST AND REFLECT. Sleep is your body’s best healer.
• SEEK SUPPORT. Don’t hesitate to talk to your doctor. Whether it’s lifestyle changes, supplements, or hormonal therapy, there are safe ways to feel your best. Alternatively, you can also seek help from support groups, such as the Malaysian Menopause Society.

“Asking for help isn’t weakness – it’s wisdom.”

Treatment Options That Help You Thrive
Perimenopause is not something you need to endure in silence. There are effective ways to manage symptoms and improve your quality of life.
• HORMONAL THERAPY: Small, tailored doses of estrogen and progesterone can ease hot flushes, mood changes, and sleep issues when used appropriately under medical supervision.
• NON-HORMONAL OPTIONS: Red clover taken with probiotics, soy-containing dietary supplements, and Evening Primrose Oil.
• VAGINAL ESTROGENS & HYALURONIC ACID VAGINAL GELS: These products help relieve dryness and discomfort, and improve intimacy.
• SUPPLEMENTS: Calcium, Vitamin D, Vitamin B, and Vitamin E.
• ALTERNATIVE THERAPY: Cognitive Behavioral Therapy (CBT), hypnotherapy, relaxation techniques, sleep hygiene, and cultivating a positive attitude are recommended to ease perimenopausal symptoms.

Rewriting the Story
For generations, menopause has been painted as an ending. But women today are rewriting the narrative. Perimenopause is NOT the loss of youth, but the gain of freedom — from monthly cycles, from expectations, and from self-doubt.

This is a time to rediscover yourself, start new ventures, travel, or explore passions. The wisdom earned through decades of living now fuels confidence and authenticity. Confidence becomes your signature. Wisdom becomes your beauty.

Strong. Wise. Unstoppable.
Perimenopause is a reminder that womanhood isn’t defined by youth. It isn’t about flawless skin – it’s the calm confidence that comes from knowing who you are. The beauty of it isn’t in fighting change, but in flowing with it. When you embrace this stage with grace and curiosity, you radiate a strength no cosmetic can match.

So, to every woman stepping into this chapter — stand tall, love your body, and embrace your journey. You are strong, wise, and unstoppable. And the world needs your fire now more than ever.

Over the past three decades, cancer surgery has undergone a remarkable transformation. What once required large incisions and long recovery times can now be accomplished through small ports and robotic arms with unparalleled precision. Minimally invasive surgery (MIS), encompassing laparoscopic and robotic techniques, has redefined how surgeons treat cancers of the esophagus, stomach, liver, pancreas, colon, prostate and other organs.

The evolution began with laparoscopic surgery in the 1980s, which proved that smaller incisions could achieve the same oncologic outcomes as traditional open surgery. The introduction of robotic systems further elevated this approach. With 3D magnified vision, wristed instruments, and tremor filtration, robotic platforms allow surgeons to perform complex dissections in confined spaces with millimeter accuracy. In cancers such as rectal, esophageal, and prostate, robotics has improved visualisation, reduced blood loss, and shortened recovery, while maintaining clear margins and complete lymph node clearance.

Beyond comfort and cosmesis, the true benefit lies in faster recovery, fewer complications, better quality of life and earlier return to adjuvant therapy, all crucial in comprehensive cancer care. For patients, this means not just surviving surgery but resuming normal life and continuing treatment sooner.

In today’s era of precision oncology, surgery remains a cornerstone alongside chemotherapy, radiotherapy, targeted therapy, and immunotherapy. The modern cancer surgeon is part of a multidisciplinary team, ensuring every patient receives personalised, coordinated care. As technology advances, integration of artificial intelligence, fluorescence imaging, and augmented reality will continue to refine surgical precision and safety.

Minimally invasive and robotic surgery are not just innovations, they represent a new philosophy in cancer treatment: doing more through less, restoring health with precision, and improving quality of life for patients on their journey through cancer.

Dr. Kelvin Voon is the head of division of surgery & a resident consultant at Sunway Medical Centre Penang, specialising in general surgery, upper gastrointestinal surgery, bariatric & robotic surgery. He completed his surgical training in Malaysia, followed by fellowships in Esophagogastric Cancer Surgery in Shanghai and Clinical Obesity & Bariatric Surgery in Taiwan. A Fellow of the Royal Colleges of Surgeons (Edinburgh, Ireland, Glasgow) and the American College of Surgeons, he is actively involved in advancing minimally invasive and robotic surgery in Malaysia. Dr. Voon is also a key leader in professional societies, committed to multidisciplinary collaboration and improving patient-centric surgical outcomes. His clinical interests include gastroesophageal cancers, gastroesophageal reflux disease, endoscopy, bariatric surgery & clinical nutrition.

by Dr. Richard Chan Tze Ming – Consultant Interventional Cardiologist & Internal Medicine Physician and Dr. Lim Eu Jack – Consultant Emergency Physician at Sunway Medical Centre, Sunway City

According to the National Health and Morbidity Survey (NHMS) 2023, over 33% or 7.6 million Malaysians are living with high cholesterol levels¹. Cardiovascular disease remains the leading cause of death among Malaysian men, responsible for 17.6% of deaths among Malaysian men in 2025².

A silent cardiac crisis is increasingly impacting men in their 20s and 30s, only to be diagnosed after a heart attack, stroke or a blood test.

“Heart problems are no longer just an ‘uncle’s disease’. We’re seeing more young adults come in numbers,” said Dr. Richard Chan Tze Ming, Consultant Interventional Cardiologist and Internal Medicine Physician at Sunway Medical Centre, Sunway City (SMC).

Dr. Lim Eu Jack, Consultant Emergency Physician at SMC said, “The youngest I’ve seen with serious heart attack were in their early 30. There are also a significant number of men who discover they had high blood pressure or undiagnosed diabetes only after they arrive in the emergency room with chest pain or a heart attack,” he says.

Why Young Men should pay attention to High Cholesterol and more
At the centre of many of these cases there is high cholesterol. Dr. Richard notes that a condition called dyslipidemia, or abnormal blood lipid levels, can affect anyone regardless of age. Studies have also found that familial hypercholesterolemia (FH) affects about 1 in 100 people or 320,000 Malaysians, which is higher than global averages³.

Dr. Richard also pointed out that while diet can account for some of your total cholesterol levels, genetics is also an important cause. “Some people are genetically wired to produce more bad cholesterol, even if they exercise and eat clean. That’s why we see patients who hardly eat oily food but still end up with high cholesterol,” he said.

Dr. Jack also said, “High cholesterol is very common, but it’s not usually detected in the ER because it requires fasting and isn’t routinely tested in emergencies. High blood pressure tops the list of undiagnosed conditions. Diabetes is also frequently undiagnosed until complications set in. These conditions are often silent for years, which is why regular health screening is so important,” he says.

Lifestyle and bad habits make it worse, health screening is key
While genes play a role, lifestyle is worsening the problem in young men, putting them at risk of early heart disease.

“Even after exercising, many young people head to mamak stalls or fast-food outlets. Processed food, reused cooking oil, and trans fats all increase LDL cholesterol,” said Dr. Richard.

“Many men ignore early signs like chest discomfort, fatigue, or breathlessness often blaming gastric issues or tiredness. With risk factors like smoking, poor diet, and family history, delaying help can be fatal. Smoking, in particular, is the most significant risk factor we see among younger patients with heart diseases,” said Dr. Jack.

Both doctors stress that it starts with awareness and simple action. “A blood test and blood pressure check can quickly reveal issues like high cholesterol, diabetes, or hypertension. Knowing your numbers is the first step to taking control. These are modifiable risk factors, and if managed early, we can prevent serious complications like heart attacks and strokes,” says Dr. Jack.

“Don’t wait until you have symptoms. Cholesterol is silent. If you have a family history, are overweight, or smoke, you should be screened as early as your 20s,” adds Dr. Richard.

For those with very high cholesterol, lifestyle changes alone may not be enough. Medications are often required to bring it down to safer levels.

“I always tell patients, don’t deprive yourself. Eat in moderation. A healthy lifestyle must be sustainable. If you go too strict, you’ll rebound and overeat later,” advises Dr. Richard.

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¹ Institute for Public Health. (2024). National Health and Morbidity Survey (NHMS) 2023: Non-communicable Diseases and Healthcare Demand – Key Findings. National Institutes of Health, Ministry of Health Malaysia. Retrieved from https://iku.gov.my/nhms-2023

² https://v2.dosm.gov.my/portal-main/release-content/statistics-on-causes-of-death-malaysia-2024

³ Chua, Y., Razman, A., Ramli, A., Kasim, N., & Nawawi, H. (2021). Familial Hypercholesterolaemia in the Malaysian Community: Prevalence, Under-Detection and Under-Treatment. Journal of Atherosclerosis and Thrombosis, 28, 1095 – 1107. https://doi.org/10.5551/jat.57026