GASTROESOPHAGEAL REFLUX DISEASE-GERD

Acid reflux is a condition where gastric juices containing acid travel back from the stomach into the esophagus (gullet or swallowing tube).Some people experience this problem regularly and have a condition called gastroesophageal reflux disease or GERD.

• The food in the stomach is partially digested by stomach acid and enzymes, which are special chemicals that help to break down food so the body can use it.
• Normally, the partially digested acidic content in the stomach is delivered by the stomach muscle into the small intestine (bowel) for further digestion.
• In patients with acid reflux, stomach acid content travels backwards into the esophagus, causing inflammation and damage.
• Factors contributing to acid reflux include fatty foods, cigarettes, chocolate, caffeine, alcohol, obesity, pregnancy and delayed stomach emptying.
• Obesity and pregnancy increase pressures within the abdomen (body trunk), pushing the stomach contents back into the esophagus.
  Some patients have stomachs that empty their contents into the intestines very slowly.
• A stomach full of food and acid is more prone to reflux, especially when the patient lies down (supine)..

People who suffer from GERD or gastroesophageal reflux disease are in plenty around the country.It is known asheartburn and is very common. When the lower oesophageal sphincter (LES) does not close up correctly,gastro esophageal reflux disease occurs and stomach bile and acid come back, or reflux, in the oesophagus which causes much irritation and heartburn. It is a chronic disease which once affected last life long.

Many of these people do not see stomach acid reflux as a serious problem but if you don’t take care of your acid reflux symptoms now it can turn into something more serious. You can do damage to your esophagus that you can’t repair which can lead to other health issues. That is why early intervention to find successful acid reflux treatment is important. Also there are measures an individual can take to prevent acid reflux.

Symptoms

More common symptoms are:

• Feeling that food may be left trapped behind the breastbone
• Heartburn or a burning pain in the chest (under the breastbone)
  • Increased by bending, stooping, lying down, or eating
  • More likely or worse at night
  • Relieved by antacids
• Nausea after eating

Less common symptoms are:

• Cough or wheezing
• Difficulty swallowing
• Hiccups
• Hoarseness or change in voice
• Regurgitation of food
• Sore throat

Signs and tests

You may not need any tests if your symptoms are not severe.

If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:

• Esophagogastroduodenoscopy (EGD) is often used to identify the cause and examine the esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
• Barium swallow
• Continuous esophageal pH monitoring
• Esophageal manometry

A positive stool occult blood test may diagnose bleeding from the irritation in the esophagus.

Treatment

Medicines

Medications commonly used in the treatment of acid reflux include:

• Acid suppressants, such as histamine2-receptor antagonists (blockers). Histamine is a chemical released in the body under different conditions, but particularly during inflammation. In the stomach it can release more acid, so blocking it reduces acid production.eg-Ranitidine(Rantac)
• Proton pump inhibitors, which reduce the production of acid in the stomach by acting on cells in the stomach wall that make acid and release it into the stomach.eg-Omeprazole(Omez),Rabeprazole(Rabeloc) etc
• Prokinetic agents, which promote emptying of the stomach so it does not overfill. They work by increasing the pressure of the lower esophageal sphincter (the muscular valve between the lower end of the stomach and the small bowel)eg;bethanechol (Betheran) and metoclopramide(Emenil)
• Antacids are over-the-counter medicines that are commonly used to treat mild acid-related symptoms, like heartburn or indigestion, and work by neutralising acid in the stomach. However, they are not usually recommended to treat the frequent heartburn suffered by people with GERD.eg;Digene

Surgical Treatment

Today many patients suffering from acute gastroesophageal reflux disease opt for surgery.  Patients go for GERD surgical procedures when they see that the medication and lifestyles changes are not bringing about much relief to their problem.  In some patients medical treatment and medicines cause many side effects. This also compels many patients to try GERD surgical procedures. One of the popular GERD surgical procedures includes Nissen fundoplication. This surgical procedure was founded by a German Surgeon Rudolf Nissen. Here the upper part of the stomach is wrapped around the oesophagus in order to check reflux. The lower oesophageal sphincter (LES) or the valve between the oesophagus and the stomach is strengthened. Depending on the situation the operation is done either through a traditional open surgery or through laparoscopic method. Today more and more people prefer the laparoscopic method as there is not much incision in this method. About 95% of people have reported improvement in the reflux with these GERD surgical procedures. Another GERD surgical procedure is the Partial Fundoplication. Here the stomach is wrapped only partway around the oesophagus. Gastropexy is another GERD surgical procedure that many patients go for. Here the stomach is attached to the diaphragm. The stomach then cannot move in this case through the diaphragm opening in the chest. Another GERD surgical procedure that many doctors suggest is the use of Angelchik ring. Here an artificial ring is placed around the oesophagus. This reinforces the lower oesophageal sphincter (LES) between the oesophagus and stomach. But there are many complications involved with procedure as there are chances for the ring to move to other places in the body. Intestinal recovery takes a few weeks after the surgery.

People going in for GERD surgical procedures should have much discussion with their doctors before opting for it. In many cases, even after surgery patients still have to continue with medications.

Home Remedies

Foods to Avoid With Acid Reflux

There are many foods which are responsible for the acid reflux within. It is important for the person to know about which foods to avoid with acid reflux and what is the natural remedy for GERD (gastro-esophageal reflux disease).These include:

• Coffee: Caffeine secretes gastric acid. This causes indigestion in people who are prone to getting an acid attack.
• Alcohol: Alcohol stimulates the gastric acid and results in a burning sensation in the chest. Thus alcohol consumption is one of the foods to avoid with acid reflux.
• Fried food and fatty foods: The fatty content in these kinds of food result in slowing down the digestion of food. These remain in the stomach and exert a kind of pressure on the stomach. This results in the stomach having a reflux action and this pushes the food towards the mouth. Since the contents are acidic, the resultant effect is an acid reflux.
• Spicy foods: Spices like pepper, chilli and other spicy foods tend to increase the acid reflux.
• Carbonated beverages: It is not good to have aerated water during a time when the person is having acidity. This is because these beverages again cause a pressure inside, and increase the pressure inside the stomach. The stomach in reaction lets out an acid reflux.
• Citrus fruits: Sometimes some people react badly to citrus fruits like lemon, orange and grapes. But this reaction varies from person to person. Easily digestible fruits like pineapple, papaya or apple are good at such times and are anatural remedy for GERD.
• Drinking milk: Sometimes the habit of drinking a glass of milk before going to bed, results in acidity and thus milk comes under the foods to avoid with acid reflux.
• Meat: Meat is certainly not a natural remedy for GERD. Meat with a lot of food is one of the foods to avoid with acid reflux.

Besides knowing which foods to avoid with acid reflux, it is also good to have regular exercise as this helps to lose weight and have a better healthier life. Following things could help in avoiding an acid reflux attack:

• Not to overeat
• To have small meals at regular intervals
• Not to lie down after having meals.

Acid reflux is a result of excess acids in the stomach being thrown out into the esophagus. This action results in a lot of indigestion, heartburn and discomfort. The following tips could be a good and natural remedy for GERD:

• Avoiding large meals: It is advisable to eat six small meals a day rather than eat three big meals. Thus more than being aware of the foods to avoid with acid reflux, if the person subjects himself to a regular routine of six small meals, he would be benefitted with a good digestive system.
• Not to drink anything before going to bed: It is a good practice to finish dinner two hours before going to bed. It is also a healthy habit not to drink anything two hours before going to bed. This relaxes the stomach and the person doesn’t feel full. Otherwise the sphincter muscles in the stomach get pressed harder by the food we consume, and result in an acid reflux. This leads to a lot of discomfort.
• Sleeping posture: It has been observed that when the head is higher than the stomach then the gravity helps to ease the pressure on the stomach. Thus a proper sleeping posture with the head and shoulder on an incline is a natural remedy for GERD.

Complications

• Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
• Bronchospasm (irritation and spasm of the airways due to acid)
• Chronic cough or hoarseness
• Dental problems
• Esophageal ulcer
• Inflammation of the esophagus
• Stricture (a narrowing of the esophagus due to scarring from the inflammation)
• Weight loss

GERD in children

Distinguishing between normal, physiologic reflux and GERD in children is important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD. Studies show GERD is common and may be overlooked in infants and children. For example, GERD can present as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or respiratory problems like wheezing, asthma, or pneumonia. Infants and young children may demonstrate irritability or arching of the back, often during or immediately after feedings. Infants with GERD may refuse to feed and experience poor growth.

If reflux-related symptoms occur regularly and cause the child discomfort simple strategies for avoiding reflux, such as burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding can reduce the discomfort. If your child is older,then your child should eat small, frequent meals and avoid the following foods:

• sodas that contain caffeine
• chocolate
• peppermint
• spicy foods
• acidic foods like oranges, tomatoes, and pizza
• fried and fatty foods

Avoiding food 2 to 3 hours before bed may also help.Raising the head of your child's bed with wood blocks secured under the bed posts can also reduce discomfort of the child. Just using extra pillows will not help. If these changes do not work, medicine's can be given to the child. In rare cases, a child may need surgery.

Please Note

Call your doctor if symptoms worsen or do not improve with 
lifestyle changes or medication.

Also call for any of the following symptoms:

• Bleeding
• Choking (coughing, shortness of breath)
• Feeling filled up quickly when eating
• Frequent vomiting
• Hoarseness
• Loss of appetite
• Trouble swallowing (dysphagia) or pain with swallowing (odynophagia)

Prevention

• Heartburn prevention techniques
• Looking at the esophagus with an endoscope and obtaining a sample of esophagus tissue for examination (esophagoscopy with biopsy) may be recommended to diagnose Barrett's esophagus.
• Follow-up endoscopy to look for dysplasia or cancer is often advised.

Points to Remember

• Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults. Anyone experiencing heartburn twice a week or more may have GERD.
• You can have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.
• If you have been using antacids for more than 2 weeks, it is time to see your doctor. Most doctors can treat GERD. Your doctor may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines.
• Doctors usually recommend lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medication. Surgery may be considered as a treatment option.
• Most infants with GER are healthy even though they may frequently spit up or vomit. Most infants outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD.
• The persistence of GER along with other symptoms—arching and irritability in infants, or abdominal and chest pain in older children—is GERD. GERD is the outcome of frequent and persistent GER in infants and children and may cause repeated vomiting, coughing, and respiratory problems.