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Heartburn and Acid Reflux Cure Program Overview

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What is gastroesophageal reflux disease or GERD

GERD is an abbreviation for gastroesophageal reflux disease. GERD has several manifestations. Classically, it can be a sensation of warmth or burning in the chest, which can be a mild discomfort to frank pain. You might regurgitate bitter material or burp it up into your mouth. These symptoms are caused by acidic stomach material refluxing from the stomach into the esophagus, which is the food pipe (Figure 1). the esophagus is above the stomach. GERD symptoms increase particularly at bedtime because the effects and benefits of gravity are removed when you lie down. Generally, nocturnal or nighttime symptoms are more severe in addition to burning chest discomfort, they can include excessive drooling, coughing, and choking. These symptoms can increase the risks of complications of chronic GERD that may affect the esophagus, lungs, or airways. Reflux is affected by weight, diet, medications, and lifestyle habits such as smoking and alcohol consumption. A patient with GERD can change or...

Implications of dyspepsia for the NHS

There is no precise definition of dyspepsia. It can be defined pragmatically as upper abdominal or retrosternal pain, with or without other symptoms thought to be arising from the upper gastrointestinal tract which is the approach that has been generally adopted by epidemiological studies. It has been suggested that dyspeptic symptoms can be categorised as ulcer-like, reflux-like, and dysmotility-like as a guide to the underlying cause. These groups, however, overlap considerably, with mixed patterns being common. Symptom patterns are not strong predictors of underlying disease. Recently it has been proposed that if heartburn or acid regurgitation are the dominant symptoms then these are sufficiently accurate predictors of gastro-oesophageal reflux to make a safe and accurate diagnosis (see next article). Fewer than a fifth of sufferers have this symptom pattern, and the predictive accuracy needs confirmation.

How many people are affected by GERD

GERD is not a new disease it is a common disease that affects many people. In 1994, the U.S. Department of Health and Human Services reported that about 7 million people in the United States at that time suffered from chronic GERD. That number has grown since, likely because of the increasing incidence of obesity and people being overweight, which are contributing factors to reflux problems. These days, Americans work longer hours, buy more fast food, and eat on the run. Poor dietary habits and the easy availability of fast food at any hour of the day have to increased GERD. Unfortunately, these factors have also caused more obesity, diabetes, heart disease, cholesterol problems, high blood pressure, and strokes, as well. Gastroesophageal reflux goes by several names that are used interchangeably, such as GERD, reflux, heartburn, and indigestion. Approximately one in three Americans experiences occasional GERD as called by any of these names. GERD does not affect any specific...

What factors cause GERD

GERD is affected by many different factors. It can be caused by factors out of your control as well as other factors that you can change or eliminate. A major cause of GERD and regurgitation is an incompetent valve, or barrier, between the esophagus and stomach. The circular muscle at the bottom of the esophagus is called the lower esophageal sphincter (LES). The LES contributes to the high-pressure zone at the junction of the esophagus and stomach that keeps ingested material out of the esophagus once it has passed through the sphincter. Other components of the high-pressure zone include the ligaments that hold the stomach in place and the diaphragm, which is the muscle separating the chest and abdomen. A hiatal hernia (or hiatus hernia) is a defect in this zone, when the ligaments are loosened and the top of the stomach moves inappropriately into the chest area (see Figure 3). The development of a hiatal hernia decreases the strength of the LES and promotes reflux. Hiatal hernias...

Is there a link between obesity and GERD in the United States

Extra body weight within the abdomen puts more pressure on the stomach forcing material back up into the esophagus. Increased food consumption requires more processing and digestion by the gut, compounding the problem and leading to heartburn symptoms. The increasing average weight combined with lifestyle choices has not only led to an obesity epidemic, but also contributes to the increasing problem of GERD in the United States. It has become apparent to me that as my weight increases and my exercise regime decreases, my incidents of nighttime acid reflux go up dramatically. I can only assume that the weight and lack of activity put additional stress on the lower esophageal sphincter (LES). The added weight makes my clothes tighfitting, especially around my stomach, and just adds to my overall physical discomfort. Yes, children can also get GERD it can

Strategies for managing dyspepsia in primary care

Initial empiric treatment with antacids or anti-secretory drugs A period of empiric treatment with antacids or H2 receptor antagonists has been the traditional strategy for managing patients with dyspepsia first consulting their doctor. This strategy recognises that most patients' symptoms are episodic and remit spontaneously and that the risk of peptic ulcer bleeding or perforation is extremely low. It also assumes that early diagnosis in the rare patient with malignant disease and no alarm symptoms has little effect on outcome.

Box 13 Causes of dyspepsia

Findings from endoscopy in 2659 patients aged > 40 years consulting their doctor for dyspepsia for the first time Figure 1.4 Symptoms of dyspepsia reported by UK adults over the previous year Figure 1.4 Symptoms of dyspepsia reported by UK adults over the previous year Implications of dyspepsia for the NHS

What are some of the typical symptoms of GERD

The major symptoms of GERD include heartburn, chest pain, sour taste in your mouth, and painful or difficult swallowing. The major or typical symptom of GERD is heartburn, but this can vary among individuals. GERD symptoms fall on a spectrum for some they are mild or silent, and for others they can be severe. Heartburn is the feeling described as stomach contents and acid travel up into the chest area. The mildest symptoms may be just a slight sense of uneasiness and burning in the chest that occurs only after meals. You might experience a sour taste in your mouth or have bad breath caused by repeated small amounts of acid coming back up into the mouth. A burning sensation behind the breastbone in the chest can be accompanied by a feeling of nausea or uneasiness. Some people experience a burning or a gnawing discomfort in the pit of their stomachs. In severe cases, GERD can cause pain that may be mistaken for a heart attack. The major symptoms of GERD include heartburn, chest pain,...

What causes newonset GERD

GERD is a disease that is caused by stomach acid abnormally moving up into the esophagus and possibly higher into the mouth or airway structures. Many different factors can contribute to the development and presence of acid reflux. Normally, your body's natural protective factors limit reflux. We produce 1 pint to 1 quart of saliva per day that is swallowed. Saliva has many jobs. Saliva neutralizes acid, which means it buffers any acid that refluxes into the esophagus. It also helps to digest food, protect the teeth, and lubricate the esophagus so we can swallow. We swallow hundreds of times a day. The purpose of a swallow is to move material from the mouth to the esophagus and ultimately to the stomach. Frequently, swallowing occurs spontaneously without our intentional control. This spontaneous swallowing is protective against reflux because it clears material from the esophagus, including refluxed acid that may be present. Decreased saliva production either as a consequence of...

How can I improve my symptoms of GERD

The best way to minimize and possibly avoid GERD is to eliminate or reduce the factors that are within your control. Simple changes to make to start include lifestyle choices. Immediately after you eat something, your body produces the greatest amount of acid for digestion of that food. Anytime you lie flat stomach acids can reflux into the esophagus. To reduce GERD symptoms, avoid eating late at night or wait at least 2 hours after you eat before you lie down. By coordinating your sleep habits and eating habits, you can allow ample time for the acid and food to pass through the stomach and can minimize reflux. To reduce GERD symptoms, avoid eating late at night or wait at least 2 hours after you eat before you lie down. A simple maneuver to improve nighttime GERD is to elevate the head ofyour bed. You can do this simply by placing small wooden blocks or bricks under the head ofyour bed. A simple maneuver to improve nighttime GERD is to elevate the head of your bed. You can do this...

Can I have GERD without any

Yes, GERD can occur with silent symptoms. Each individual's body reacts differently to different situa- tions, so not everyone will have heartburn and be diagnosed with GERD. Silent GERD is one of the most difficult conditions to diagnose. Instead of complaining of heartburn, often some people report sleep disruption, which is caused by acid refluxed into the esophagus as they lie down to sleep. As the acid travels up into the esophagus, people occasionally become aroused from their sleep. These sleep disturbances can occur regularly and cause severe interruptions to their sleep. Therefore, physicians should consider a diagnosis of GERD when people present with complaints of difficulty sleeping. People with silent GERD also present with a persistent cough. As mentioned earlier, stomach acid may reflux up from the stomach into the esophagus and enter the trachea. This can lead to irritation of the airways and cause a cough and, in more severe instances, asthma attacks. Silent GERD can...

Can GERD cause changes in my voice

Yes, GERD can cause changes in your voice. High reflux can irritate your voice box, or larynx. Chronic acid damage of the larynx can cause voice changes. Repeated acid damage of the voice box can cause growths (polyps) to develop and can increase your risk of cancer. Cancer of the larynx is the most common cancer of the head and neck and is usually related to smoking. However, laryngeal cancer has been reported in people who have never smoked and who do not live with a smoker. These people might have developed cancer of the larynx as a result of acid reflux.

Can stress increase GERD

Stress affects all people differently. Each individual's body reacts differently to stress, whether it comes in the form of a new assignment at work or a stressful conversation at home. Stress incorporates itself into your life and must be dealt with daily. If stress always led to GERD, most people would experience heartburn and reflux almost every day But this is not the case. Some people do experience heartburn in times of stress. This can occur because stress hormones cause stomach relaxation, and food can linger in the stomach for increased periods of time. Stress hormones may increase stomach acid production. Both of these stress-related factors may result in flares of GERD during emotionally difficult times. Stress can also lead to other symptoms that are similar to a flare of GERD. Stress hormones affect the heart, increasing its workload, and also may increase blood pressure. Some people can feel angina, a type of pain related to the heart, which is increased in times of...

Nonulcer dyspepsia functional dyspepsia

Symptoms that mimic an ulcer in patients who have no objective evidence of an ulcer are termed non-ulcer dyspepsia. Dyspepsia is a rather vague term that relates to symptoms of epigastric discomfort, burning or pain, nausea, bloating and belching. The condition of non-ulcer dyspepsia probably covers a spectrum of mucosal, motility and psychiatric disorders. The symptoms caused by motor dysfunction are analogous to the motility disturbances that occur in irritable bowel syndrome indeed, these disorders commonly occur together. Clinical features of non-ulcer dyspepsia Management of non-ulcer dyspepsia Explanation and reassurance are essential for patients with non-ulcer dyspepsia. Possible psychological factors should be explored and the concept of psychological influences on gut function should be explained. Lifestyle advice may be necessary cigarette smoking and alcohol abuse should be discouraged and sensible dietary advice provided. Drug treatment should only be used when symptoms...

How can I avoid GERD problems if I have to take my pills

Any medication has side effects, and sometimes you might resort to alternative medications to alleviate particular side effects, but in some cases you may not have a choice but to take a drug that will exacerbate your GERD. Many of the medications mentioned earlier are necessary to treat medical conditions, and the side effects that come along with them may be unavoidable. However, even if the side effects are present, you may be able to take precautions to decrease their severity. It is important to remember that if a medication has side effects, there may be an alternate way to take the medication or there may be an alternative drug to use for the same condition. The disease should always be worse than the cure It is important to read the labels on medications, and if you have

What kind of foods can make GERD worse

High-fat foods are more difficult to digest. The digestion of fatty food can cause increased stomach acid production and delays stomach emptying. Both of these effects cause higher amounts of acid to be present, and the longer time the food dwells in your stomach, the chances of reflux disease increase. Similarly, spicy foods can also increase acid production. Many people find that spicy foods are associated with symptoms of heartburn and reflux. Carbonated beverages exacerbate reflux through multiple mechanisms. Many carbonated drinks, such as colas, contain caffeine that relaxes the LES. Further, the gas from carbonated drinks is released in the stomach. This excess gas causes belching however, it also increases pressure within the stomach, facilitating GERD. Finally, all sodas are acidic and increase the overall amount of acid in the stomach, which can be highly corrosive. If you put a few drops of a commonly consumed cola on the hood of a car and let it sit overnight, the paint...

What kind of foods should I eat ifI have GERD

On the other hand, juices such as orange, cranberry, grapefruit, tomato, and lemon can cause increased acid production in your stomach and lead to heartburn symptoms. If you do desire juices, seek out the low-acid alternatives that are available. Then, you can enjoy your share of juices and avoid the reflux symptoms associated with their full-acid counterparts. Historically, before there were antiulcer medications such as H2 blockers or proton pump inhibitors, people with GERD followed a special diet called a sippy diet. This diet worked for ulcers because it coated the stomach and neutralized acid. Unfortunately, in the new millennium, the sippy diet would not be recommended because it is very high in fat but the concept was a good one. Foods and drinks were sipped constantly to neutralize acid as it was produced. Foods used in the sippy diet included creams, dairy products, cheeses, and eggs to name a few. Today there are low-fat alternative to these foods that are healthier and...

Will eating fast food make my GERD worse

These large, fatty, and caffeinated meals increase GERD by impairing stomach emptying, increasing pressure within the stomach, and relaxing the LES. Because these foods are also available in most markets 24 7, people eat them at night before bed, increasing nighttime symptoms. Indirectly, these foods make people fatter, which is another precipitating cause or GERD. As a consequence of obesity, high blood pressure, heart disease, and diabetes, as a population Americans take more medications, which may have side effects that exacerbate GERD.

How else can I change my eating habits to prevent GERD

Changing your lifestyle and eating habits is easier said than done. However, by making some simple modifications you can improve GERD symptoms and decrease some of the dangers associated with GERD. As mentioned previously, eating late at night and eating large meals can increase your heartburn symptoms. If you lie down to sleep with a stomach full of food and acid, chances are you will experience heartburn symptoms. Avoiding late-night meals and avoiding eating for at least 2 hours prior to bedtime are good ways to start changing your lifestyle. Eating large meals increases reflux symptoms. By eating smaller meals rather than three large meals Dieting can be difficult, and by definition when you are dieting you are sacrificing or withholding something from yourself. Reading labels and educating yourself and understanding what you are eating enables you to make small, sensible changes that are easy, less painful, and maintainable in the long run. All of these strategies can help you...

Can my weight affect my GERD

Weight plays a major role in many aspects of your health and well-being. Being overweight can increase your chance of heart disease, diabetes, high blood pressure, strokes, certain cancers, and acid reflux. GERD has a higher association with those who are overweight as defined by an elevated body mass index. Extra abdominal weight creates more pressure on the stomach. In turn, this can lead to stomach contents and acid being forced up through the LES and can expose the esophagus to reflux symptoms. Some obese people tend to have poor eating habits that may include fast food or other high-calorie foods that promote GERD. Further, they may eat larger meals or snack prior to bed. Because many diseases are associated with being overweight, there is a tendency for obese people to take more medications, which can adversely impact reflux. Given that multiple factors are at play in exacerbating reflux in those who are overweight, multiple issues can be acted on. Interestingly, only small...

When should I consider medications for GERD

Initial management of GERD takes the form of lifestyle modification. Often, making small changes in diet or time of eating can improve symptoms. On the other hand, when you suffer from GERD and have tried the recommendations outlined in this book to no avail, medications may be in order. Different types of medications and different tiers, or strengths, of medications are available for the treatment of GERD. The mildest GERD medications are antacids these are generally the safest, cheapest, and have the least number of side effects of all GERD medications. You take antacids during episodes of reflux, and they work by neutralizing acid in the esophagus. A couple of examples of antacids are alumina magnesia (Maalox) and calcium carbonate (Tums). Many different types and brands of antacids are available at your local pharmacy. Antacids are not very useful for preventing future GERD, though. Thus, antacids are generally recommended for rare or infrequent reflux. For moderate and or...

What are the complications of GERD and are they serious

Complications of GERD include those that occur in the esophagus and outside the esophagus (extra-esophageal complications) (see Figure 7). Esophageal complications include esophagitis (inflammation of the lining of the esophagus), Barrett's esophagus, narrowing or strictures, and, rarely, cancers. Extraesophageal complications can include sinus problems or infections, ringing in the ears, voice changes, dental problems, worsening of asthma, and recurrent pneumonia. Some of these complications are more like inconveniences however, Barrett's esophagus, cancers, asthma, and pneumonias can be life-threatening. This is all the more reason to have GERD evaluated by a doctor. An expanded discussion of GERD complications follows. Figure 7 GERD Pyramid.

Your Health Heartburn

Heartburn occurs when the stomach contents pass back up into the esophagus. This regurgitation can occur when the person vomits, the stomach is overfull, or the person is obese, pregnant, or running. The cardiac sphincter and the diaphragm do not entirely close off the connection to the stomach. It is fairly easy to overcome these barriers and bring stomach contents back up into the tube. Because the pH of the stomach fluids is usually below 4, or about the strength of a car's battery acid, the acid burns the epithelial layers of the esophagus and may cause scarring of the tissue. If this occurs, the esophagus does not fold when empty or propel food properly through peristaltic contractions. The scarring also leaves the tissue susceptible to further damage due to the loss of the stratified epithelial layers that protect the underlying tissue.

Is there a relationship between GERD and asthma or chronic lung disease

Some people with asthma have symptoms of GERD, but many do not. A study of 199 asthmatics who had pH studies (see Question 69) conducted by Harding, Guzzon, and Richter, and published in Chest in 1999, showed that 72 had abnormal amounts of acid in the esophagus. Reflux makes asthma worse when aspirated stomach acid enters the lungs and burns the airways, causing these muscles to go into spasm. A large portion of the patients studied reported no reflux symptoms. So, asthmatics may have a problem with silent reflux and not even know it. Other studies of patients with asthma have shown improvement of asthma symptoms and decreased need for asthma medications for those treated with antacid medications. Because of this, many lung doctors recommend a 3-month trial of antacid medication for asthma patients with obvious GERD. Antacid medications might also be considered for those with poorly controlled asthma that requires multiple medications.

Is there a relationship between GERD and a chronic cough

GERD with or without symptoms plays a major role in many lung diseases such as asthma, chronic cough, aspiration, pneumonia, and LPR. There are several causes of chronic coughing. Some people with asthma do not have the usual symptoms of shortness of breath or wheezing and may only have coughing. Postnasal drip with mucus dripping down the throat can cause a chronic cough. Obviously, infections such as bronchitis or pneumonia can cause coughing. GERD or laryngopharyngeal reflux (see Question 52) can cause a chronic cough. Acid, which is a potent irritant, refluxes up the esophagus and into the larynx (the voice box) and the airways. This stimulates the nerves that line these structures and causes a cough in an attempt by the body to clear the offending irritant. It is felt that GERD is probably responsible for 30-40 of chronic coughing. Of those with GERD-related cough, about two-thirds have heartburn symptoms but a third do not. GERD with or without symptoms plays a major role in...

Does GERD play a role in chronic chest pain

There are many causes of chest pain because many structures live in the chest. The chest wall, the muscles, ribs, and cartilage can cause pain. Chest pain may be related to the heart or lungs or the esophagus. The types and character of the discomfort related to these organs are generally different but can be quite similar in some individuals. Sometimes it can be very difficult to tell whether the chest pain a patient is experiencing is a heart attack or just heartburn. Because of this have a doctor immediately evaluate any chest pain or discomfort. Heart attacks can be treated, and patients absolutely need to be evaluated for the presence of impaired blood flow to the heart. This can be a matter of life and death. That said, if you have chest pain or discomfort, have been evaluated by a doctor, and have had heart problems tested for and ruled out, then GERD may be the issue. This is called noncardiac (not heart) chest pain. Sometimes it can be very difficult to tell whether the chest...

Should I just have a trial of medication for GERD

If you experience GERD symptoms or heartburn rarely or infrequently, over-the-counter medication is a good place to start. Antacids may be helpful for more rarely experienced symptoms. For more frequent or severe symptoms, drugs called H2 blockers such as ranitidine, cimetidine (Tagamet), and famotidine (Pepcid) can be used. For more severe GERD, omeprazole (Prilosec-OTC) can be used. However, omeprazole is approved for use only for 14 days. All of these medications are over the counter (OTC) and do not require a doctor's prescription. Generally, for mild to moderate GERD symptoms, a trial of medication is reasonable. If you have ongoing symptoms despite a trial of medication, then visit your doctor. Many different medications are available for treatment of GERD, both over the counter and by prescription. Generally speaking, the prescription drugs are stronger and work better for more severe symptoms. Also, some medications are effective only when taken appropriately. For example, the...

Indigestion When is it functional

Patients often complain of indigestion, but what do they mean Indigestion is an old English word that means lack of adequate digestion, but patients and doctors interpret this in different ways. Many patients mean heartburn or acid regurgitation, the classic symptoms of gastro-oesophageal reflux disease. Some describe belching, abdominal rumblings, or even bad breath as indigestion. Others mean pain localised to the epigastrium or a non-painful discomfort in the upper abdomen which may be described as fullness, bloating, or an inability to finish a normal meal (early satiety). Dyspepsia is best restricted to mean pain or discomfort centred in the upper abdomen. There are many causes of dyspepsia, but at least two thirds of patients have no structural or biochemical explanation for their symptoms. It has been suggested that dyspepsia can be subdivided based on groups (or clusters) of symptoms. However, subgroups have not proved to be of value in identifying the underlying cause of...

Does gastroesophageal reflux disease cause ulcers

As mentioned earlier, when people talk about ulcers, they usually are speaking of ulcers in the stomach or part of the small intestine, the duodenum. GERD does not cause this type of ulcer. Ulcers can occur in the esophagus, but through a different mechanism. Esophageal ulcers are generally caused by GERD when acid damages the lining of the esophagus. Esophageal ulcers can cause symptoms or can be silent and have no symptoms. The symptoms associated with an esophageal ulcer can be heartburn, difficulty swallowing with the feeling of food getting stuck, or pain on swallowing.

Gastrooesophageal reflux disease

It is important and practical to distinguish gastro-oesophageal reflux disease (GORD) from dyspepsia. Frequent heartburn is a cardinal symptom of GORD acid reflux causes a retrosternal or epigastric burning feeling that characteristically radiates up towards the throat, is relieved transiently by antacids, and is precipitated by a meal or by lying down. Up to 60 of people with upper gastrointestinal symptoms report both heartburn and epigastric pain or discomfort. This overlap can be confusing, but it is not the presence of a symptom but its predominance that is most helpful clinically. For example, if the main complaint is a burning epigastric pain that radiates up towards the throat then this is highly predictive of GORD (as can be objectively demonstrated by abnormal results from 24 hour oesophageal pH monitoring).

Does H pylori cause GERD

H. pylori does not really cause GERD. But some recent medical studies suggest that H. pylori infection can play a small role in heartburn. Because H. pylori damages the lining of the stomach, the stomach produces less acid. If acid production is decreased, in some people H. pylori infection may actually protect against GERD or at least decrease the amount of acid in the material that is refluxed from the stomach into the esophagus. So, if you have GERD and find out that you also have an H. pylori infection, getting the infection treated could make the GERD symptoms worse. However, given the risk of developing an ulcer or stomach cancer, the current recommendation is to treat the infection if it is diagnosed. H. pylori does not really cause GERD.

Should I have surgery for my GERD

This is a difficult question to answer, and the decision really is yours. The real issue is how bad your GERD and or regurgitation is. Does medication control your symptoms adequately How difficult or costly is it to take a medication once or twice a day Is your GERD making your life difficult or miserable If the answer to these questions is yes, then surgery may be an option. The goal of anti-reflux surgery is to strengthen the lower esophageal sphincter, which is the barrier to reflux of material from the stomach into the esophagus. First, there are risks to surgery and anesthesia are you a surgical candidate Because GERD can be treated with medication, this is elective surgery, meaning that the surgery is being done to improve your lifestyle, not for a life-and-death condition. Patients with heart disease such as angina, recent heart attacks, and congestive heart failure are at increased risk in surgery and under anesthesia. Those with severe lung disease such as asthma, chronic...

Will I be able to stay off GERD medications ifI have surgery

Few studies have addressed this question. Short-term studies (2 years after surgery) show that surgery decreases the risk of esophagitis on endoscopy and improves GERD symptoms when compared to those patients who only take medications. However, medications are effective for alleviating both symptoms and esophagitis. A long-term study by Spechler and associates that was published in 1992 in the New England Journal of Medicine looked at patients 9 to 10 years after anti-reflux surgery and compared them to patients treated only with medication. The authors found that more than 60 of those who had the operation required medication for GERD in the long term. This study was done by gastroenterologists who treat GERD and may be more objective about surgical results than surgeons can be. So, the data suggest that surgery is effective in the short term, for a couple years, and helps improve GERD symptoms and esophagitis and decreases the need for medication. But in the long term, some patients...

Bonus Question What would I do if I had chronic GERD

DLB answers This is a good question because I have had GERD almost daily for the last 20 years. I take my medication every day, and it controls my symptoms. And if I miss a dose, I know it. Lifestyle modification truly helps, and the greatest benefit is avoiding food for 2 hours prior to bed. Given the lack of long-term documented benefit of endoscopic anti-reflux procedures, I would not have one and do not recommend these procedures to my patients. As for anti-reflux surgery, well, surgery has risks and complications. The long-term benefit of a Nissen procedure performed either openly or laparoscopically is roughly equal to that of medication. And frequently, those who have had the surgery need to go back to their medication. The disadvantage to this approach is the need to take regular medicine and its associated cost. So, my usual recommendation to my patients and what I do for myself is stick to the medication because it is safe for long-term use and effective in controlling GERD...

Is there a difference between daytime and nighttime GERD

GERD can occur at any time because the stomach is constantly producing acid, but acid production varies at different times. Food enters the mouth and moves down to the stomach, stimulating production of stomach enzymes and acid for digestion. The first major step in food processing is in the stomach, which slowly moves material into the small intestines where nutrients are absorbed. Certain fried and high-fat foods can stimulate the stomach to produce more acid and digestive juices than normal. Also, fatty foods slow stomach emptying, which means acidic material sits in the stomach for longer periods of time. Both of these factors explain why GERD symptoms might increase after you eat larger and fatty meals. Nighttime GERD occurs because when you lie down to sleep, your stomach is actually level with or higher than your esophagus. This allows stomach fluid and acid to flow into the esophagus. Because of nighttime reflux, you might experience sleeping difficulties, wake up frequently,...

Does GERD affect one gender more than the other

Females are slightly more affected by GERD than males are. The reason women are more prone to develop GERD may be related to female hormones. The female body produces the hormones estrogen and progesterone. One of the many functions of these hormones is to relax muscles in the body. For example, during pregnancy, women produce larger amounts of these hormones to relax the muscles in the uterus to allow it to grow along with the baby. Just as hormone levels change during pregnancy, women experience hormonal variations on a regular basis. GERD than males are. The reason women are more prone to develop GERD may be related to GERD is a serious disease when it goes untreated or is affecting their ability to do their job. The esophagus takes the food from the mouth and delivers it to the stomach for further digestion. As the esophagus relaxes, the food moves more slowly down to the stomach, thus increasing the time during which the esophagus can be affected by acid reflux. Similarly, the...

What about other chest symptoms with GERD

GERD can affect other systems in your chest besides your mouth and stomach. To understand how it can affect other systems in your chest, it is important for you to visualize the anatomy of the human body. GERD can As the refluxed acid comes in contact with your airway, it can cause other symptoms in your chest, including persistent coughing and irritation of your throat, which causes some people to feel like they constantly have to clear their throats. The irritation can become so severe that it may even affect your voice box, which can cause you to have a hoarse voice. Finally, it is thought that people whose airways are constantly affected by acid reflux can develop hypersensitive airways and that this may eventually lead to asthma or make asthma worse, requiring more asthma medication.

What is the relationship between ulcers and GERD

Typically, PUD is not associated with GERD. Typically, PUD is not associated with GERD. The confusion about this is because frequently patients with GERD can have the same or similar symptoms to that of someone with an ulcer. The treatment for PUD and GERD can be the same with H2 blockers or PPI medications. Additionally, when patients with GERD have endoscopy or barium studies, an ulcer in the esophagus is commonly found. This is not peptic ulcer disease. Esophageal ulcers are not caused by an H. pylori infection. Esophageal ulcers are caused by The only real relationship of PUD to GERD is acid. To get PUD the stomach needs to produce acid. Obviously, to have GERD you need acid refluxing up into the esophagus. This is the reason antacid medications are effective in treating both diseases.

If antacids do not work or are not appropriate for my GERD what is the next step or tier ofmedications to try

Antacids are first-line therapy for mild or infrequent heartburn however, sometimes these medications will not work or are simply not appropriate. To properly understand the other options available for anti-reflux therapy, it is important to know the biology of the stomach and how it produces acid for digestion. To recap, there are several ways to stimulate stomach acid production and two effective classes of medications, called H2 blockers and proton pump inhibitors, or PPIs. The benefit of these drugs is they reduce or eliminate stomach acid and are very effective for the treatment of GERD or peptic ulcer disease (stomach or duodenal ulcers). Thus, these medications treat GERD before it happens and prevent it. H2 blockers and PPIs reduce eliminate stomach acid These medications treat GERD before it happens and prevent it. H2 blockers reduce acid production, whereas PPIs block acid production altogether. So, PPIs are considered much stronger. Many H2 blockers are available, and most...

Which specific medications can exacerbate GERD or damage the esophagus

As mentioned, medications can act in different ways to affect GERD and reflux symptoms (see Table 1). Medications can either affect the nerves that control the LES or the muscles that control the tightness of the LES. 100 QUESTIONS & ANSWERS ABOUT GASTROESOPHAGEAL REFLUX DISEASE (GERD) Table 1 Medications that May Cause Reflux or Heartburn The anticholinergic medications, such as antinausea medications, control the autonomic nerves responsible for digestion. These medications can decrease the nerve output to the muscles of the LES, thereby causing the muscles to relax and worsening the symptoms of GERD. Anticholingeric medications also slow stomach emptying, giving reflux more time to occur. Examples of commonly prescribed anticholinergic medications used for nausea are prochlorperazine (Compazine), promethazine (Phenergan), and scopolamine. All of these medications are very commonly used and have the potential side effect of increasing GERD or directly damaging the esophagus.

What does an endoscopy show when patients have GERD

Patients with chronic GERD symptoms undergoing endoscopy have been studied by Winters and colleagues. In a report published in Gastroenterology in 1987, the authors found that of approximately 100 patients with longstanding or chronic GERD who had an upper endoscopy, 42 were normal, 45 demonstrated erosive esophagitis, and 12 had Barrett's esophagus. So, it is reassuring that more than 40 of patients were found to be normal however, it is the other nearly 60 of patients who have a positive exam and may need further treatment. Chronic acid damage of the esophageal lining can result in recurrent inflammation with replacement of the normal mucosa with an acid-resistant abnormal mucosa called Barrett's esophagus. Endoscopically, this looks like tongues of salmon-colored mucosa extending from the gastroesophageal junction, GEJ, up into the esophagus. This area requires a biopsy to determine whether it has the microscopic features that confirm the diagnosis of Barrett's esophagus....

Can GERD manifest as mouth symptoms in the absence oftypical chest discomfort

Yes, mouth symptoms can occur in the absence of chest discomfort. The acid can travel up from the stomach through the esophagus and into your mouth this is called regurgitation. Most individuals experience symptoms with acid reflux however, this is not always the case. Occasionally, people may not feel any pain because their esophagus has a decreased sensation to pain, or over the years they have become accustomed to the feeling and might not even notice it. This is called silent reflux. Without these people knowing it, the acid is traveling up into their mouths and causing different types of symptoms. When acid enters the mouth, it brings with it some of the contents of the stomach, such as partially digested food, stomach enzymes, and acid that can leave a sour and bitter taste. If regurgitation occurs often, people can develop bad breath or dental problems. Acid regurgitation can cause cavities or can damage tooth enamel which results in discoloration of the teeth. However, before...

Acidum Nitricum For Heartburn

Incontinence & frequent urination 268-69 indigestion 234-35 insomnia 63, 244-45 irritability & anger 63, 244-45 labor pains 262-63 morning sickness 262-63 nausea 236-37 travel sickness 275 vomiting 236-37 Strychnos toxifera (Curare) 168, 290 styes 220-21 sulphuratum rubrum sulfuret of lime see Hepar sulphuris calcareum Sulphur (Sulfur) 99, 308 dandruff 242-43 heartburn 234-35 diaper rash 246-47 measles 252-53 menopause 258-59 mild eczema 240-41 skin problems in elderly people 268-69 vaginal thrush 260-61 Sulphur iod. sulfur iodide 308

Can I have chest pain caused by conditions other than GERD

GERD is only one of the many conditions that can cause chest pain. Other causes of chest pain range from life-threatening to minor inconveniences. Of course, a severe and life-threatening cause of chest pain is a heart attack as discussed earlier (see Question 13). These are only a few of the conditions that can mimic GERD. Please note that all of these conditions have serious risks and can be life-threatening. It might be difficult for you to identify the cause of your chest pain because the pain resulting from any of the conditions mentioned can be so similar at times. If you experience symptoms, see a doctor to look into the cause.

What kind of doctor treats GERD

Your primary care doctor should do the initial evaluation of GERD. This kind of doctor is usually an internist or doctor who does general internal medicine and only treats adults. Other primary care doctors might be family practitioners who treat both adults and children. Your doctor may treat you with medication for GERD and or order tests. If you are on medication that is not working or have any of the symptoms from the preceding question, your doctor may refer you to a gastroenterologist. Gastroenterologists are doctors who have trained in adult internal medicine and have done several years of additional training in diseases of the digestive tract, liver, and pancreas. They generally see patients in the office and do various procedures. These procedures are usually upper endoscopy and colonoscopy. Upper endoscopy involves passing instruments down through the mouth to examine the esophagus, stomach, and duodenum and can be used to evaluate GERD. A colonoscopy is a screening test for...

If my GERD is chronic and possibly lifelong do I need to take medications for life or are there any other options

If you have long-standing frequent GERD and lifestyle modifications such as weight loss do not improve your symptoms, then you may need to take medications for life. The good news is that H2 blockers are safe for long-term use and have been on the market for more than 25 years demonstrating their safety. Proton pump inhibitors are felt to be safe for long-term use as well, and these have been on the market for more than 15 years. There were early concerns with long-term PPI use because initial studies showed increased risk of a rare cancer in rats on omeprazole. However, these cancers never developed in humans taking long-term PPIs. Long-standing use of PPIs has sometimes been associated with development of a vitamin B12 deficiency. A simple blood test by your doctor can check whether you have a B12 deficiency. Also, people who take long-term PPIs have an increased risk of stomach polyps. Stomach polyps are benign polyps that do not turn into cancer they are different from colon...

When should I see my doctor about my GERD symptoms

You should see your doctor about GERD or heartburn before waiting too long. A burning chest discomfort may be GERD or it could be something else such as a heart problem. Angina or heart pain can be difficult to differentiate from GERD. If you are not sure or have any questions, this should prompt a visit to your doctor, especially if the discomfort is associated with shortness of breath, dizziness, sweating, and or arm or jaw pain or if the chest discomfort is associated with exercise. People with risk factors associated with heart disease such as a family history of heart attacks, smokers, those with high blood pressure, and those with high cholesterol are at increased risk for heart disease, and any chest pain warrants a doctor visit. Assuming the GERD is really just heartburn, any of the following requires a visit to your doctor If you have had problems with GERD for more than a few months and are regularly taking over-the-counter medications. You may want to see your doctor...

Can medicines exacerbate GERD

Some medications can exacerbate GERD. Good examples are certain blood pressure drugs. Antihyper-tensive medications, or medications for high blood pressure, are of many types and have multiple mechanisms of action to effect lower blood pressure. One class of such drugs is called calcium-channel blockers, and they are quite effective at lowering blood pressure. But, as mentioned, all medications can have side effects that are generally undesirable. Calcium-channel blockers relax a type of muscle cell in the body called These are only a few examples of drugs that can affect the esophagus. Medications can cause problems with GERD for a variety of different reasons the three main reasons are as follows

What are alarm signs of GERD

When symptoms start affecting your overall health, you should seek medical attention. Look for the following key signs to distinguish the severity of your GERD Do you experience GERD or heartburn 3 or more times per week Is the pain in your chest from heartburn or reflux debilitating

Does GERD get worse with age

Aging is inevitable and unavoidable the body becomes less efficient at functioning and does not seem to work like it used to. As you age, the tendency is that you will slowly gain weight, which contributes to GERD symptoms. Acid in the esophagus is neutralized by saliva, and saliva production decreases with age. Further, many medications used by the elderly cause dry mouth and decrease saliva production, compounding the problem. With increasing age, stomach emptying is slowed and further affected by medications. Hiatal hernias, which promote GERD as a result of a loss of the normal function of the lower esophageal sphincter, become more common with age. A hiatal hernia occurs when the normal position of the anatomy and junction of the esophagus and stomach is lost (see Question 22). Ligaments that hold the stomach in its normal position become lax as you age. The diaphragm, the muscle that separates the chest from the abdomen, has a hole in it where the esophagus passes through to...

Can smoking cause GERD

Smoking is a dangerous habit that can result in many health risks. Smoking is associated with many cancers, heart disease, vascular disease, stomach ulcers, and lung disease, to name a few. Some studies have shown a link between smoking and GERD. Even though smoking does not directly cause GERD, it can exacerbate GERD symptoms. The nicotine in cigarette smoke can reduce the ability of the lower esophageal sphincter to contract or close, allowing acid to reflux. The LES is a muscle that keeps acid produced in the stomach from entering the esophagus. Anything that relaxes this muscle (cigarettes, alcohol, foods, or medications) causes the esophagus to be exposed to acid. Studies have shown that smoking increases irritation of the esophagus when acid refluxes and increases symptoms of heartburn. Aside from discomfort caused by reflux, the greatest complication of GERD is the development of cancer, and smoking greatly increases esophageal cancer risk. food and lubricates the esophagus....

What is heartburn

Heartburn is discomfort or pain in the chest that is caused by acid in the esophagus. It is a manifestation of how pain is felt in the esophagus. Heartburn feels like burning, warmth, or pain in the midchest area. Although heartburn, a symptom of reflux, often feels like burning and can be very similar to the pain or discomfort caused by heart problems or heart attacks, heartburn does not affect the heart, as its name suggests. The reason is that the esophagus passes through the chest almost directly behind the heart, so pain in this area can easily be confused with pain caused by heart problems (see Figures 2 and 2a). Occasionally, the pain is so similar that people actually need to undergo testing to prove the pain is caused by acid in the esophagus and not by a heart attack.

What is acid reflux

Acid for digestion of food is normally produced in the stomach in response to eating. Normally, acid can reflux, or move up, into the esophagus, but protective mechanisms are in place to remove or neutralize refluxed acid. These include saliva, which neutralizes acid, and esophageal pumping, which moves refluxed acid back down to the stomach. Acid reflux disease occurs when increased or prolonged episodes of reflux overwhelm the protective factors, resulting in symptoms. Gastroesophageal reflux disease (GERD) is a disease that is caused by a combination of symptoms. These symptoms can include heartburn, regurgitation, Gastroesophageal reflux disease (GERD) is a disease that is caused by a combination of symptoms. These symptoms can include heartburn, Approximately one in three Americans experiences occasional GERD as called by any ofthese names. chest pain or discomfort, bitter taste in the mouth, and difficulty swallowing. Chronic GERD results from repeated reflux generally defined...

Do children get GERD

Yes, children can also get GERD it can affect anyone. Infants may exhibit symptoms different from adults. They may become irritable after eating, repeatedly belch or vomit, or suffer from persistent coughing. These symptoms may manifest as poor feeding and impaired weight gain or colic. GERD is often overlooked in young children because their symptoms are very subtle and infants often outgrow the condition. Parents can take precautions to prevent GERD symptoms in infants, such as keeping infants upright for 30 minutes after feeding instead of placing them directly in the crib. Also, burping the baby more frequently during feeding time can help to avoid the buildup of gas and pressure that may add to a baby's GERD discomfort. If you feed your baby formula, consider changing the formula to reduce symptoms you should discuss this decision with your child's doctor. If these simple measures do not help, medications may be in order. Some H2 blockers and proton pump inhibitors (PPIs) are...

Is GERD serious

GERD is a serious disease when it goes untreated or is ignored. It can cause occasional or daily problems that are noticeable as a result of pain or discomfort. Reflux disease can be silent or can manifest with atypical symptoms. Frequent episodes often cause pain or suffering in a patient's everyday life. Untreated chronic GERD can lead to damage of the esophagus. Typical esophageal complications may be inflammation of the esophageal lining, narrowing of the esophagus that leads to difficulty swallowing, or inflammatory conditions predisposing a person to esophageal cancer. Complications of reflux can involve other organ systems, including the sinuses, ears, airways, and lungs. The risks and specific complications of gastroesophageal reflux disease are extensive, and Part Five, Complications of Gastrointestinal Reflux Disease, in this book discusses these issues.

Oesophagus Heartburn

Nevertheless, oesophagitis resulting from GORD has become the commonest single diagnosis resulting from endoscopy carried out for dyspepsia, although whether this represents a true increase in prevalence or simply reflects a change in referral practice is unclear. There is little doubt that a spectrum of severity of disease exists, with most affected people never consulting a doctor and only a minority with unremitting symptoms or complications from the disease receiving attention from hospital specialists. Consequently, treatment of patients presenting in general practice may not be best guided by the outcome of most clinical trials, which have recruited patients from those referred to hospital.

Dyspepsia

A first-line OTC treatment for heartburn, indigestion and dyspepsia has often been an antacid based on calcium carbonate in combination with magnesium and aluminum salts. Calcium in combination with the other ingredients reduces stomach acid and increases the rate of gastric emptying (Vatier et al 1996). In trials comparing H2 blockers with calcium carbonate tablets, calcium was found to be equipotent, yet delivered a more rapid response and shorter duration of action (Feldman 1996). There have been many papers highlighting the dangers of prolonged use of these traditional antacids however, pure calcium carbonate formulas attract the least concern, with the incidence of 'milk alkali syndrome' resulting from their over use reported to be rare (Ching & Lam 1994, Herzog & Holtermuller 1982).

Indigestion

Indigestion Another name for an upset stomach that usually results when a child eats too much food, or eats too quickly. Also known as dyspepsia, only very rarely does indigestion mean a person may have a more serious digestive problem or an ulcer in the digestive tract. Stress and not enough sleep may make indigestion worse. obesity also tends to promote indigestion. Indigestion causes pain or burning in the middle of the belly, nausea, bloating, uncontrolled burping, and heartburn. The best way to prevent indigestion is to avoid foods that seem to cause it. Children with the tendency toward indigestion should eat healthy, smaller meals throughout the day, avoiding junk food, fatty foods, too much chocolate, and too many citrus fruits. Eating slowly and avoiding stress can also help. In addition, children should never exercise with a full stomach. Indigestion is fairly common, but usually it only happens occasionally. A child who gets indigestion despite a healthy diet, plenty of...

Heartburn

Heartburn or acid reflux occurs when hydrochloric acid and pepsin from the stomach seep into the lower part of the esophagus, irritating the lining which is not suited for the strong acids. Sometimes the pain is mistaken for a heart attack. Acids are allowed to pass into the esophagus because of the relaxation of the esophageal sphincter, a small ring-shaped mus cle that opens to let food into the stomach but closes tightly to keep contents in. This muscle can become weakened. A hiatal hernia can develop in this area, which also causes acid reflux. Eating too fast or too much puts pressure on the sphincter muscle, weakening it, as does too much body weight. Eating the wrong foods or food combinations can cause heartburn. Foods that can act as muscle relaxants causing the sphincter muscle to open inappropriately are chocolate, fatty foods, and alcohol. Foods that increase the acidity of the stomach are coffee, beer, milk, and colas. Coffee, citrus foods, hot spicy foods, and tomatoes...

How do I know whether my heart is causing the chest pain

Heartburn is a pain in the chest, but is a type of misnomer. True heartburn is related to refluxing acidic materials back into the esophagus where is passes through the chest, which causes a burning sensation. Even though the name is heartburn, the condition actually has nothing to do with your heart's health. The name of this condition likely was developed when people mistakenly confused reflux pain with a heart attack.

What is a hiatal hernia and why does it cause reflux

Move abnormally into the chest, creating a condition known as a hiatal or hiatus hernia. Normal position of the junction of the esophagus and stomach is required to maintain appropriate strength of the lower esophageal sphincter, a muscle within the wall of the esophagus. The LES is the main barrier to stomach acid reflux. When a hiatal hernia occurs, the LES becomes weaker, predisposing you to reflux. There are two major types of hiatal hernias, and both increase GERD. Typically, people refer to a sliding hiatal hernia. It is called a sliding type because the stomach can slide in and out of the chest. The other type of hiatal hernia is called a paraesophageal hernia. A paraesophageal hernia is a condition in which the stomach slides up into the chest through the hiatus alongside the esophagus. Paraesophageal hernias are more common in those older than 70 years. In a parae-sophageal hernia, the stomach is in the chest though its blood supply comes through the diaphragm from the...

What are the symptoms of a hiatal hernia

Symptoms you might experience are heartburn and regurgitation. A hiatal hernia causes the LES to be less effective, resulting in GERD, but the hiatal hernia itself really has no symptoms. Many patients report dyspepsia, which is the feeling of a sour stomach, and they think that means they have a hiatal hernia. But dyspepsia is a nonspecific stomach disorder treated with a proton pump inhibitor (PPI).

Does my bed make a difference in nighttime symptoms

Your bed, its position, and type of mattress can make a difference in nighttime symptoms. As discussed previously, nighttime GERD can cause symptoms that you may not even be aware of. These symptoms can affect your sleep and make you wake up without feeling refreshed. Night symptoms include heartburn, regurgitation with coughing, choking, gasping for air, and a bitter taste in your mouth or excessive drooling. On rare occasions nocturnal regurgitation can lead to aspiration and pneumonia. toms. The main strategy is to position yourself so that your esophagus and stomach are not at the same level, which can decrease the possibility of reflux and reduce nighttime symptoms. One way to raise the level of your head is to raise the entire head of the bed. Elevating the head of the bed can be achieved by placing risers or bricks underneath the feet of the bed to create an incline that keeps the esophagus at a higher level than your stomach. Wedge pillows also have the same effect they are...

What is Barretts esophagus

Most people with Barrett's esophagus have chronic heartburn or GERD symptoms. In fact, because Barrett's is more acid resistant, many patients report that their heartburn was worse when they were younger but is better now. If you have chronic or long-standing heartburn symptoms and you are a white or Hispanic male between the ages of 40 and 60 years, you should see your doctor about an endoscopy test. study by Cameron and associates published in Gastroenterology in 1999 demonstrated a rate of 376 cases per 100,000 people. Barrett's is usually not found in young children and is thought to be an acquired condition. It is found predominantly in males that are middle-aged and is more common in Caucasians and Hispanics. Patients with chronic GERD undergoing endoscopy have been studied, and about 10-15 have Barrett's esophagus. About 40-50 of endoscoped patients have normal exams and the rest (about 40 ) have esophagitis. Thus, if you have chronic or long-standing heartburn symptoms and you...

Will I get cancer from having Barretts esophagus

You may be able to decrease your cancer risk by avoiding smoking, limiting alcohol use, maintaining a healthy weight, eating a balanced diet that includes fruits and vegetables, taking heartburn medication, and getting periodic endoscopy if Barrett's has developed. If you have questions, a lot of information is available, so ask your doctor.

What can be done to make Barretts esophagus better or make it go away

There is some debate in the literature whether Barrett's will regress, shrink, or go away with aggressive antacid treatment or with surgery for GERD. But the information is mixed some doctors feel that regular use of antacid drugs such as proton pump inhibitors (for example, omeprazole) may decrease the amount of Barrett's lining the esophagus. It has been clearly demonstrated that the more of the esophagus lined by Barrett's, the greater the cancer risk. My recommendation to patients is that surgery for GERD does not improve Barrett's once it has developed. Most patients with Barrett's have heartburn if I make the diagnosis of Barrett's, I tend to treat them with daily or twice daily doses of proton pump inhibitors. There really is no downside, and such treatment may limit progression of Barrett's, but the data in the literature to support this are not conclusive. The disadvantages of this approach are drug cost and the requirement of taking regular...

What are the alarm or concerning symptoms that might suggest esophageal cancer

Table 3 GERD Alarm Signs Suggesting Workup those diagnosed with esophageal cancer die of their disease. Hopefully, by doing endoscopy on people with chronic heartburn and diagnosing Barrett's esophagus, this mortality rate can be improved by identifying precancer or cancerous changes earlier.

How can I decrease my risk of getting cancer of the esophagus

Specifically for esophageal cancer, tobacco and alcohol are the major factors you can modify to decrease the chances of developing cancer. For patients with chronic GERD, endoscopy, as previously mentioned, can help diagnose cancer at an earlier stage or may help to diagnose Barrett's esophagus. Some studies show that aspirin or a class of drugs called NSAIDs (most over-the-counter pain relievers, except acetaminophen Tylenol ) can decrease the risk of developing cancer in patients with Barrett's esophagus.

What symptoms should prompt a doctors evaluation

Frequent GERD, occurring three or more times a week or longstanding symptoms of more than 6 months may be a sign of damage to the esophagus. Acid damage of the esophagus called esophagitis is present in about half of patients who have an endoscopy test. About 5-10 may have Barrett's esophagus (see color plate 3). Barrett's esophagus is an inflammatory change in the lining of the esophagus that can predispose you to the development of esophageal cancer.

What is a barium study or upper GI series

If you see a doctor, he or she may recommend evaluation of GERD symptoms or difficulty swallowing. A barium study is one of these tests. It goes by multiple names such as upper GI series, barium swallow, or barium esophagram. This is a simple and easy test that is usually done at a hospital in the X-ray or radiology department. It involves drinking a liquid material that may be chalky tasting that is closely followed by an X-ray examination. The entire exam usually takes less than 30 minutes. Normally, the esophagus and upper gastroesophageal tract cannot be seen well on X-ray. However, the barium liquid coats the lining of the esophagus, stomach, and small intestine, which allows careful examination. Sometimes the doctor or technician may ask you to take something called fizzies. This is a material that produces gas and helps to distend your stomach so it can be more carefully examined. Rarely, you may need an intravenous line (IV) to administer other medications, but generally an IV...

Should I be checked for H pylori at the endoscopy

As discussed earlier, an endoscopic biopsy is a benign and painless procedure. Helicobacter pylori (H. pylori) is the bacterium that causes ulcers and predisposes you to the development of stomach cancer. Thus, finding and treating H. pylori is desirable. Generally, biopsies are done for H. pylori in patients who have ulcers or a history of prior ulcers because they may have a chronic H. pylori infection. Those with stomach irritation on endoscopy, a family history of stomach cancer, or dyspepsia should be evaluated for H. pylori. Dyspepsia is a combination of symptoms that resemble an ulcer in the absence of an ulcer and is characterized by upper abdominal discomfort such as burning or gnawing that is improved with antacid medication. Some doctors check all patients for H. pylori when they do an endoscopy. When it is found, H. pylori should be treated, which involves about 2 weeks of medication. H. pylori therapy usually includes three drugs an antacid and two antibiotics.

Who should have an endoscopy and why

As mentioned, nearly 60 of people with chronic or frequent GERD have positive findings on endoscopy. Endoscopy is recommend for all patients with GERD symptoms longer than 6 months in duration and or symptoms that occur 2 or more times per week. People at increased risk for esophageal or stomach cancer in addition to GERD should consider endoscopy. Those with a family history of esophageal or stomach cancer, smokers, and chronic alcohol users are at increased risk for cancer.

What is a manometry or motility study and why is it done

Several different tests are available for evaluation of GERD and heartburn symptoms. Barium studies and endoscopy give your physician information about the structure of both a normal and abnormal esophagus and upper gastroesophageal tract. Sometimes if patients have atypical symptoms, do not respond appropriately to medications, or are under consideration for surgery, other tests may be in order.

How should I take the medications and when will they work

Proton pump inhibitors work by a different mechanism and are very ineffective for treating GERD that is already occurring. These medications take 24 to 48 hours to start working. PPIs need to be taken at the appropriate time for maximum effect. Second-tier therapies, H2 blockers, are safe and are best taken before reflux occurs. For example, a person with nighttime GERD might take a bedtime dose of an H2 blocker. If you have occasional GERD and plan to have a spicy meal, then taking a dose prior to the meal (as needed) may be better. Those with more frequent or severe symptoms can take a full dose of medication daily. Most H2 blockers are taken two, three, or rarely, four times a day. Proton pump inhibitors work by a different mechanism and are very ineffective for treating GERD that is already occurring. These medications take 24 to 48 hours to start working. PPIs need to be taken at the appropriate time for maximum effect.

What should I do if the medication is not working

You may not find over-the-counter H2 blockers effective for moderate to severe heartburn. If the reflux disease is severe enough, it may require increased medication dosing or a prescription-strength H2 blocker. If H2 blockers are not effective enough in controlling symptoms, then movement to the next tier of GERD therapy is warranted. PPIs are the most potent of the medications used to treat acid reflux because they block stomach acid production completely. Remember, both H2 blockers and PPIs are very effective in preventing heartburn. They do not work well once symptoms have occurred antacids are more effective when symptoms are present. If symptoms occur while you are taking an H2 blocker, read the label on the H2 blocker because not all drugs are sold at the same dose. Ranitidine HCL, for example, is sold over the counter and comes in a 75-mg and 150-mg pill. The packaging on both is nearly identical, and failure of the smaller dose may be remedied by taking the larger dose....

Will surgery decrease my risk of getting Barrettsassociated esophageal cancer

There really is no data in the medical literature to answer this question. Of all patients with chronic GERD, 10 have Barrett's esophagus, and the risk of getting esophageal cancer with Barrett's is 0.5 per year (in other words, if 2000 people have GERD, 1 person per year will get esophageal cancer). Really, the risk of getting cancer with chronic GERD is low but is increased compared to those without GERD. For example, of those 2000 people previously mentioned, 80 will get colorectal cancer and 100 women will get breast cancer. Cancer risks need to be kept in perspective. So, the short answer is anti-reflux surgery will not decrease your risk of getting cancer associated with GERD and Barrett's esophagus.

If my symptoms get better can I stop taking medication

Once you stop taking the medication, the whole process of damaging the esophagus by acid can reoccur. Because of this fact, many patients cannot stop their medications because reflux symptoms will return. Frequently, H2 blockers or PPIs need to be taken for life. The only way to change this is to modify your lifestyle. For example, overweight patients with GERD frequently experience improvement of symptoms and can decrease or stop medications when they lose weight. Cutting down or eliminating alcohol use and not eating for at least 2 hours prior to sleep can also help reduce medication requirements.

What are antacids and how and when should they be used

Antacids are compounds that can be used to neutralize acid on the spot, thus providing immediate relief of heartburn symptoms. Antacids are available at any drugstore, convenience store, and supermarket. All antacid products are over the counter and do not require a prescription. They are available for the general consumer to use at his or her own discretion. As mentioned, more than 7 million people suffer from regular GERD, and even more people suffer from occasional or infrequent heartburn symptoms. For this reason, people can choose from the hundreds of available options for antacids. They are available in many different forms tablets, chewable pills, liquids, elixirs, or even powders that can be dissolved in water and ingested. Antacid products are available for adults and child use. The main purpose of all of these medications is to provide a substance that can block the damaging effects of acid that causes reflux symptoms. Antacids are generally used as first-line therapy for...

What are the different proton pump inhibitors How should they be taken

Proton pump inhibitors completely shut down stomach cells that produce acid because they work directly on the site of acid production. Because they are the strongest acid-blocking medication, they are considered third-tier treatment for GERD. The tiers represent the step-wise management of GERD symptoms, starting with the cheapest and safest medication as first tier and ending with PPIs as third tier. PPIs are the most expensive medications for GERD and have, generally speaking, more side effects. Proton pump inhibitors as a group are overall much more effective for controlling stomach acid production than H2 blockers are. Proton pump inhibitors are the drug of choice for severe GERD symptoms, esophagi- Despite the fact that PPIs are strong, they are virtually useless if heartburn is already present because PPIs can take hours to a day to start working. These drugs are most effectively used to prevent GERD from occurring. So, PPIs should be taken regularly once or twice a day, not...

Do I need to be checked for H pyloric

If you have a history of stomach or duodenal ulcers even in the remote past, then yes, you should be checked. If you have a primary relative like a parent or brother or sister who has stomach cancer, then it is probably a good idea to be checked for H. pylori infection. Treating an H. pylori infection can decrease your chances of getting future ulcers and your risk for getting stomach cancer. In an endoscopy, if your physician finds any irritation of the stomach or duodenum or finds ulcers, then he or she should perform stomach biopsies to check for infection. There is some debate, but it can be helpful to check for H. pylori in patients with dyspepsia. Dyspepsia is a nonspecific term for a sour stomach. Dyspepsia has many causes, and symptoms can be bloating, nausea, upper abdominal discomfort or pain, feeling filled up quickly while eating, vomiting, or indigestion. The diagnosis and treatment of H. pylori in people with these symptoms might be...

What is an Endo Cinch or endoscopic plication

The Bard EndoCinch has been on the market since 2000 and is the most studied and tested of the devices mentioned here (see Figure 16). A complicated technique of placing several stitches in the region of the esophagogastric junction is required. Studies on patient outcome are limited. In a 2-year study of 85 patients who had the procedure, more than half of the patients reported improved GERD symptoms and more than 40 did not require PPI medication at 2 years.

What is apHstudy and why is it done

The stomach makes acid that aids in digestion of food. GERD, or heartburn, is movement of the acid into the esophagus. Sometimes patients have vague, odd, or atypical symptoms instead of classic burning chest discomfort. A trial of antacid medication can help sort this out if your symptoms go away with treatment. But other things can cause chest pain like heart or lung problems and can be very difficult to differentiate from GERD. Additionally, patients with GERD symptoms may be on a maximum amount of medication and still experience GERD-type symptoms. A pH study measures the amount of acid present in the esophagus and how long it stays there. This helps determine when a patient actually has pain or discomfort and the amount of acid in the esophagus to see if they correlate. When you experience heartburn and the pH test shows acid, then true GERD is present. But frequently people may have heartburn symptoms with no acid this is not GERD, may need to be treated differently, and will...

Which medications can affect both esophagus and stomach

Max), and clarithromycin (Biaxin), can cause stomach irritation. Medications for osteoporosis, the bis-phosphonates, can cause problems by irritating the lining of the esophagus as well as that of the stomach. Bisphosphonates, which include risendronate (Actonel) and alendronate, can directly affect the lining of the esophagus and increase the acid production in the stomach. Finally, pain medications related to aspirin in the drug family called non-steroidal anti-inflammatory drugs (NSAIDs), which includes over-the-counter medication such as naproxen (Aleve) and ibuprofen (Advil and Motrin), can irritate the stomach lining and cause ulcers in the esophagus, stomach, or duodenum. Symptoms from these medications include heartburn, abdominal pain, and nausea.

Can exercise affect my reflux

Exercise is generally good and beneficial, but not always. Exercise is good for improving strength, heart conditioning, weight control, and overall health. On the other hand, it can affect reflux and make it worse. Exercise can cause problems with reflux because of its effects on the digestive system and the physical positioning and pressures it places on the stomach and the esophagus. However, acid reflux should not be a reason to avoid exercising because exercise has so many positive and beneficial effects on your body. Exercising properly can help you avoid the problems caused by reflux disease. The types of food you eat around the time of exercise can also make a difference. Foods that are higher in fat content generally take longer to digest and remain in the stomach a longer period of time. These foods also require higher acid production for complete digestion, which is a good setup for worsening reflux disease. Carbohydrates are digested more quickly and can pass through the...

Do I need a biopsy of the esophagus and does it hurt

It is fairly common to do biopsies during an endoscopy. A small biopsy forceps is passed down the endoscope and a tiny pinch of tissue is removed. This is sent to a pathologist, who examines the tissue under a microscope. This can be extremely helpful for the evaluation of patients with GERD. A normal-appearing esophagus on endoscopy can have microscopic clues to the presence of reflux disease. Abnormal areas can be biopsied to check for cancer. a bacterium that lives in the stomach and can cause stomach ulcers. It is diagnosed usually by biopsy of the stomach and treated with 10 to 14 days of antibiotics and antacid medication. The role of H. pylori in GERD is unclear.

What is an esophageal dilation

Esophageal dilation is the technique of stretching the esophagus and is used to treat difficulty swallowing caused by strictures or rings. Most patients with GERD do not need dilation. It is done at the time of endoscopy while patients are sedated. Several different kinds of dilators and different tools are used for different jobs. Your doctor will choose the appropriate dilator based on the location of the narrowing, its length, how tight it is,

What are the longterm risksbenefits of endoscopic antireflux procedures

The short answer is we really do not know the long-term risks of endoscopic anti-reflux procedures because they have only been on the market for a few years. Likewise, we do not know their long-term durability to control GERD symptoms and provide heartburn relief without medications. These are promising technologies that make sense from a medical standpoint, but they have not yet stood the test of time. Because these technologies are still fairly new, think carefully before you have your esophagus plicated or ablated by radiofrequency. GERD, for the most part, is a benign but inconvenient condition. These procedures have risks that can be life threatening, and the long-term outcome is unknown. To date, endoscopic antireflux procedures are not the standard of care. (Standard of care is what the average doctor would do or what is expected of most doctors.) The current standard of care for someone who has long-term GERD is medication, and if that fails, open or laparo-scopic surgery...

What is aspiration

There are ways to minimize the risk of nighttime reflux and aspiration. Avoid food for 2 hours prior to bed to allow the stomach to empty and to eliminate material to aspirate. Because there is no food or less food in the stomach, the pressure in the stomach is lower and the force promoting reflux is diminished. Elevating the head of the bed and sleeping on an incline can help use gravity to keep material down in the stomach. Special wedge-shaped pillows keep the head and chest above the level of the stomach. Antacid medications that will help with nighttime heartburn

What is an endoscopy

When patients have had frequent or long-standing GERD symptoms, they can develop inflammatory changes to the esophagus called Barrett's esophagus that can predispose them to esophageal cancer. The only way to make the diagnosis of Barrett's is to do an endoscopy test. Difficulty swallowing can be evaluated and treated at the time of endoscopy.

What is H pylori

There really is no strong association between H. pylori infection and GERD. However, we discuss it here because invariably patients have questions about H. pylori infection and its association to disease, particularly to stomach problems. H. pylori is a bacterium or germ and is one of the most common infections in humans. It is present in about half of the world population. H. pylori is uncommon in children living in the developed world and is usually acquired as people age. In the United States, estimates suggest that approximately 40-50 of people have H. pylori. In underdeveloped countries with poor sanitation, lack of appropriate sewage systems, and inadequate water treatment facilities, H. pylori infection is common and occurs in childhood. In these countries, infection is present in greater than 75 of adults. Most people with H. pylori infection have no symptoms, and not all people with H. pylori infections get ulcers or experience damage. H. pylori causes ulcers of the duodenum...

Risks of surgery

Ability to stop taking or to reduce GERD medications possibly for life. Finally, surgery can lead to improvement in asthma or extraesophageal GERD symptoms. A French study by Pessaux and colleagues, published in 2005 in the Archives of Surgery, followed for 5 or more years 1340 patients who had anti-reflux surgery. The study found that about 5 of patients had severe difficulty with swallowing, more than 7 had gas and bloating, more than 5 of patients required another operation, and 10 of patients required a proton pump inhibitor to control GERD symptoms. Interestingly, in esophagitis on endoscopy and improves GERD symptoms when compared to those patients who only take medications.

What is Enteryx

Enteryx is a material that could be injected into the area of the LES at the time of endoscopy. It is a liquid polymer that stays in place where it is injected and solidifies into a spongy material. This material can bulk up the LES and become a barrier to reflux. Small studies suggested that Enteryx was effective for GERD. Side effects included chest pain, difficulty swallowing, bloating, nausea, garlic odor, and fever.

What is esophagitis

Esophagitis is inflammation of the lining of the esophagus that is diagnosed by a barium X-ray or endoscopy. Generally, it is not a diagnosis that can be made by a doctor in the office through a history or physical examination. The inflammation is usually caused by reflux of acid that burns, damaging the esophagus. However, medications can sometimes cause esophagitis, for example, aspirin or over-the-counter pain relievers, iron pills, potassium pills, some antibiotics, and certain drugs used to treat osteoporosis such as alendronate sodium. Rarely, infections of the lining of the esophagus such as yeast (Candida) or certain viruses can cause esophagitis. But again, generally most esophagitis is caused by acid reflux disease. Symptoms of esophagitis are heartburn, occasionally chest pain, and or difficulty swallowing. Treatment involves taking medication that suppresses acid production by the stomach, such as proton pump inhibitors like omeprazole (Prilosec) or a class of medications...

Digestive disorders

Symptoms Indigestion, and vomiting with painful retching. Diarrhea is accompanied by abdominal cramps, and nausea by colicky pain. Constipation may make it difficult to empty the bowel fully Hemorrhoids and constipation may be due to rectal spasms. The abdomen is often bloated and flatulent. There may be cravings for stimulants or spicy, fatty, or rich foods, even though these only aggravate symptoms. Symptoms better For warmth for resting for sleep for firm pressure on the abdomen in the evening.

Answers To Patients Frequently Asked Questions

Aloe gel is traditionally used for burns, wounds and inflammatory skin disorders. There is good scientific evidence that aloe may be of benefit in these conditions however, the chemical composition of Aloe vera products will vary depending on geographical and processing factors. Traditionally, aloe is also used internally for dyspepsia, gastrointestinal ulcers and IBS. 2007 Elsevier Australia

Indications Indian Gum Arabic Tree

(f KAB WO3) Burn (f SKJ WO3) Cancer (f BIB JLH) Cancer, ear (f JLH) Cancer, eye (f JLH) Cancer, liver (f JLH) Cancer, spleen (f JLH) Cancer, testes (f JLH) Cataract (f GHA) Catarrh (f GHA HH2) Childbirth (f DEP) Chill (f ZUL) Cholecystosis (f BIB EB22 173) Cholera (f SKJ WO3) Cold (f GHA) Colic (f KAB) Condyloma (f BIB) Congestion (f BIB) Conjunctivosis (f DEP NAD) Cough (f DEP KAB NAD) Cramp (f BOU) Cystosis (f DEP) Dermatosis (f BOU WO3) Diabetes (f1 BOU DEP GHA SUW WO3 ZUL) Diarrhea (f GHA GMH PH2 SUW) Dysentery (f BIB DEP SUW) Dyslactea (1 X15283686) Dyspepsia (f ZUL) Dysuria (f KAB) Edema (1 X8982438) Enterosis (f1 DEP X15476301) Fever (f BIB BOU UPW) Flu (1 FNF) Fracture (f KAB) Fungus (1 WO3) Gastrosis (f DEP) Gingivosis (f BOU DEP PH2) Gonorrhea (f1 DEP KAB ZUL) Hemorrhoid (f BIB KAB PH2) Hepatosis (f1 BIB WO3 PR14 510 X11054840) High Blood Pressure (f1 BOU ZUL) HIV (1 X10189947) Hypersalivation (f DEP) Impotence (f NAD UPW) Induration (f BIB JLH) Infection (1 WO3 ZUL...

Your body during weeks 5 to

The second month of pregnancy brings enormous changes for your body. It's the time you're likely to begin experiencing most of the major discomforts and annoyances of early pregnancy, such as nausea, heartburn, fatigue, insomnia and frequent urination. But don't let these get you down. Consider them as signs that your pregnancy is proceeding smoothly. A recent study, in fact, found that women who experience pregnancy-related signs and symptoms by their eighth week were less likely to have a miscarriage.

Materials and methods

For this purpose, blood and archival cancerous human tissues from ESCC and CRC samples, also, esophageal tissue samples from GERD patients were collected. This study included 43 formalin-fixed, paraffin-embedded (FFPE) tissues from patients diagnosed with ESCC who had undergone curative surgical resection at Imam Khomeini hospital, 17 colorectal cancer tissues from patients diagnosed with adenocarcinoma who had undergone curative surgical resection at Tehran hospital. Then blood samples from eighty-two patients with at least one of three important symptoms of GERD (heart burn, acid regurgitation, or dysphagia) and erosive reflux esophagitis as diagnosed by endoscopy at the Endoscopy Ward of Fayazbakhsh Hospital (Tehran, Iran) and from 103 healthy indivituals were selected. None of the GERD patients had taken proton pump inhibitors and Nonsteroidal antiinflammatory drugs (NSAIDs) during last 4 weeks before beginning of the study. All cases underwent treatment with omeprazole as a...

Apparent Life Threatening Events

In addition to the above types of apnea, the cessation of breathing also can occur in connection with Apparent Life-Threatening Events (ALTEs). An ALTE itself is not a sleep disorder but an event that is a combination of apnea, change in color, change in muscle tone, choking, or gagging. Most ALTEs can be frightening to see, but they usually are uncomplicated and do not recur. However, some ALTEs (especially in young infants) are associated with medical conditions such as gastroesophageal reflux (GERD), infections, or neurological disorders. These medical conditions require treatment, so all children who experience an ALTE should be seen by a doctor immediately.

Movement of the Dosage form Along the

The extent to which shape controls gastrointestinal transit is important as illustrated for pellet and single unit emptying of the stomach however, in the small intestine formulations appear to travel at approximately the same rate. Measurements indicate that there are only small perturbations caused by meal components such as fat. Early emptying of partially digested lipid, initiated by gastric lipase and perhaps backwash of proximal intestinal contents into the stomach, initiates the ileal brake. Following administration of a light meal, movement through the proximal gut is rapid and longer periods of stasis become evident as the formulation enters in the terminal ileum. Bunching of the formulation label is noticeable at the ileocaecal junction, immediately before entry into the caecum. Eating initiates propulsive activity and approximately 15 min after a meal, pulses of activity can be recorded in the sigmoid colon. Essentially, material is swept forward from the small intestine to...

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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