GERD: Symptoms, Diagnosis & Treatment
What is GERD? GERD, which stands for Gastroesophageal Reflux Disease, often called Acid Reflux, is a long-term disease condition where stomach content (especially acidic content) refluxes or comes back to the mouth via the esophagus or the food tube, giving rise to heartburn, acidic taste in the mouth, chest pain, and even breathing problems among many. However, studies reveal that symptoms associated with GERD are more common (20 – 25%) among people living in Western countries (such as the U.K.) as compared to those belonging to Asian countries (such as Malaysia), where it is limited to 10 – 15%. What are the GERD symptoms? The most common symptoms of GERD include HEARTBURN (even though it has nothing to do with the heart), strong acidic taste in the mouth, sore throat, swallowing problem, high rate of salivation, and coughing. Repeated GERD episodes often cause injury to the esophagus, resulting in: Reflux esophagitis – Necrosis (death of local cells) of esophageal epithelium, causing ulcers close to the connection between the stomach and the esophagus Esophageal strictures – Narrowing of the esophagus caused by reflux-induced inflammation Barrett’s esophagus – Intestinal metaplasia (changes of the epithelial cells from squamous to intestinal columnar epithelium) of the distal esophagus Esophageal adenocarcinoma – A type of cancer. Even though some people claim GERD causes sinusitis, recurrent ear infection, and idiopathic pulmonary fibrosis, these have not been medically established so far. What causes GERD? Gastroesophageal Reflux Disease is primarily caused by the failure of the Lower Esophageal sphincter valve, thus allowing a part of the acidic stomach contents to travel back to the esophagus, creating all the issues stated above. However, some of the following factors also contribute to the onset of GERD: Obesity – Increasing BMI is often associated with GERD to a large extent. With more than 2,000 people with symptomatic reflux disease, it has been proven that 13% of changes in esophageal acid exposure are attributable to changes in BMI. Hiatal Hernia increases the likelihood of GERD on account of mechanical and motility factors. Zollinger-Ellison Syndrome, which can be found in increased gastric acidity due to gastrin production. High blood calcium levels can also heighten gastrin production, giving rise to higher acidity. Scleroderma and systemic sclerosis may cause esophageal dysmotility. Prednisolone (High consumption rate). Visceroptosis or Glenerd Syndrome, in which the stomach has gone down in the abdomen, upsetting the motility and acid secretion of the stomach. How is GERD diagnosed? Diagnosis of gastroesophageal reflux disease is primarily based on the symptoms presented by the patient, as well as the following tests and observations. A test to monitor the amount of acid in your esophagus – Ambulatory acid (pH) probe tests use a device to measure acid for 24 hours. The device identifies when, and for how long, stomach acid regurgitates into your esophagus. One type of monitor is a thin, flexible tube (catheter) that’s threaded through your nose into your esophagus. The tube connects to a small computer that you wear around your waist or with a strap over your shoulder. Another type is a clip that’s placed in your esophagus during endoscopy. The probe transmits a signal, also to a small computer that you wear. After about two days, the probe falls off to be passed in your stool. Your doctor may ask that you stop taking GERD medications to prepare for this test. If you have GERD and you need surgery, you may also have other tests, such as: ■ An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach, and upper intestine (duodenum). ■ A flexible tube to look inside your esophagus. Endoscopy is a way to visually examine the inside of your esophagus and stomach. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. Your doctor may also use an endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett’s esophagus. ■ A test to measure the movement of the esophagus. Esophageal motility testing (manometry) measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus. What are the modes of Treatment for GERD? Treatment for GERD usually begins with over-the-counter medications that control acid. If you do not find relief within a few weeks, your doctor may recommend other treatments, including medications and surgery. Over-the-counter treatments that may help control GERD symptoms include: ■ Antacids that neutralize stomach acid. Antacids, such as Maalox, Mylanta, Gelusil, Gaviscon, Rolaids, and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation. ■ Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), or ranitidine (Zantac). H-2-receptor blockers don’t act as quickly as antacids do, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form. ■ Medications that block acid production and heal the esophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec, Zegerid OTC). Postscript: GERD is best controlled by leading a healthy lifestyle, reducing or cutting down alcohol consumption, and also giving up smoking for good. Over and above, consumption of fried and/or fatty food should be eliminated. And as a last reminder – Do not indulge in drinking Champagne.
Indigestion: Symptoms, Causes, Diet & Treatments
With the wrong diet, no medicine can help. With the right diet, no medicine is necessary – Confucius. Indeed, the famed Chinese philosopher most likely had indigestion in his mind when he delivered that sermon. People usually suffer from indigestion when consuming unhealthy food that the stomach fails to digest. The result: uncomfortable feeling in the upper abdomen, pain, fullness, bloating, and nausea. Some also suffer from GERD (Gastroesophageal Reflux Disease) along with indigestion, while doctors debate whether indigestion causes GERD or GERD causes indigestion, even though GERD is mostly caused by failure of the esophageal sphincter valve. What actually causes Indigestion To be precise, indigestion has many causes that include disease conditions, side effects of certain medications, and an unhealthy lifestyle. Disease conditions include: ■ Ulcers ■ GERD ■ Gastroparesis (a condition when the stomach fails to empty itself appropriately; mostly occurring in people with diabetes) ■ Stomach infection ■ IBS ■ Chronic Pancreatitis ■ Thyroid problem ■ Malignant growth in the stomach (rather rare) ■ Pregnancy (Though not a disease condition) Side effects of certain medications include: ■ Aspirin and sundry other painkillers, such as NSAIDs like ibuprofen (Motrin, Advil) and naproxen. ■ Estrogen and oral contraceptives ■ Steroid medications ■ Some antibiotics ■ Thyroid medications Leading an unhealthy lifestyle, such as the following, also causes chronic indigestion: ■ Gluttony ■ Consuming high-fat food or spicy food ■ Eating late-night dinner ■ Alcoholism ■ Chain smoking ■ Lack of physical exercise Incidentally, some people have persistent indigestion that is unrelated to any of the above conditions and so are termed as Functional, or Non-ulcer dyspepsia. How to Prevent Indigestion Even though we are well acquainted with the adage that proclaims “Prevention is better than cure”, very few of us are aware of what actually prevents indigestion. However, obeying the following rules will help prevent indigestion and its accompanying uneasiness and discomfort. Instead of eating three heavy meals (Breakfast, Lunch, and Dinner), eat many smaller meals per day so that the digestive power of the stomach is not over-stressed. Stay away from food items that have given rise to indigestion in the past. Eat slowly; do not gulp. Cut down or avoid foods/beverages that contain caffeine. If stress triggers indigestion (according to experience), learn how to manage stress that includes Yoga or the Biofeedback technique. Cut back on alcohol consumption. Don’t go to bed immediately after dinner. Treatment of Indigestion When indigestion is caused by excessive stomach acid, ulcers, GERD, esophagitis, or gastritis, your doctor is likely to prescribe potent acid blockers for immediate relief that include: ■ Omeprazole ■ Lansoprazole ■ Rabeprazole ■ Pantoprazole ■ Esomeprazole A grouping of antibiotics as well as acid blockers may be prescribed for longer periods if the underlying cause is related to Helicobacter pylori (H. pylori). If, on the other hand, the underlying cause is found to be gastroparesis, a pro-motility drug such as Metoclopramide is often prescribed. If, however, the underlying cause of indigestion is related to depression or anxiety, antidepressants are routinely prescribed. Postscript Occasional bouts of indigestion and accompanying discomfort are mostly cured without the use of prescription medicine, but persistent spells of indigestion or chronic dyspepsia need thorough investigation and prolonged treatment by a gastroenterologist.
Belching: Causes, Symptoms & Diagnosis
Belching involves expulsion of gas from the esophagus (and stomach) through the mouth (after a meal), resulting in the distinctive resonance known as Burp! Among certain ethnic groups, dinner receptions are not considered gratifying unless the guests belch loudly while leaving the table. Nevertheless, we all belch after consuming a hearty meal, which provides some comfort and satisfaction as the expelled gas brings relief to the distended stomach somewhat filled by swallowed air. However, too much or excessive belching can be a cause of concern needing medical attention by a gastroenterologist, such as Dr. V.K. Rai, since there are several medical conditions that may cause this wacky malady, calling for prompt diagnosis and treatment, if necessary. Medical Conditions Causing Excessive Burping Hiatal Hernia – A hiatal hernia that causes excessive burping occurs if and when the upper part of a person’s stomach pushes up through the diaphragm, reaching the chest region. Normally, the stomach remains below the diaphragm, but in people with a hiatal hernia, a part of the stomach pushes up through the diaphragm, while the opening it moves through is called a hiatus, and hence the name. However, when part of the stomach pushes up through the diaphragm, it remains at the same level as the lungs. But when the pressure drops in the chest cavity due to muscle movement (as a person breathes in), the same effect happens in this part of the stomach, pulling air in. On breathing out, the chest pressure changes, the lungs expel the air, but the bizarrely located stomach does not want to let go, thus making it uncomfortable for the person who feels the urge to belch for relief. Hiatal hernia may be diagnosed by a Gastroenterologist such as Dr. V.K. Rai, MD, in the following ways… ■ Barium X-ray – The gastroenterologist may have you drink a liquid with barium in it before taking an X-ray. This X-ray provides a clear silhouette of your upper digestive tract. The image allows the gastroenterologist to see the location of your stomach. If it’s protruding through your diaphragm, you have a hiatal hernia. ■ Endoscopy – The gastroenterologist may slide a thin tube down your throat and pass it down to your esophagus and stomach. He/she will then be able to see if your stomach is pushing through your diaphragm. Any strangulation or obstruction will also be visible. GERD – Acid reflux or gastroesophageal reflux disease (GERD) can oftentimes cause excessive belching by promoting increased swallowing. Chronic belching may be related to inflammation of the stomach lining (gastritis) or to an infection with Helicobacter pylori, the bacterium responsible for some stomach ulcers. In these cases, the belching is accompanied by other symptoms, such as heartburn or abdominal pain. Diagnosing GERD involves three basic tests: (a) Upper Endoscopy, (b) Esophageal pH monitoring, and (c) Manometry, to be conducted by a gastroenterologist, such as Dr. V.K. Rai, MD for the following reasons. ■ Upper Endoscopy: An upper endoscopy can be used to determine the cause of heartburn and is often performed as an outpatient procedure. ■ Esophageal pH Test: The esophageal pH test is commonly used to help confirm the diagnosis of GERD or to identify the cause of various symptoms. ■ Esophageal Manometry: Esophageal manometry is an outpatient test that can identify problems with movement and pressure in the esophagus that may lead to problems like heartburn. Swallowing air – Bad or harmful habits cause excessive belching, too. These include overindulgence in drinking carbonated beverages, particularly when drinking with a ‘straw’. Also, people who eat and drink quickly, or when they are on the go. Chain smokers fall in this category in no uncertain way. Indigestion – Indigestion and heartburn can cause excessive belching, while the latter can stem from acid reflux, whether as a symptom of peptic ulcer, or a sign that last night’s spicy meal did not agree with your stomach lining. When acid moves back up the esophagus from the stomach, as in GERD, people often swallow frequently as a way to relieve some of the discomfort and then have to belch. Continuous swallowing causes more air to enter the system, which in turn causes more belching. Gastroparesis – A medical condition called gastroparesis can lead to excessive belching. Gastroparesis, sometimes referred to as delayed gastric emptying, is a condition in which food remains in the stomach longer than it should because the stomach’s muscles become weak or are damaged. Weak stomach muscles become unable to push food to the next stage of digestion. Undigested food that remains in the stomach can cause nausea, vomiting, and excessive burping, too. Postscript Belching is a normal human phenomenon associated with the ingestion of food and starts from the very primary stage, i.e., with newborn babies. However, when it gets beyond control or becomes unmanageably excessive, one needs medical intervention, especially by a senior Gastroenterologist like Dr. V.K. Rai.