heartburn

Heartburn or Acid Reflux Problem ?


14 Surprising Facts About Heart burn and GERD

KNOW ABOUT WHAT IS HEARTBURN/ACID REFLUX GERD / SYMPTOMS/CAUSES/COMPLICATIONS /DIAGNOSIS / FOODS TO AVOID IN HEARTBURN / LIFE STYLE CHANGES/ TREATMENT

HOW DOES HEARTBURN FEEL LIKE ?

Heartburn is typically described as a burning sensation in the retrosternal area ( behind sternum ), most commonly experienced in the postprandial (after food ) period .

When acid reflux and heartburn occur at least twice a week, a person may be diagnosed with Gastroesophageal Reflux Disease or GERD.

Over time, GERD damages the lining of the esophagus and may even cause a precancerous condition known as Barrett’s esophagus.

OTHER SYMPTOMS OF GASTROESOPHAGEAL REFLUX DISEASE / HEARTBURN :

●Stomach pain (pain in the upper abdomen)

●Non-burning chest pain

●Difficulty swallowing (called dysphagia), or food getting stuck

●Painful swallowing (called odynophagia)

●Persistent laryngitis/hoarseness

●Persistent sore throat

●Chronic cough, new onset asthma, or asthma only at night

●Regurgitation of foods/fluids; taste of acid in the throat

●Sense of a lump in the throat

●Worsening dental disease

●Recurrent lung infections (called pneumonia)

●Chronic sinusitis

●Waking up with a choking sensation

WORRISOME SYMPTOMS

Why Do We Worry? About Risk, The Future, & Fear of the Unknown

Alarm features that are suggestive of a gastrointestinal malignancy include:

●New onset of dyspepsia/ indigestion in patient ≥60 years

●Evidence of gastrointestinal bleeding (blood in vomit or blood in stool )

●Iron deficiency anemia

●Anorexia – decreased appetite

●Unexplained weight loss

●Dysphagia – difficulty in swallowing

●Odynophagia – painful swallowing

●Persistent vomiting

●Gastrointestinal cancer in a first-degree relative

WHO ARE AT RISK FOR HEARTBURN / GERD ?

CAUSES:

  • Lower oesophageal sphincter hypotension
  • Hiatus hernia : upper part of the stomach protrudes through the hiatus, the opening where the esophagus meets the stomach.
  • Esophageal dysmotility (eg systemic sclerosis),
  • Obesity
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Smoking
  • Alcohol
  • Pregnancy
  • Drugs (tricyclics, anti cholinergics, nitrates etc)
  • Helicobacter pylori infection

COMPLICATIONS OF GERD / HEARTBURN

Vast majority of patients do not develop GERD complications , particularly when reflux is adequately treated.

Ulcers — Ulcers can form in the esophagus as a result of burning from stomach acid. In some cases, bleeding occurs. You may not be aware of bleeding, but it may be detected in a stool sample to test for traces of blood that may not be visible. This test is performed by putting a small amount of stool on a chemically coated card.

Stricture — Damage from acid can cause the esophagus to scar and narrow, causing a blockage (stricture) that can cause food or pills to get stuck in the esophagus. The narrowing is caused by scar tissue that develops as a result of ulcers that repeatedly damage and then heal in the esophagus.

Esophageal Stricture secondary to Heartburn or GERD

Lung and throat problems — Some people reflux acid into the throat, causing inflammation of the vocal cords, a sore throat, or a hoarse voice. The acid can be inhaled into the lungs and cause a type of pneumonia (aspiration pneumonia) or asthma symptoms. Chronic acid reflux into the lungs may eventually cause permanent lung damage, called pulmonary fibrosis or bronchiectasis.

Barrett’s esophagus — Barrett’s esophagus occurs when the normal cells that line the lower esophagus (squamous cells) are replaced by a different cell type (intestinal cells). This process usually results from repeated damage to the esophageal lining, and the most common cause is longstanding gastroesophageal reflux disease. The intestinal cells have a small risk of transforming into cancer cells.

As a result, people with Barrett’s esophagus are advised to have a periodic endoscopy to monitor for early warning signs of cancer.

Esophageal cancer — There are two main types of esophageal cancer: adenocarcinoma and squamous cell carcinoma. A major risk factor for adenocarcinoma is Barrett’s esophagus, discussed above.

Squamous cell carcinoma does not appear to be related to GERD. Unfortunately, adenocarcinoma of the esophagus is on the rise in the United States and in many other countries.

However, only a small percentage of people with GERD will develop Barrett’s esophagus and an even smaller percentage will develop adenocarcinoma

Esophageal Cancer secondary to GERD or heartburn

DIAGNOSIS OF GERD / HEARTBURN

The diagnosis of gastroesophageal reflux disease (GERD) can often be based on clinical symptoms alone in patients with classic symptoms such as heartburn and/or regurgitation .

However, patients may require additional evaluation if they have alarm features, risk factors for Barrett’s esophagus, or abnormal gastrointestinal imaging performed for evaluation of their symptoms

Upper Gastro intestinal endoscopy is indicated in patients with suspected GERD to evaluate alarm features or abnormal imaging if not performed within the last three months

 Biopsies should target any areas of suspected metaplasia, dysplasia, or, in the absence of visual abnormalities, normal mucosa to evaluate for eosinophilic esophagitis

UGI endoscopy for heartburn or GERD

Esophageal manometry — Esophageal manometry involves swallowing a tube that measures the muscle contractions of the esophagus. This can help to determine if the lower esophageal sphincter is functioning properly

Ambulatory esophageal pH monitoring — Ambulatory pH monitoring is also used to confirm the diagnosis of GERD in those with persistent symptoms (whether typical or atypical, particularly if a trial of twice-daily Proton pump inhibitors has failed) or to monitor the adequacy of treatment in those with continued symptoms.

The test involves inserting a thin tube through the nose and into the esophagus. The tube is left in the esophagus for 24 hours. During this time the patient keeps a diary of symptoms.

The tube is attached to a small device that measures how often stomach acid is reaching the esophagus. The data are then analyzed to determine the frequency of reflux and the relationship of reflux to symptoms.

24-Hour pH monitoring for GERD or heartburn

TREATMENT OF GERD / HEARTBURN

Gastroesophageal reflux disease is treated according to its severity.

Mild symptoms — Initial treatments for mild acid reflux include dietary changes and using non-prescription medications, including antacids or histamine antagonists.

FOODS IN HEARTBURN :

FOODS THAT HARM
Fatty foods

3 Ways to Avoid Fat in Your Diet - wikiHow


FOODS THAT HEAL
Small meals at regular intervals

FOODS TO LIMIT
Alcohol
Caffeine and other caffeinated drinks
Chocolate
Spicy foods
Peppermint
Tomatoes
Pickles
Vinegar
Citrus fruits

TOP 8 DIETARY TIPS TO PREVENT HEARTBURN OR GERD

  • Eat small, frequent meals : You may be able to digest five to six smaller meals better than three large ones. Avoid eating within 2 hours of bedtime.
  • Eat a balanced, low-fat diet :The stomach will digest a low-fat diet that offers a balance of protein, starches, and fiber-rich vegetables and fruits more easily than fatty foods, which take longer to digest and thus slow down the rate of food emptying from the stomach.
  • Avoid acidic foods and drinks :Coffee, including decaffeinated brands, promotes high acid production; so do tea, cola drinks, and other sources of caffeine. Acidic foods include citrus fruit, tomatoes, pickles, and anything made with vinegar.
avoid cola drinks in heartburn
  • Avoid spicy foods : Omit from your diet other foods that tend to irritate your stomach or provoke bouts of indigestion. Avoid curries, hot peppers, and any other offenders that cause discomfort.
avoid spicy food in heartburn or GERD
  • Avoid foods that relax the diaphragmatic muscle : Chocolate or peppermint worsens indigestion by relaxing the sphincter muscle connecting the esophagus to the stomach.
Heartburn Food: Foods that can Trigger Heartburn | HeartburnBay.com
  • Limit alcohol intake : Alcohol can irritate the stomach lining.
  • Dine earlier in the evening : If you give yourself at least 3 hours between dinner and bedtime, your stomach is more likely to be empty when it’s time to lie down, so reflux is less likely to occur.
  • Chew non-mint gum for dessert :In the case of GERD, chewing gum stimulates you to produce more saliva, which contains bicarbonate. Gum chewing also increases your rate of swallowing. The saliva then neutralizes the acid in the esophagus—so you’re activating nature’s own antacid system. However, mint gums may cause the lower esophagus to relax, potentially allowing more stomach acid to rise.

NOTE :Avoid drugs affecting oesophageal motility (nitrates, anticholinergics, Ca2+ channel blockers—relax the lower oesophageal sphincter) or that damage mucosa (NSAIDS, K+ salts, bisphosphonates).

ALSO READ : https://www.thedoctips.com/tips-to-get-constipation-relief-know-what-is-constipation-causes-diagnosis-home-remedies-treatment/

TOP 9 LIFE STYLE CHANGES FOR HEARTBURN / GERD :

Why you shouldn't exercise to lose weight, explained with 60+ ...
  • Don’t smoke : Smoking increases stomach acid levels, and nicotine relaxes the sphincter muscle, which causes acid reflux.
File:No smoking sign.svg - Wikipedia
  • Sit up straight after meals : Bending over or lying down increases pressure on the stomach and promotes acid reflux.
  • Maintain a healthy weight :Extra weight around the abdomen pushes up your stomach and causes acid reflux in your esophagus.
  • Don’t wear tight-fitting clothes :Clothes that are too snug around the waist place additional pressure on your stomach.
  • Elevate your head at bedtime :If heartburn strikes frequently at night, raising the head 3 to 6 inches (8 to 15 cm) can help symptoms.
Intubate with the head of the bed elevated – emupdates
  • Sleep on your left side : This helps reduce pressure on your stomach, which is likely to reduce the chance of reflux.
  • Track your triggers : You have to know which foods trigger your symptoms.Foods that work well for one person may cause problems for another. Common foods that trigger GERD include chocolate, caffeinated beverages, and alcohol.
  • Keep a journal to note your symptoms : as you list foods and beverages for each meal, also note what else is going on. Write down symptoms and their frequency. Your diary should also note all medications taken, including supplements. Your doctor should review this diary to help identify specific contributing factors.

ANTACIDS

These are commonly used for short-term relief of acid reflux. However, the stomach acid is only neutralized very briefly after each dose, so they are not very effective.

Examples : magnesium trisilicate mixture – Dose -(10mL/8hourly), or Alginates, eg Gaviscon (10–20mL/8hourly Per oral ) relieve symptoms.

HISTAMINE ANTAGONISTS :

Histamine antagonists — The histamine antagonists reduce production of acid in the stomach. However, they are somewhat less effective than proton pump inhibitors (PPIs).

Examples of histamine antagonists available in the United States include ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet), and nizatidine (Axid). These medications are usually taken by mouth once or twice per day.

PROTON PUMP INHIBITORS

Proton pump inhibitors — PPIs include omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), and rabeprazole (AcipHex), which are stronger and more effective than the Histamine antagonists.

Once the optimal dose and type of PPI is found, you will probably be kept on the PPI for approximately eight weeks. Depending upon your symptoms after eight weeks, the medication dose may be decreased or discontinued.

If symptoms return within three months, long-term treatment is usually recommended.

If symptoms do not return within three months, treatment may be needed only intermittently.

The goal of treatment for GERD is to take the lowest possible dose of medication that controls symptoms and prevents complications.

Long-term risks of PPIs may include an increased risk of gut infections, such as Clostridium difficile (C. diff), or reduced absorption of minerals and nutrients.

WHAT TO DO NEXT IF SYMPTOMS ARE NOT CONTROLLED WITH ABOVE TREATMENT ?

 If your symptoms of gastroesophageal reflux disease are not adequately controlled with one PPI, one or more of the following may be recommended:

●An alternate PPI may be prescribed or the dose of the PPI may be increased

●The PPI may be given twice per day instead of once

●Further testing may be recommended to confirm the diagnosis and/or determine if another problem is causing symptoms

●Surgical treatment may be considered

WHAT SURGERY IS DONE ?

In general, anti-reflux surgery involves repairing the hiatus hernia and strengthening the lower esophageal sphincter.

The most common surgical treatment is the laparoscopic Nissen fundoplication. This procedure involves wrapping the upper part of the stomach around the lower end of the esophagus.

Although the outcome of surgery is usually good, complications can occur. Examples include persistent difficulty swallowing (occurring in about 5 percent of patients), a sense of bloating and gas (known as “gas-bloat syndrome”), breakdown of the repair (1 to 2 percent of patients per year), or diarrhea due to inadvertent injury to the nerves leading to the stomach and intestines.

CONCLUSION :

Heartburn is typically described as a burning sensation in the retrosternal area ( behind sternum ), most commonly experienced in the postprandial (after food ) period .

When acid reflux and heartburn occur at least twice a week, a person may be diagnosed with Gastroesophageal Reflux Disease or GERD.

WHO ARE AT RISK ?

CAUSES:

  • Lower oesophageal sphincter hypotension
  • Hiatus hernia : upper part of the stomach protrudes through the hiatus, the opening where the esophagus meets the stomach.
  • Esophageal dysmotility (eg systemic sclerosis),
  • Obesity
  • Gastric acid hypersecretion
  • Delayed gastric emptying
  • Smoking
  • Alcohol
  • Pregnancy
  • Drugs (tricyclics, anti cholinergics, nitrates etc)
  • Helicobacter pylori infection

COMPLICATIONS :

  • Ulcers
  • strictures
  • Aspiration pneumonia
  • Barrett’s esophagus
  • Esophageal cancer

DIAGNOSIS :

The diagnosis of gastroesophageal reflux disease (GERD) can often be based on clinical symptoms alone in patients with classic symptoms such as heartburn and/or regurgitation.

However, patients may require additional evaluation if they have alarm features, risk factors for Barrett’s esophagus, or abnormal gastrointestinal imaging performed for evaluation of their symptoms.

Following tests are usually done

  • Upper GI endoscopy
  • esophageal manometry
  • Ambulatory 24 hour pH monitoring

TREATMENT :

Mild symptoms — Initial treatments for mild acid reflux include dietary changes , Lifestyle changes and using non-prescription medications, including antacids or histamine antagonists.

The goal of treatment for GERD is to take the lowest possible dose of medication that controls symptoms and prevents complications.

Drugs commonly used :

  • Antacids
  • Histamine antagonists
  • proton pump inhibitors

Surgical treatment may be considered in patients with refractory symptoms.

Summary

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