GERD Blog

GERD (Gastroesophageal Reflux disease)

Gastroesophageal reflux is essentially the reflux or regurgitation of stomach contents back into the food pipe or esophagus. This is a normal process that occurs in otherwise healthy children, and adults. Most episodes are brief without causing any symptoms or problems. However, in some people, acid reflux can injure the esophagus and result in symptoms such as heartburn, vomiting, or pain when swallowing. This condition is called gastro esophageal reflux disease (GERD).
GERD occurs when the lower esophageal sphincter (LES) becomes weak or relaxes when it shouldn’t, thereby causing the stomach contents to rise up in the esophagus. Increased pressure on the abdomen due to excessive weight, obesity, pregnancy, and certain medicines such as those for asthma, calcium channel blockers, painkillers, sedatives, antidepressants and smoking, all contribute to the eventual weakening of the lower esophageal sphincter
The most common symptoms of GERD include heart burn, the regurgitation of food, chest fullness/ pain, feelings of excessive salivation and so on. Some patients also experience feelings of nausea, pain or the feeling of constantly having a lump in their throat, bad breath and the wearing down of their teeth. These symptoms are further exacerbated at night while lying down flat to sleep.
GERD can affect people of all ages, from infants to older adults. People with asthma are at a higher risk of developing GERD as asthma flare ups cause the stomach contents to flow back, or reflux into the esophagus. Conversely, acid reflux can make asthma symptoms worse by irritating the airways and the lungs. If one has both GERD and asthma, managing the GERD may help control the asthma symptoms.
Investigations may be necessary in some cases and may include Endoscopy (inserting a tube through the mouth to examine the inside of the esophagus), an X-ray of the upper digestive system, an ambulatory acid pH test (which monitors the amount of acid in the esophagus), and an esophageal impedance test (which measures the movement of the substances in the esophagus). If you have accompanying symptoms like persistent vomiting, loss of appetite, weight loss, difficulty in swallowing or vomiting blood etc. it is advisable to immediately see a doctor and get their advice.
Treatment for GERD starts with changes in lifestyle measures such as waiting for at least two hours after food before lying down, raising the head of the bed, avoiding tobacco, losing weight if overweight, decreasing alcohol intake, avoiding heavy meals, and decreasing caffeine intake.

However, the first step for treating GERD is to begin making the necessary dietary changes to help reduce the severity of your symptoms and give your body time to heal. It is important to consider which foods cause heartburn and discomfort and which foods don’t cause any painful symptoms at all. Few foods which are best avoided when on a GERD diet are spicy foods, trans fat and high-fat foods, very hot foods and liquid, mint and chocolate, alcohol and other foods which could be triggering an individual’s GERD. It should also be noted that each individual’s case is different and not everyone reacts the same way to particular foods. One needs to take the time to find out what ‘triggers’ theirs symptoms and make their own ‘safe to eat’ and ‘foods to avoid’ lists. It may take a little while before you fully understand your body’s reactions, but the most effective way to manage the condition is to “listen” to your body and work with it to devise a plan that will help in your specific situation. If these symptoms interfere with your daily life it is time to see your physician. Medications like proton pump inhibitors or histamine blockers may be necessary. Although sometimes in severe and intolerant cases, surgery may also be recommended.

Dr. Vijay Anand. V

Specialist Gastroentrologist

Aster Clinic, Al Qusais

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GERD – Symptoms and Prevention

GERD is a condition in which the stomach acid or contents from the stomach flow back into the food pipe (esophagus). The backwash (reflux) irritates the lining of the esophagus and causes GERD. Gastroesophageal refers to the stomach and the esophagus. While reflux refers to the back-flow of acidic or non-acidic stomach contents into the esophagus. A band of muscles at the junction of the stomach and esophagus called the lower esophageal sphincter (LES) normally act, in conjunction with the diaphragm, as a barrier to prevent the reflux of stomach contents into the esophagus. It is when that barrier is relaxed at inappropriate times or is otherwise compromised that reflux occurs.

GERD is characterized by symptoms and/or tissue damage that results from repeated or prolonged exposure of the lining of the esophagus to contents from the stomach. If tissue damage is present, the individual is said to have esophagitis or erosive GERD. The presence of symptoms with no evident tissue damage is referred to as non-erosive GERD.

GERD symptoms are often persistent, such as chronic heartburn and the regurgitation of acid. But sometimes there are no apparent symptoms, and the presence of GERD is revealed only when complications become evident. While the symptoms of GERD vary from person to person, the majority of people with GERD have mild symptoms, with no visible evidence of tissue damage and little risk of developing complications.

Periodic heartburn is a symptom that many people experience. If it occurs occasionally just after a meal and less than once per week, it is likely a “benign” condition. However heartburn that occurs more frequently than once a week, becomes more severe, or occurs at night and wakes a person from sleep, may be a sign of a more serious condition and consultation with a physician is advised. Even occasional heartburn – if it has occurred for a period of 5 years or more, or is associated with difficulty in swallowing– may signal a more serious condition. People with long standing chronic heartburn are at greater risk for complications including stricture or a potentially pre-cancerous disease that involves a cellular change in the esophagus called Barrett’s esophagus.

Persistent chronic heartburn and acid regurgitation are the most common symptom of GERD. But there are numerous less common symptoms that also may be associated with GERD. These may include:

  • Belching
  • Difficulty or pain when swallowing
  • Water brash (sudden excess of saliva)
  • Dysphagia (the sensation of food sticking in the esophagus)
  • Chronic sore throat
  • Laryngitis
  • Inflammation of the gums
  • Erosion of the enamel of the teeth
  • Chronic irritation in the throat
  • Hoarseness in the morning
  • A sour taste
  • Bad breath

Chest pain may also indicate acid reflux. Nevertheless, this kind of pain or discomfort should prompt urgent medical evaluation in order to exclude possible heart conditions. Relief of symptoms after a two-week trial therapy with a proton pump inhibitor (a prescription medication that inhibits gastric acid secretion) is an indication that GERD is the cause. This can also be confirmed with pH monitoring, which measures the level of acid refluxing into the esophagus and as high as the larynx.

On the positive side, since GERD is a lifestyle disorder, making significant changes in your lifestyle and eating habits can greatly reduce the impact of GERD or even prevent its onset to begin with. Here are 10 tips you can try to prevent GERD.

  1. Lose weight. Obesity is the leading cause of GERD because the extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus.
  2. Avoid foods known to cause reflux.If you’re at risk for GERD, avoid:
    • Fatty foods
    • Spicy foods
    • Acidic foods, like tomatoes and citrus
    • Mint
    • Chocolate
    • Onions
    • Coffee or any caffeinated beverage
    • Carbonated beverages
  3. Eat smaller meals.Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
  4. Don’t lie down after eating.Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.
  5. Elevate your bed.Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.
  6. Review your medications.There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus. These medications include:
    • Non-steroidal anti-inflammatory drugs, or NSAIDs
    • Calcium channel blockers (often used to treat high blood pressure)
    • Certain asthma medications, including beta-agonists like albuterol
    • Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
    • Bisphosphonates, used to boost bone density
    • Sedatives and painkillers
    • Some antibiotics
    • Potassium
    • Iron tablets

If you are taking any of these medications, talk to your doctor about switching to another drug that does not have the same effect on the upper digestive tract. However, never stop taking a prescribed medication without first consulting your doctor.

  1. Quit smoking.Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.
  2. Cut back on alcohol.As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
  3. Wear loose-fitting clothes.Do not wear tight clothing or belts that can constrict your stomach.

In the UAE itself, there has been a rise in the incidents of patients suffering from some degree of GERD. Specialists at Aster Hospital and Clinic often receive 2 to 3 patients a day with GERD. In the last 1.8 years, they have treated around 320 patients with the condition. Aster Hospital and Clinic has initiated a “GERD Awareness Campaign” to educate the residents of UAE on alarming symptoms or critical symptoms associated with the disease which, if noted, should prompt medical attention. Through dedicated programmes for the general population, Aster aims to encourage early diagnosis and proper treatment in order to improve the quality of life of people suffering from the condition.

 

Dr. Sabu Antony

Specialist Gastroenterologist

Aster Clinic, Bur Dubai (AJMC)

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High Incidence of GERD in UAE

According to Healthline, up to 60 percent of the adult population worldwide experiences some form of acid reflux and about 20 to 30 percent of people complain about having weekly symptoms in a 12 month period.

An increasingly common digestive disorder, gastroesophageal reflux disease (GERD) occurs when the stomach acid or contents of the stomach make their way back into the esophagus (food pipe). This backwash creates a feeling of uneasiness and irritates the esophageal lining resulting in severe heartburn, which is the primary indicator of having GERD.

According to the Scientific and Research Committee of the Emirates Gastroenterology Society, as of 2014, more than 30 percent of the population of UAE suffered from acid reflux.

The most common signs and symptoms of GERD include a burning sensation in the chest (heartburn) which sometimes spreads to the throat along with a sour taste in the mouth, chest pain, difficulty in swallowing, dry cough, hoarseness of voice or a sore throat, the sensation of a lump in the throat etc.

The primary causes of GERD rest on an individual’s eating habits. However, there are also other factors that can exacerbate the symptoms of GERD, such as obesity, smoking and heavy consumption of alcohol and caffeine.

UAE has seen a rise in the cases for chronic GERD over the last decade. The concurrent rise in obesity rates is a cause that has contributed the most to the alarming rise in GERD. According to a disease study report, obesity in UAE is double the world’s average. A report entitled “Global Burden of Disease Study 2013” shows that over 66% of men and 60% of women living in the UAE are obese or overweight. Almost 47.5 percent of UAE residents are overweight, with a BMI between 25 and 30 and about 13 % are obese with a BMI of over 30.

Obesity is the accumulation of body fat to a degree that it makes a person more susceptible to diseases and health problems, one of which is the prevalence of GERD. Studies indicate that obese individuals are three times more likely to have heartburn than people with normal weight, because the extra fat around the belly increases the pressure on the stomach, forcing the stomach acid to back up into the esophagus. Obesity also increases the risk of having fatty liver, a condition describing the buildup of fat (adipose tissue) in the liver. Individuals who have fatty liver are also at a greater risk of being diagnosed with GERD.

Obesity is the result of risk factors such as genetics, lifestyle, inactivity, unhealthy diet, medical problems, certain medications etc. The rise in the consumption of fast food explains the rise in the levels of obesity across the UAE. Long working hours coupled with the lack of time to cook and eat healthy, has caused people to gravitate towards fast food.

Furthermore, due to the extremely hot summers that last for nearly half the year, residents of UAE do not engage in too many physical activities or sports. The scorching temperatures prevent people from walking or cycling to their destinations, resulting in them using air conditioned cars everywhere they go. Lack of physical activity coupled with the rampant fast food consumption has resulted in UAE having one of the highest rates of obesity in the world, which has, in turn, caused the prevalence of GERD in nearly 3 million people across the seven Emirates.

Another key factor in rising levels of GERD cases amongst UAE residents, is the high rates of smoking present in the UAE. According to the WHO report on the “Global Tobacco Epidemic”, 12.8 percent of adults in the UAE smoked some form of tobacco daily. Doctors say that smoking contributes to GERD by relaxing the lower esophageal sphincter (a ring of muscle connecting the esophagus and stomach) which is one of the body’s main defences against GERD. Smoking also reduces  saliva, that contains an acid-neutralizing substance called bicarbonate, which is a natural antacid. Smoking is harmful to mucus membranes that help protect the esophagus from acid damage. It also prompts the stomach to produce more acid, increasing the risk of gastric juices being refluxed into the esophagus.

The symptoms of GERD can be prevented by simple changes that individuals can make in their everyday lifestyle. A change in one’s diet can be a great help. Furthermore, by quitting smoking an individual can not only greatly reduce their chances of getting heartburn and GERD but also eliminate the possibility of being diagnosed with pulmonary disorders.

 

Dr . Amal Premchandra Upadhyay

Consultant in Gastroenterology

Aster Hospital Mankhool

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The link between GERD and Fatty Liver

According to research done by the Emirates Gastroenterology Society, UAE is on the list of countries that are severely affected by GERD. Gastroesophageal reflux disease, commonly known as GERD is a chronic digestive disorder affecting around 3 million people in the U.A.E today.

GERD is a condition in which the stomach acid or occasionally, contents from the stomach, flow back into the food pipe (esophagus). The backwash (reflux) irritates the lining of the esophagus and causes GERD. The most common indication of having developed this condition is the presence of heart burn. Other symptoms include chest pain, difficulty in swallowing, dry cough, hoarseness of voice or a sore throat and the sensation of having a lump in the throat.

GERD being a digestive disorder, the primary causes of the condition involve a person’s dietary habits. In a country like U.A.E, with a number of residents experiencing long working hours coupled with a propensity to limit their consumption of home cooked meals, GERD cases have risen over the years. The advent of a number of fast food chains and unhealthy and untimely eating habits, smoking, consumption of caffeinated products and alcohol has resulted in increasing incidents of acidity and heartburn. The condition is further exacerbated in individuals who are overweight or obese. Studies indicate that obese individuals are three times more likely to have heartburn than people with normal weight, because the extra fat around the belly increases the pressure on the stomach, forcing the stomach acid to back up into the esophagus. Obesity also increases the risk of having fatty liver, a condition describing the buildup of fat (adipose tissue) in the liver. While it is normal for the liver to have some amount of fat, a fat buildup of more than 5 to 10 percent of the organs weight is called fatty liver. Individuals who have fatty liver, are at a greater risk of being diagnosed with GERD.

Fatty liver disease is of two types, Alcohol Liver Disease (ALD), that manifests itself through the excessive use and abuse of alcohol and Non-Alcoholic Fatty Liver Disease (NAFLD) which is far more common. Both these conditions involve the accumulation of fat in the liver, leading to enlargement of the organ.

NAFLD has been found to be an independent risk factor for GERD. A study conducted by the University of Catania in 2014, involving 206 patients diagnosed with NAFLD, revealed that the presence of typical symptoms of GERD was higher is those with NAFLD.

NAFLD is usually asymptomatic and causes patients to run the risk of developing insulin resistance, liver inflammation and scarring, and even liver failure, if not diagnosed on time. This condition may be caused due to genetic factors, obesity, diabetes, side effects of medicines or hyperlipidemia which is excess cholesterol in the blood.

GERD and NAFLD are both more prevalent in obese individuals. Prevalence of both these conditions in the U.A.E can be traced back to the high rates of obesity in the society.  A 2015 survey conducted by Zurich International Life, ascertained that 47.5% of all U.A.E. residents were over-weight with 13% of all residents being obese. Furthermore, a profile on the U.A. E. by Health and Data listed high body mass index (BMI) as the 2nd most prevalent risk factor in deaths and disabilities, and this includes conditions like GERD.

Since GERD and NAFLD are largely lifestyle disorders, they are preventable to a great extent. Medical management of GERD and NAFLD include lifestyle changes, which primarily entails an individual to ensure that their lifestyle is structured in a way to avoid falling into the vicious cycle of weight gain, elevated BMI and obesity. The easiest and most important step an individual can take to prevent GERD, NAFLD and weight gain is to adopt a healthy, balanced diet. Focusing on what we eat, how much we eat and when we eat, can significantly lower the risks of contracting disorders like GERD.

For those who seek to lose weight, a healthy diet coupled with frequent exercise would pay large dividends in terms of the quality of the life you lead. Avoiding food that triggers the conditions and reducing consumption of alcohol, caffeine and cigarettes would not only alleviate heartburn and indigestion but would also significantly reduce the risk of liver disease.

Effective medicines are available for management of reflux.

For those patients who are unable to take these medications, surgery is an option that can provide long-term relief.

Despite the frequency in its prevalence, GERD is manageable and preventable if one adopts a healthy and balanced approach in all facets of their lifestyle. This becomes even more important for those who are already diagnosed with some degree of GERD, because just like any other disorder, GERD too can have detrimental long term effects, if not treated at the earliest.

 

Dr. Amal Premchandra Upadhyay

Consultant in Gastroenterology

Aster Hospital Mankhool

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Bad Breath, a silent symptom of GERD.

If regular brushing, flossing and popping innumerable breath mints does not work for bad breath, it is time to realise that the problem is deeper and beyond the mouth. GERD has a definite link to bad breath which is a rather embarrassing problem, causes for which sometimes can be medical.

Gastroesophageal reflux disease, better known as GERD is a chronic digestive disease that occurs when the acids of the stomach generally flow back into the food pipe or esophagus, this reaction irritates the esophagus hence causing GERD. The acid moving back into the esophagus may cause a burning sensation, discomfort and tissue damage. With reflux, an enzyme called ‘pepsin’ enters the throat which causes unpleasant breath.

Studies show that over 30% of the UAE population suffers from acid reflux with various studies revealing that there is 15-40% prevalence of GERD among various populations. Although this could be misjudged because a lot of times GERD may be asymptomatic in some patients and may present atypical symptoms in others. The condition generally affects people over the age of 60 but the number of people of different ages affected by the disease is on the rise both locally and globally. The burden of the disease is enormous, affecting the quality of life, physical, emotional and social well-being of patients.

Despite the high prevalence of GERD, there is the serious lack of awareness about the condition among the population. People are generally less aware of GERD when it presents with atypical symptoms.

GERD has a number of reasons to its cause. Modern lifestyles leading to high levels of stress, extremely high consumption of rich and fatty foods and lack of any physical activity are few of the lifestyle factors that make people susceptible to GERD.

GERD is caused when the esophagus becomes weak or relaxes when it shouldn’t, hence causing the contents of the stomach to rise up. Weakening or relaxation of the esophagus is caused due to increased pressure on the abdomen from being obese/ overweight, certain medications may cause the same to happen or smoking could be the cause. Hiatal Hernia is a condition which a part of the stomach pushes upward through the diaphragm. The diaphragm originally has a small opening through which the food pipe is connected to the stomach. This condition cause the stomach to move up into the chest, hence making the natural anti-reflux mechanism weak or incompetent.

Healthy adults may experience GERD either as heartburn or acid regurgitation or it may even go unnoticed, being asymptomatic.

GERD may cause a number of symptoms like burning sensation in the chest or throat or frequent heartburn, sore throat, bitter taste in the mouth, coarse voice, persistent cough, difficulty in swallowing, nausea, bloating etc.

Foul smelling breath, respiratory problems, vomiting, wearing away of teeth etc are other symptoms that are caused by GERD.

Certain lifestyle changes like maintaining an optimum weight, avoiding foods that trigger heart burn, eating smaller portions of meals, quitting smoking etc. may help reduce the incidence of heartburn.

Effective medicines for treating GERD are available, and most patients can be managed well with simply a couple of pills a day. A small percentage of patients will have severe/refractory reflux. Some of these patients might even develop complications like scarring/stricture of the food pipe, or a more sinister change called Barrett’s esophagus. Patients who are inadequately controlled with medicines or who cannot take these pills for whatever reason have the option to be treated with a surgery that attempts to correct the junction between the esophagus and the stomach.

There are no alternative medicines or therapies for the treatment and prevention of GERD. Lifestyle changes are advisable to reduce the risk of any disease including GERD. Medicine and alternative therapies may provide relief but surgery is the ultimate cure for GERD.

 

Dr. Amal Premchandra Upadhyay

Consultant in Gastroenterology

Aster Hopsital, Mankhool.

 

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