The most common symptoms of indigestion (dyspepsia)

Indigestion or dyspepsia-is a general feeling of discomfort in your upper abdomen. It may be an unpleasant or even painful sensation in the top of the abdomen or lower part of the chest, which usually comes after eating or drinking. Indigestion is a symptom but not a disease as such.

Symptoms

People with indigestion may have one or more of the following symptoms:

  • Abdominal burn
  • Bloating/feeling of distension in the upper abdomen.
  • Nausea.
  • Early fullness while eating.
  • Feeling uncomfortable after eating

When to see a doctor

Consult your doctor if discomfort persists for more than two weeks. Contact your doctor right away if pain is severe or there is

  • Reduced appetite
  • Unintentional weight loss
  • Recurrent vomiting or vomiting with blood
  • Black, tar-like stool
  • Difficulty in  swallowing
  • Fatigue or weakness

 

 

 

 

 

 

 

 

 

 

 

Dr. Vijay Anand

Specialist Gastroenterologist

Aster Clinic, Al Qusais (Damascus St.)

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Heartburn During Pregnancy

Many women experience heartburn for the first time during pregnancy, although rather common and mostly harmless it can be very disturbing. The increase in acidity and heartburn is, in fact, one of the lesser discussed side-effects of pregnancy. Pregnant women, more often than not, are subject to symptoms of heartburn, which usually begins sometime around their second or third trimester and carries on until the end of their pregnancy.

Heartburn is a burning sensation that begins from a person’s stomach and extends till their chest. The lower esophagus that keeps the content of the stomach in place, leaks or becomes weak and lets the acids flow back into the esophagus, hence causing a fiery sensation.

Pregnant women are prone to heartburn and acid reflux for two main reasons; an increase in the amount of progesterone that their body produces during the course of a pregnancy. The change in hormone levels causes the lower esophageal sphincter to relax, resulting in the backwash. Another reason for the increased incidence is the fact that the growing uterus can crowd the abdomen, putting pressure on the stomach and the lower esophagus and forces the stomach acids upwards. These are not the only reasons for heartburn, however, these are most common reasons. Many women experience gastrointestinal issues during their pregnancy that comes and goes during the course until the baby is born.

Despite the inevitability of experiencing heartburn during pregnancy, there are a number of ways to manage and reduce heartburn during pregnancy. Certain common lifestyle changes can help self-manage heartburn during the course of pregnancy.

  • Eat slow and small meals: Eating smaller meals with an adequate interval between them as opposed to a few large meals can greatly help in reducing the effects of heartburn and acidity. Eating your food slowly allows your stomach to better digest the food and also prevents you from overeating. These steps go a long way in calming the acidity that might flare up during and after meals.
  • Drink water before meals: Sipping on a glass of water before meals would not only help you increase your fluid intake, but also give you a sense of fullness that might prevent you from overindulging during your meals. Intake of fluids should be before or after meals rather than during meals.
  • Stand or walk after your meals: It is strongly suggested to stand or walk around for a brief period of time, rather than simply sitting or lying down. Some light activity after meals can help quicken digestion.
  • Do not go to bed right after eating: Despite the fatigue that accompanies pregnancy, doctors say that going to bed right after eating a meal, heavy or light, can exacerbate the symptoms of heartburn. The suggested time period of having a meal is 3 hours before bedtime. This gives the body enough time to begin digestion and prevent the reflux of stomach contents while you sleep.
  • Elevate your head and chest while sleeping: Putting blocks under the legs of your bed can help in elevating your upper body while you sleep. This prevents the backwash or reflux of the stomach acids up to your esophagus.
  • Understand your triggers and avoid it: Different foods elevate heartburn symptoms in different women. It is important to identify and avoid those food items.
  • Wear loose fitting clothes: The growing fetus is already putting pressure on your stomach. Added to which, tight fitting clothes would only serve to add to that pressure on your already crammed abdomen. Wearing loose fitting or maternity clothes from an early stage in your pregnancy can help your stomach and abdomen area have some room to breathe.

There are also certain home remedies to relieve the symptoms of heartburn. Antacids can also be considered, however only after consulting with a gynaecologist. Heartburn during pregnancy is not something that has to be dealt with silently. A few changes in lifestyle practices can help towards ensuring a smooth and heartburn free pregnancy.

 

Dr.Prakash B Shankar 

Specialist Gastroenterologist

Aster Speciality Clinic, International City 

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*Aster Clinics are currently running special GERD clinics on Mondays and Thursdays. For more information and appointments, visit – http://asterclinic.ae/gerd-gastroesophageal-reflux-disease/

 

 

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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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