July and August call for travel plans, as children have their summer vacations and all of us look forward to vacations during this time of the year to beat the scorching heat in UAE. Vacations are an exciting time for all, with your bags packed and tickets booked, you may not be able to hold your excitement to get onto the plane that takes you to your destination. However are you forgetting one of the most important thing before travelling, particularly while travelling with kids? Do you ever visit your doctor before leaving for your vacation?
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
Aster Clinic, Al Qusais
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:
- Difficulty or pain when swallowing
- Water brash (sudden excess of saliva)
- Dysphagia (the sensation of food sticking in the esophagus)
- Chronic sore throat
- 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.
- 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.
- Avoid foods known to cause reflux.If you’re at risk for GERD, avoid:
- Fatty foods
- Spicy foods
- Acidic foods, like tomatoes and citrus
- Coffee or any caffeinated beverage
- Carbonated beverages
- Eat smaller meals.Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.
- 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.
- 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.
- 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
- 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.
- 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.
- Cut back on alcohol.As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.
- 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
Aster Clinic, Bur Dubai (AJMC)