| Living with GERD* |
| Written by Thomas Gibson | |
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GERD can even cause earaches and halitosis (bad breath). None of these symptoms are in themselves life-threatening. They often subside when patients adjust their diet and exercise regimes, and take medicine. For the more severe cases, surgery can stop acid reflux from hurting the esophagus. The lining of the stomach produces acids that help in digesting food, and keep stomach bacteria from running wild and destroying body organs. One of the functions of the liver is to break down cholesterol molecules in our blood, and convert them to sodium-based bile salts such as taurochlorate and glycholate. These bile salts are then used by the intestine to contain and emulsify fat. In healthy people, stomach acids and bile salts are secreted and used in the digestive system, then quickly recycled. GERD patients, however, have creakier and more inefficient digestive systems than healthy people. Healthy people trap acid in their stomachs with the lower esophageal sphincter (LES), a circle of muscle, which opens only when they swallow. A weak or overly relaxed sphincter allows stomach acid to spill into the intestine and esophagus and cause heartburn. If a person with GERD also has a hiatal hernia, in which the stomach pushes up against the chest and diaphragm, the symptoms get even worse because the intestines become crowded. The food being digested, and the stomach acids and bile salts that keep digestion going, cannot both fit in the available space, so they leak into the esophagus, disrupting the digestion, and as a result, patients experience a burning feeling in the breast and esophagus area. Doctors usually diagnose GERD with an esophagoscopy and a biopsy. They use an endoscope to look at the esophagus, and take a sample of esophageal tissue to examine for evidence of acid reflux. Since esophageal cancer can have symptoms similar to GERD, they may also look for cancerous cells or dysplasia (signs of pre-cancerous abnormalities in the cells). GERD symptoms cause some discomfort at the very least, and they are often extremely painful. The best way to avoid the condition is through a familiar litany of lifestyle changes -- losing five to ten pounds of extra weight, getting more exercise, and giving up substances that can increase the likelihood of GERD such as alcohol, tobacco, mint or chocolate. These products are dangerous because they loosen the muscles that separate the stomach from the esophagus. It may also help to cut down on spicy and acid-rich foods, like oranges, tomatoes, coffee or salsa. However, food and drink are not the only causes of GERD. Heartburn and acid reflux are sometimes the side effects of medication. Some of the prescription medications that could cause GERD include:
Given that so many medicines and lifestyle habits lend themselves to GERD, it is important for patients to learn home-based prevention techniques. When symptoms persist for more than two weeks, it’s time to consult with a physician so the leaking stomach acids don't cause permanent harm to the esophagus. Other options to try at this point can include a new eating schedule -- lots of small meals instead of three big ones, no more midnight snacks. During daytime, one way to fight off GERD symptoms is to wear loose-fitting clothes that lighten up pressure on the stomach. If acid reflux hits hard at night, patients may be able to ease symptoms by changing their sleeping positions. They can make use of the force of gravity by raising the heads of their beds eight inches, using solid wood blocks or foam wedges, rather than soft pillows that will flatten under the weight of the head. In this way, the body is better positioned for stomach acids and bile salts to fall back into the stomach where they belong. In addition to the measures mentioned above --changing clothes, eating habits and sleeping positions, exercising more often and easing up on the consumption of substances (medical and not) that provoke heartburn --- patients can also fight persistent, frequent GERD with over-the-counter antacids, proton pump inhibitors, or H2 blockers, such as Prilosec, Tums, or Pepcid. Of these medicines, the only one that works its magic for 24 hours a day is Prilosec OTC, and for this reason it may be the best choice. H2 blockers prevent stomach acid production. In high, prescription-level doses, they help to tame heartburn symptoms, but they tend to be ineffective with inflammation of the esophagus, or esophagitis. Patients should take them half an hour before meals and just before going to bed so the body won't produce acid at night. In addition to Pepcid, other easily available H2 blockers include Tagamet, Zantac and Axid. Proton Pump Inhibitors (PPIs) such as Protonix, Prevacid, Nexium, Aciphex, or Zegerid are stronger than H2 blockers, and may stop the body from producing any acid at all. Patients should take them an hour before eating. Both H2 blockers and proton pump inhibitors can help the esophagus heal by shielding it from corrosion by acid, but there are side effects when the body doesn't produce the stomach acids it uses to digest. Patients should be prepared for side effects when taking H2 blockers -- they should expect to get dizzy, nauseous, gassy, and full of aches. The medication can cause pain in the abdomen, headaches, a runny nose and sore throat, and diarrhea. Another option for treating GERD is a promotility agent, which stimulates intestinal muscles and strengthens the sphincter at the bottom of the esophagus so acids leave the stomach more quickly. However, this type of drug has a checkered safety record. One promotility agent, Reglan, has severe side effects such as fatigue, restlessness, and diarrhea, and another, Propulsid, caused irregular heartbeat (arrhythmia) and was taken off the market. Whether patients go for medicine or for home treatment, the important thing is to get treatment. GERD unchecked can cause severe illnesses such as bleeding, ulcers or esophagitis, and it increases the risk of cancer. * This article is based on the information at http://www.mayoclinic.com/health/gerd/, http://www.nlm.nih.gov/medlineplus/ency/article/000265.htm, http://www.webmd.com/heartburn-gerd/tc/gastroesophageal-reflux-disease-gerd-symptoms, http://www.gerd.com/, ttp://www.medicinenet.com/gastroesophageal_reflux_disease_gerd/article.htm |
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