Of course the first statement is just a common saying, having nothing to do with your heart. Similarly “heartburn” refers to a burning sensation you feel in your chest affecting the esophagus (the gullet), which is in the center of your chest behind your sternum. Your heart is on your left side.
GERD is the acronym for gastroesophageal reflux disease. In a nutshell, it means that acidic contents from your stomach, and duodenum, enter your esophagus when really they shouldn’t. It ought to be a one-way system, whereby whatever you eat and drink go downward until they find their way into your toilet.
There is a sphincter, a ring of muscle, at the junction of your esophagus and stomach, which opens as food and liquid is ingested. That should be the only time. Besides that, it should always be closed. However, if the sphincter is incompetent and opens under certain situations, stomach contents, acid, will go up through (reflux) the sphincter into your esophagus and even further upwards. And what does acid do? You got it, it burns. And it can cause serious damage, we know that. By the way, some people use the term dyspepsia for heartburn, or even acid indigestion.
WHAT CAUSES GERD?
*Inappropriate relaxation of the lower esophageal sphincter (LES) is a cause and, in fact, the mechanism. There is an upper esophageal sphincter, as you’ve guessed but it is unimportant for our little discussion today.
*Chronic belching. I bet a lot of you didn’t know that. Swallowing a lot of air, called aerophagia, is also causative. Whenever you swallow saliva, chew gum, talk a lot, and get very nervous often, this happens.
*Genes appear to play a role, so it can run in families.
*Pregnancy. This may be easy to understand, when you consider that as a baby grows bigger and pushes on the stomach, the sphincter may eventually be compromised. Besides, one of the hormones of pregnancy, progesterone, causes the sphincter, or valve, to relax.
*Scleroderma, progressive systemic sclerosis, is a disease which causes stiffening and loss of elasticity of certain body structures. These structures happen to be involved.
*Chalasia of infancy. We will talk about the circumstances of babies shortly.
*Heller’s myotomy (a surgical procedure) for achalasia, a problem with the esophagus which effectively narrows it.
*Zollinger-Ellison syndrome, in which there is hyper-secretion of acid and resulting ulcers throughout the GI tract
CAN I PREVENT GERD?
Only if you can prevent the causes just listed. Well men are safe where pregnancy is concerned. And maybe the operation I mentioned may not be necessary for most people-achalasia is not that common.
WHAT CAN I DO IF I HAVE IT?
It turns out there are several things you can do and not do to alleviate your symptoms.
1) Don’t eat too fast.
2) Avoid spicy, acidic foods. Also fatty foods like chocolate and citrus fruits and fruit juices. Tomato based foods should also be avoided. They are good for the prostate, but not for GERD. You just can’t have it both ways in this world these days.
3) Watch your weight. Being overweight increases pressure within your abdominal cavity and this aggravates reflux.
4) Don’t gorge yourself at mealtime. Eat moderate amounts of food.
5) Limit your intake of coffee, tea, alcohol, and colas.
6) Don’t exercise too soon after eating.
7) Stop, or cut down on, smoking.
8) Avoid bedtime snacks and eat meals at least 3 to 4 hours before lying down.
9) Elevate the head of your bed with blocks. About 6 inches will do. Using extra pillows does not give the same effect; please bear this in mind. You see, if you lie flat the effect of gravity will drive the acid upwards even more. Elevating your head will counteract that effect.
10) See you physician if you are taking antacids to relieve the problem three or more times a week. It makes sense that you should take antacids. More on this just now.
WHAT DRUGS ARE AVAILABLE?
Because the burning and all the discomfort and even the bitter taste in your mouth is caused by stomach acid, one wants to reduce it or neutralize it. So antacids taken when necessary or between meals and at bedtime are useful. You know them: Diovol, Mylanta, Maalox, Gaviscon, Tums. In addition doctors prescribe two types of drugs which reduce acid production in your stomach. One type is called H2 receptor antagonists and the other proton-pump inhibitors. The former types are your Tagamet (Cimetidine), Zantac (Ranitidine), Pepcid (Famotidine) and one or two others which are not common around here. The latter include Losec (Omeprazole), Nexium (Esomeprazole) and Lansoprazole.
One does not get rid of all your acid because it is necessary for the absorption of Vitamin B12 and to break down some of your food into manageable molecules. It is also necessary as a defense, first line, against bacteria and other foreign bodies. In fact although the mechanism by which it occurs is not known, the proton-pump inhibitors have recently been associated with pneumonia in some persons. It may be because too much acid suppression causes proliferation of bacteria. But how they get to the lung is still a matter for speculation. A human just cannot have it both ways. Drugs are also given to speed up mobility of upper GI contents downwards, so that less or no reflux occurs.
WHAT ARE GERD’S CONSEQUENCES?
If acid keeps attacking your esophagus, it is going to do some serious damage. Over a period of time, it will erode it, you will be said to have erosive esophagitis and this can be
serious, so this is why it must be treated, and treated aggressively early.
Acid can regurgitate as far upwards as your throat and spill over into you lung’s entrance and down into the lung. Pneumonia, especially in babies and infants, may be the result. Believe me; one does not want for this to happen.
A LITTLE MORE SCIENCE
What may feel like GERD, that is, heartburn, dyspepsia, acid indigestion may actually be a hernia of a part of your stomach from your abdominal cavity into your chest cavity. A defect in your diaphragm will allow this to occur. You may have a rolling or a sliding hernia, depending on the part of the stomach that has herniated. The diaphragm separates the two areas – abdomen from chest – and is crucial in respiration. When you take a breath, it descends to allow more space for your lungs to take more air in. When you exhale; it ascends to decrease the size of the chest cavity to expel the lung’s contents. For a hernia, surgery is necessary if symptoms are severe, as it may be for a severe GERD to essentially tighten the sphincter muscles at the esophagus-stomach junction.
WHAT ABOUT THE YOUNG ONES?
I will mention just a few pertinent points regarding infants, who can also have GERD. Vomiting and fussiness after feeding may, in fact, be signs of this. Most kids will outgrow it without medication, but some need aggressive treatments.
It’s normal to occasionally spit up small amounts following a feeding, especially when being burped. With GERD, it tends to be more forceful, sometimes it’s a ‘wet burp.’
One of the problems which can occur because of spill- over of acid into the lungs is pneumonia. The infant may also have periods of apnea (failure to breath) which, obviously, can lead to sudden death.
SIGNS TO WATCH OUT FOR
• An infant who cries constantly or suddenly. This is an uncomfortable child. Sometimes this may be mistaken for colic.
• Vomiting more than one hour after eating.
• Symptoms persisting for more than one year, when most children would be growing out of it.
• Poor sleep.
• Refusing food, even when obviously hungry.
• Wet burps or hiccups.
• Failure to gain weight or weight loss.
• Frequent sore throat.
• Respiratory problems (bronchitis, pneumonia)
• Bad breath.
WHAT TO DO FOR THE KIDS
There is no real consensus on this. Some advocate certain type of formula, and to thicken expressed breast milk or formula.
Some may require medication or even surgery.
Caring for the children with GERD includes feeding in the vertical position, burping frequently but not too forcefully, and holding or sitting them upright after meals.
See you next week.
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