Heartburn Relief Through Drugs

Mild cases of heartburn can be cured through over the counter antacids such as Tums or Gaviscon. These are sufficient for occasional outbreaks, but should not be used where heartburn occurs more than two or three times a week, due to the risk of kidney damage.

For more severe or chronic cases of heartburn, histamine receptor blockers such as Pepcid AC or Zantac can provide ongoing relief. They stops the making of stomach acid. They do not provide instant relief, taking 45 minutes to an hour to work and so are best taken either on a daily basis or an hour before you eat that 5-alarm chili that you know you’re going to regret later! The long term effects of histamine receptor blockers are unknown, but some researchers fear that an ongoing reduction in the overall acidity of the stomach could lead to the patient being more susceptible to infections.

More recently, combined antacids and histamine receptor blockers have appeared on the market, led by Pepcid Complete. These combine the advantages (and the drawbacks) of the two classes of heartburn relief medicines mentioned above.

Heartburn Relief Through Surgery

In the most severe 10% of cases, drugs alone may not be enough to provide sufficient heartburn relief. A surgical procedure called fundoplication can inhibit heartburn by putting pressure on the sphincter muscle that allows the stomach acid to flow into the esophagus. The success rate for this procedure has traditionally been low, with 65% of patients reporting a recurrence of heartburn within a few years, but newer, less invasive forms of fundoplication have recently been developed that have increased the chance of permanent heartburn relief.

Heartburn Relief Through Lifestyle Changes

Not all cures for heartburn involve drugs or doctors. Some can be achieved through simple lifestyle changes. Drinking milk can help line the stomach, and is particularly recommended for heartburn relief during pregnancy. To prevent heartburn, eat simple food that should not be fatty, spicy and fried. Alcohol and caffeine can also contribute towards heartburn. Generally speaking, the healthier your lifestyle, the less chance you have of developing heartburn. Heartburn relief is readily available, but prevention is better than cure.

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GERD sufferers frequently have sleep problems because of nocturnal reflux and due mainly because they are lying flat. The refluxed gastric contents rush up the esophagus and wakes the sufferer.

Elevating the bed has been proven to be a very good idea. It means the esophagus sits higher than the stomach while asleep. Similarly by sleeping on your left side you can reduce reflux. During foetal development, the stomach rotates and the left side becomes the top (anterior) and the right becomes the bottom. So if you lie on your right side, the stomach is high. By lying on your left side the bulk of the stomach is below the esophagus.

If you have acid reflux and you go to bed with a full stomach, you are likely to have problems. You are not likely to get a good night’s sleep. It takes approximately three hours for the stomach to empty it’s contents into the small bowel. If your stomach is empty before you go to sleep, reflux is less likely. So make sure you have nothing to eat or drink for 3 hours before going to bed. Alcohol increases acid production in the stomach and relax LES. If you have acid reflux and you want a better night’s sleep, consider your relationship with alcohol. If alcohol is a culprit, consider reducing or stopping.

If you need a good night’s sleep, avoid too much sleep during the day and make sure the environment is right for a good night’s sleep. This means looking at the room temperature, aroma and using fresh linen. How about a nice relaxing bath before retiring. Use your bed only to sleep, apart from sexual reasons. Do not lie in bed watching TV or reading a book.

If all this fails you may need to discuss your problems with your doctor. He may prescribe a sleeping tablet.

Dr. Phil Hariram

Acid Reflux.

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Acid reflux is often worse at night because we sleep lying down and by doing so we lose the benefit of gravity. Most of us have our biggest meal in the evening. This is not a good idea if you have acid reflux. Most of us drink alcohol more often in the evening. If you have GERD, do not eat at least three hours before going to bed. Avoid caffeine and alcohol.

The simplest way to counteract the loss of gravity as an aid for acid reflux, is to elevate the head of the bed. You can do this by buying an expensive bed that raises the head of the bed at the touch of a button. If the bed bends in the middle, then you can potentially squeeze the abdomen and increase intra-abdominal pressure.

There is no doubt that elevating the head of the bed reduces the back flow of gastric contents into the esophagus while you are lying down. The simple way to elevate the head of the bed is by using two 4 by 4 inch blocks and nail or attach a fitting to it so that the casters or legs of the bed fit firmly and are not likely to slip off.

Also available and becoming popular are triangular foam wedges that can fit under the mattress. This can raise the head of the bed 6 to 10 inches. Ordinary pillows to help prop you up higher is ineffective. The pillows rarely stay in position and often when the pillows are in place only the head is raised when you really need elevation of the upper body.

Dr. Phil Hariram

Acid Reflux.

Remember Keith from an earlier post? He had gained weight and became obese, drank excessively and smoked far too much. He developed GERD. He had sleep problems. Whatever position he slept, heartburn bothered him. He would sleep for an hour or two only to be awaken by heartburn or fluid rushing upwards into his mouth. At first this happened occasionally then it came on every other night, then every night. Not only was Keith having problems with his acid reflux but he felt tired and exhausted during the day.

A survey in 1998 showed that in GERD sufferers, 65% admitted that acid reflux affected their sleep.

Experts have also suggested a link between GERD and sleep apnoea. Sleep apnoea is a disorder where during sleep a sufferer will stop breathing for short periods of time. They often wake up gasping for breath or choking. Sleep apnoea causes extreme tiredness. It is linked to stroke and heart attacks. Long distance lorry drivers are now being screened for sleep apnoea because of the risk of falling asleep at the wheel of an awesome auto mobile.

The link between sleep apnoea and GERD is in sufferers that are obese and consume alcohol. Obesity and alcohol consumption on their own are linked to sleep apnoea. Experts suggest that in GERD sufferers with sleep apnoea, acid reflux during sleep can reach the larynx and cause it to swell (develop oedema). This swelling can cause obstruction of the larynx and sleep apnoea.

During sleep you naturally lie flat in bed. It is no surprise that acid reflux can be worse at night. The problem escalates if a heavy meal is consumed soon before going to bed. Statistics show that midnight is the popular time for the first attack during the night of acid reflux. At midnight most people are in bed and lying down.

Some drugs can affect the efficiency of the lower esophageal sphincter. A person with sleep problems may be prescribed a hypnotic or tranquilliser. These drugs relax muscles and can relax the LES causing nocturnal acid reflux and disturbing sleep it is meant to improve.

Alcohol and caffeine affect the LES and can encourage acid reflux.

Dr. Phil Hariram

Acid Reflux.

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If you do not have a problem with acid reflux then LES is your friend and obedient servant. He serves you well. He is always attentive and does the right things at the right time. Like most of us, he only occasionally makes a mistake and that is on the odd occasions you put pressure on him.

If you have acid reflux, you would like to think he is your friend. At times, however, he is unpredictable but most frequently he does the wrong things when you do not want him to. Sometimes he can be so inefficient, you have to employ special agents to pick up the pieces after his destructive pattern of behaviour.

Yes, you want him to be your friend but sometimes you dislike his incompetence whether it is predictable or not. Sometimes his repetitive behaviour makes you suspect he has OCD.

LES, whether a friend or foe, is important to you. You cannot break off relations. He is fragile and the equilibrium in his life relies on the relationship he has with you. He gets hurt when you gain weight, have heavy meals, smoke and consume too much alcohol. When he is hurt, he is erratic and makes you know, the only way he can, by not doing his job properly.

Sometimes I think LES is your Health Guru but his carrot and stick attitude is a worry. He is happy when you are doing all the right things in your life. He loves you best when you eat less fat and stay slimmer.

Sometimes LES is completely incompetent. He cannot do anything right. He feels disabled. This is when he need you as his best friend.

Allow me to introduce you to LES. He is your Lower Esophageal Sphincter.

Dr. Phil Hariram

Acid Reflux.

Image by Phoney Nickle via Flickr

The commonest symptom of acid reflux is heartburn. Do not worry unnecessarily if you have heartburn. Most of us have heartburn at some time or other especially when we over indulge. Usually a single dose of antacid settles the problem. However, if the heartburn pain returns after treatment and becomes recurrent then the lower esophageal sphincter may be faulty and opens when it should not.

There may be factors that influence the efficiency of the LES and by eliminating them you may well control your acid reflux. On the other hand if it is true LES incompetence, then you will need specific acid reflux treatment by your doctor or specialist.

In addition to heartburn, acid reflux can produce other non-specific chest pains. This may cause concern to sufferers because there is a fear that it could be a heart attack and quite a few of these patients end up in the Accident and Emergency departments of hospitals.

Other symptoms of acid Reflux are:

Difficulty in swallowing

Chronic cough

Acidic taste in the mouth

Burning feeling in the throat

Uncomfortable feeling in the upper abdomen and chest

In some cases of acid reflux there are the following symptoms:

Gum disease

Persistent clearing of the throat

Hoarseness of the voice

Night cough or choking

Recurrent or chronic sinusitis

Bad breath.

In addition if acid reflux reaches as far as the throat and mouth, then dental damage can occur in addition to gum disease. The enamel of teeth can be worn down and cavities can develop.

From the list above you can see that acid reflux can be a serious problem if not treated adequately. If the acid reflux treatment you are using at home is not working and you think you have GERD, see your doctor.

Dr. Phil Hariram

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Acid reflux is a common condition. Heartburn occurs in up to 20% of people weekly and up to 10% of these have erosive esophagitis.

GERD is generally a benign condition with few problems but when symptoms are persistent, it can cause considerable distress.

Retrospective studies have shown that acid reflux patients who initially had normal endoscopies tend to continue to have normal endoscopies. There is, however, a small group that will develop Barrett’s esophagus, adenocarcinoma and stricture.

Some GERD sufferers may have very severe symptoms and at endoscopy instead of significant changes the esophageal lining is normal. In such cases the esophagus is very sensitive to the acidic assault even though there is no damage. On the other hand, Barrett’s esophagus can develop in patients with minimal symptoms.

So it is clear that severity and frequency of symptoms do not always indicate the level of esophagitis. Some patients with minimal symptoms can develop strictures, Barrett’s esophagus and adenocarcinoma.

The commonest symptom of acid reflux is heartburn. A GERD patient may also have an unpleasant taste in the mouth. According to NIDDK, there are over 60 million Americans who suffer heartburn once a week and up to 25 million have heartburn once a day.

Infants and pregnant women have a high incidence of heartburn and as we grow older the incidence of acid reflux increases. In UK 20% have heartburn once a week and in Canada this figure is 13%.

The incidence of heartburn is high in the west. Do not ignore your symptoms. If they are persistent see your doctor for effective acid reflux treatment.

Dr. Phil Hariram.

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Acid reflux is extremely common in infants and usually resolves in the first year. For these children, conservative treatment is all that is needed. Small frequent feeds, thickened feeds and positioning the infant to minimise reflux are measures used.

However, true GERD in children, although uncommon, warrants investigations. Before considering investigations, it is important to exclude other potential causes of vomiting in infants. These include cows’ milk protein allergy, infections and systemic conditions that can cause vomiting.

The common investigations done are endoscopy with biopsy and 24 hour pH monitoring of the esophagus. The symptoms of GERD in children are a major worry for parents and part of the overall treatment of acid reflux in these cases is reassurance for the parents and families.

Acid reflux commonly starts between four weeks and four months after birth. It is estimated that up to 65% of normal children have acid reflux in the first year. After one year this figure drops dramatically.

True GERD is a serious and distressing condition. The common acid reflux symptom is vomiting. In addition there can be poor weight gain and respiratory symptoms such as persistent coughing. When GERD is severe and reflux reaches the lungs, the child can develop stridor, wheezing and in infants prolonged periods of apnoea.

The prevalence of GERD in children is one in 300 children. In true GERD the lower esophageal sphincter is not functioning well, and medication is necessary to control acid reflux.

Dr. Phil Hariram.

Do you know that in addition to the many disorders of the esophagus, acid reflux or GERD can also cause problems related to the ears, throat and respiratory system?

Acid reflux can cause chronic coughing, hoarseness or voice change and even earache.

Commonly acid reflux can lead to esophageal disorders.

Here is the list:

Esophagitis

Ulcers.

Strictures.

Barrett’s Esophagus.

Adenocarcinoma.

These are serious and distressing complications of acid reflux but we must also be aware of the other potential manifestation of this serious condition and include them in our acid reflux treatment plan if symptoms suggesting these conditions develop.

Gastric acid contains pepsin and a high concentration of the acid hydrochloric acid. The lining of the stomach is configured to accommodate these two chemicals. The rest of the gastro-intestinal tract above the stomach are not.

Gastric contents, refluxed up from the stomach, not only reach the esophagus. It can reach as far as the trachea, the bronchi, the lungs, larynx, pharynx and the mouth and teeth. Occasional reflux does not pose a problem but injury results when the refluxed gastric contents are frequent and remains for a significant length of time.

Cherry and Margulies in 1968 first highlighted the extra-esophageal manifestation of GERD. They described three patients with pharyngo-laryngeal reflux and laryngeal ulcers. Acid reflux treatment resolved the problem in these three patients.

Dr. Phil Hariram.

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Chronic coughing in a patient with acid reflux can be a big and annoying problem. Coughing following acid reflux is mainly due to irritation. The reflux can tract high up the esophagus to the larynx and pharynx.

Irritation in this area can cause hoarseness and coughing. The reflux can also go as far as the trachea and into the bronchi. This will trigger the cough reflex. This is a natural phenomenon. If you accidentally swallow something down the wrong tube, the first thing you will do is cough.

This is a violent expulsion of air from the bronchi and will hopefully expel the offending item.

In acid reflux patients, food can regurgitate up into these areas because the lower esophageal sphincter is not functioning well and opens when it should not. Often this happens at night and sufferers wake up with a cough which may improve during the day. Acid reflux treatment is usually effective but there are some cases where acid reflux treatment is ineffective in relieving chronic coughing.

A study by Ziora et al in 2005 assessed the benefits of anti-reflux surgery on chronic cough of GERD. They used the citric acid cough threshold to assess  any change before and after surgery.

They included 30 patients with chronic cough due to GERD and 15 volunteers. The cough threshold was found in individuals by increasing the amount of citric acid consumed before cough started. 20 of these patients had surgery. This surgery was laparoscopic Toupet fundoplication.

Following surgery the cough score improved after two weeks and at 13 weeks in some the cough disappeared or was significantly improved. 14 of the 20 patients significantly improved. 3 had partial improvement and 3 had no improvement.

The trial showed that acid reflux patients have a significantly lower cough threshold than healthy subjects and that anti-reflux surgery was beneficial in GERD induced coughing.

If you have a chronic cough and you have symptoms of GERD, then you should see you doctor. Adequate acid reflux treatment will reduce acid in the refluxed gastric content and reduce the chance of inflammation in the pharynx, larynx, trachea and bronchi. Persistent high acid in this area can result in stricture just as in the esophagus. Crico-pharyngeal stricture is very unpleasant. Avoid this at all cost. Acid reflux treatment does reduce coughing due to GERD.

Dr. Phil Hariram.