GERD/ ACID REFLUX DISEASE Hello and welcome to medsimplified. I hope all of you are doing well. In this video we will discuss about GERD aka Acid reflux disease or Heartburn. GERD happens when contents from your stomach move up into your esophagus. It’s aka acid regurgitation or gastroesophageal reflux. At the entrance to your stomach is a valve, which is a ring of muscles called the lower esophageal sphincter or LES. Normally, the LES closes as soon as food passes through it.
If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest discomfort called heartburn. If acid reflux symptoms happen more than twice a week, you may have acid reflux disease, also known as gastroesophageal reflux disease (GERD). So now we know a little bit about what is acid reflux disease, let’s look at the three main factors that lead to ARD- They are: • Poor or slow clearance of food from the stomach • Delayed stomach emptying • Too much acid in the stomach Slow clearance of food from the stomach can be caused by various reasons like • Eating large meals or lying down right after a meal • Being overweight or obese • Eating a heavy meal and lying on your back or bending over at the waist • Snacking close to bedtime All these habits lead to retention of food in your stomach for longer periods of time and more chances of the acidic contents of your stomach to regurgitate into your esophagus.
Delayed stomach emptying is also known as Gastroparesis, and one of the most common causes that lead to Delayed stomach emptying is Diabetes. It can also be caused due to pregnancy as the uterus can push against the bowel and stomach leading to partial mechanical obstruction. Other causes include a lack of thyroid hormone aka hypothyroidism, Viral stomach infections, Medications such as narcotics and some antidepressants, and it can also happen in diseases like Parkinson's disease and Multiple sclerosis. The third main factor that leads to Acid reflux diseases is much more common than the previous two and that is Excessive production of acid in your stomach.
Some of the most common causes that lead to Excessive production of acid in your stomach are • Eating certain foods, such as spicy or fatty foods, chocolate, garlic, onions and citrus fruits. • Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea. • Smoking is also one of the most common causes of hypersecretion of acid in the stomach. • Many medicines can lead to excessive acid secretions and these include pain medications like NSAIDS like ibuprofen, Diclofenac, aceclofenac etc • Aspirin, some blood pressure medications like nifedipine, Iron supplements and Bisphosphonates takes for low bone density or osteoporosis. • Excessive levels of stress and people with type A personalities also develop excess acidity in their stomachs. So these were the three main factors which lead to GERD. • Poor clearance of acid or food from the stomach which can be due to eating large meals at once or lying down early after eating meals. Obesity is also an important reason for this. • Delayed gastric emptying which is aka gastroparesis, can be due to diabetes, pregnancy, hypothyroidism and many other factors. • The last and the most important factor is hypersecretion of acid from your stomach which is due to eating wrong types of food and beverages, taking too much stress, smoking and certain medications.
Other than these some structural defects can also lead to acid reflux disease and one of the most common of them is Hiatal Hernia. The diaphragm is a muscle that separates your stomach from your chest. Normally there is a Hole or “hiatus” in the diaphragm through which the esophagus passes and connects to the stomach. If this hole or Hiatus enlarges, the upper part of the stomach can partially move through the abdomen into your chest which increases acid reflux. Weak muscles in the diaphragm can allow the stomach to move freely into the hiatus, or inherited structural abnormalities in the diaphragm can cause a congenital hiatal hernia, which presents at birth. Other causes include excess pressure on the abdomen or muscle strain due to heavy coughing, constipation or intense physical exertion. Pregnancy and obesity are also risk factors for hiatal hernia. So, these were some of the causes of Acid reflux disease, now let’s look at some of the symptoms with which this condition can present.
One of the most common symptom of Acid reflux disease is heartburn which is a burning pain or discomfort that moves from your stomach to your abdomen or chest, or even up into your throat. You can also experience frequent regurgitations of food or liquids into the mouth which leaves a very sour taste on the tongue. If you are having acid reflux for a long duration you may experience difficulty in swallowing food and a feeling of lump in your throat, a constant dull pain in your stomach or chest or shortness of breath can also be the presenting symptoms. Chronic acid reflux can lead to erosions in your stomach or esophagus which may bleed overtimes.
This blood is passed in your stools which appear blackish. Blood in vomiting can also indicate bleeding in your esophagus or stomach which usually presents as fresh blood. Other symptoms include Hiccups that don't let up, Nausea, Weight loss for no known reason, Wheezing, dry cough, hoarseness, or chronic sore throat. Now let’s talk about how is Acid reflux disease diagnosed. You should see your doctor if you have acid reflux symptoms two or more times a week or if medications don't bring lasting relief. Symptoms such as heartburn, sour eructation in the mouth, abdominal pain and hoarseness of voice key symptoms to diagnose acid reflux disease and most cases of acid reflux are diagnosed with clinical symptoms alone.
If your problems persist for a longer duration of time or if you are not having relief with typical medicines your doctor may perform certain invasive tests to confirm the diagnosis of GERD. These include X-rays of your upper digestive system. Xray’s are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. This liquid which usually contains barium allows to visualize a silhouette of your esophagus, stomach and upper intestine. Upper GI Endoscopy: In this test a thin, flexible tube equipped with a light and a camera is inserted down your throat, to examine the inside of your esophagus and stomach. Endoscopy can detect inflammation of the esophagus, Hiatus hernia, strictures or other complications.
The endoscope can also be used to collect a tissue sample for various tests like biopsy or tests for H. Pylori. Another test that can be used to diagnose GERD is the Ambulatory acid pH probe test. In this test a monitor is placed in your esophagus to identify how frequently the acid from your stomach regurgitates in your esophagus. The monitor connects to a small computer that you wear around your waist. Esophageal manometry measures the rhythm of muscle contractions in your esophagus when you swallow. It also measures the coordination and force exerted by the muscles of your esophagus. So now we have talked about what is acid reflux disease, how it presents and how it is diagnosed. Now let’s jump over to the Treatment part of Acid reflux disease.
Although there is a plethora of OTC and prescription Medicines available in the market to treat acid reflux disease, the first thing you should try before medical treatment is Dietary and Lifestyle modifications. While diet does not cause GERD, it can aggravate or increase the reflux of acid into your esophagus causing heartburn. Certain foods compromise the LES’s ability to prevent reflux and are best avoided. This may differ person to person but it is usually noted that foods like Spicy, fried and fatty foods, onions, tomatoes, chocolates, Beverages like tea, coffee and alcohol cause the most trouble.
So, it is best to completely avoid these types of foods. Certain types of food are very helpful to reduce the symptoms of acid reflux disease. These foods contain Curd and yoghurt, ginger, Oats, Green leafy vegetables like Spinach and celery, fruits like watermelon, pineapple and papaya. So, try to include these foods more often in your diet. IN the end of this video I will share 2 wonderful and effective home remedies for acid reflux so make sure to watch this video till the end and If you want to know more about diet related to ARD click the link on the i-button above to know about the best and worst foods to eat for people with acid reflux disease. Also make sure to subscribe and hit the bell icon if you want to be notified about our upcoming health and fitness videos in the future. Now there are lots of Lifestyle changes too that you can do, that will help you to avoid reduce acid reflux. Don’t go to bed with a full stomach. Eat meals at least 2-3 hours before lying down. This will give food, the time to digest and get out of your stomach.
Don’t overeat. Eat smaller portions at mealtimes or try to eat four to five small meals instead of three big ones. Raise the head end of your bed by placing wood or cement blocks under the feet of your bed so that the head end is raised by 6 to 9 inches. This ensures that the acid doesn’t reflux easily into the esophagus while you are sleeping. Maintain a healthy weight. Excess weight especially due to abdominal obesity can put pressure on your abdomen, pushing up your stomach and causing acid reflux. Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter. Stop smoking. Smoking decreases the lower esophageal sphincter's ability to function properly and also leads to excessive secretion of acid in your stomach. So, these were some lifestyle and dietary modifications that you can do to prevent and decrease the symptoms of acid reflux disease. Now let’s look at the medical treatment of acid reflux disease and before we begin its my duty to inform you that I cannot prescribe all these medications on a YouTube video and the content of this video are just to educate you all.
Many of these drugs are available OTC means you don’t need a prescription for them; however, it is important to see your doctor if you are having these symptoms for a longer duration of time. Well, with that said, let’s look at what different types of medicines are given in acid reflux disease. No. 1 are the antacids which are the most common drugs used for ARD. As the name indicates these are anti acids which means they contain basic chemicals that neutralize the acid present in your stomach so that there is no acid to reflux. The problem with antacids is that their action is very short lived.
They are emptied from the empty stomach quickly, in less than an hour, and the acid then re-accumulates. The best way to take antacids, therefore, is approximately one hour after meals, which is just before the symptoms of reflux begin after a meal. Since the food from meals slows the emptying from the stomach, an antacid taken after a meal stays in the stomach for longer and is more effective. Antacids are usually aluminum, magnesium or calcium based. Aluminum-containing antacids have a tendency to cause constipation, while magnesium-containing antacids tend to cause diarrhea. Antacids containing both aluminum and magnesium cause less problems. I have included links to all these medicines in the description below so you can check them out.
After the antacids the next class of drugs that are used in acid reflux disease are known as the H2 blockers. You see, there are H2 receptors in the cells of the wall of stomach. When these receptors are stimulated by histamine it leads to acid secretion. So, drugs were developed to block these receptors. These include cimetidine, ranitidine, nizatidine and famotidine. All four are available over-the-counter (OTC), without the need for a prescription. However, the OTC dosages are lower than those available by prescription. As histamine is particularly important for the stimulation of acid after meals, H2 antagonists are best taken 30 minutes before the meal. The reason for this timing is so that the H2 blockers will be at peak levels in the body after the meal when the stomach is actively producing acid. H2 blockers can also be taken at bedtime to suppress the nighttime production of acid.
The 3rd type of drugs developed specifically for acid-related diseases were proton pump inhibitors aka as PPI’s, specifically, omeprazole. A PPI also blocks the secretion of acid into the stomach. The advantage of a PPI over an H2 blocker is that the PPI shuts off acid production completely and for a longer period of time. Not only is the PPI good for treating the symptom of heartburn, but it is also good for protecting the esophagus from acid so that the esophageal inflammation can heal. PPIs are used when H2 blockers do not relieve symptoms adequately or when complications of GERD occur. Other than omeprazole, lansoprazole, rabeprazole, pantoprazole and esomeprazole are other PPI’s that are available for treatment of GERD. PPIs are best taken an hour before the meals. The reason for this timing is that the PPIs work best when the stomach is most actively producing acid, which occurs after meals.
If the PPI is taken before the meal, it is at peak levels in the body after the meal when the acid is being made. Next category of drugs used for acid reflux disease are the Pro-motility drugs which work by stimulating the muscles of the gastrointestinal tract, including the esophagus & stomach. One pro-motility drug, metoclopramide, is approved for GERD. Pro-motility drugs increase the pressure in the lower esophageal sphincter and strengthen the contractions of the esophagus. Both effects would be expected to reduce reflux of acid. However, these effects on the sphincter and esophagus are small. Therefore, it is believed that the primary effect of metoclopramide may be to speed up emptying of the stomach, which also would be expected to reduce reflux. Pro-motility drugs are most effective when taken 30 minutes before meals and again at bedtime. One more category of drugs that are used for acid reflux are known as Foam barriers. Foam barriers provide a unique form of treatment for GERD. Foam barriers are tablets OR LIQUIDS that are composed of an antacid and a foaming agent.
As the tablet disintegrates and reaches the stomach, it turns into foam that floats on the top of the liquid contents of the stomach. The foam forms a physical barrier to the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes into contact with the foam. The tablets are best taken after meals (when the stomach is distended) and when lying down, both times when reflux is more likely to occur. There is only one foam barrier, which is a combination of aluminum hydroxide gel, magnesium trisilicate, and alginate.
The drugs described above usually are effective in treating the symptoms and complications of GERD. Nevertheless, sometimes they are not. Sometimes the amount or number of drugs that are required for satisfactory treatment are so great that drug treatment is unreasonable. In such situations, surgery can also be done to effectively stop the acid reflux. The surgical procedure that is done to prevent reflux is technically known as fundoplication aka anti-reflux surgery.
During the fundoplication surgery, the part of the stomach that is closest to the entry of the esophagus known as the fundus of the stomach is gathered, wrapped, and sutured around the lower end of the esophagus and the lower esophageal sphincter. The gathering and suturing of one tissue to another is called plication. This procedure increases the pressure at the lower end of the esophagus and thereby reduces acid reflux. Also, if the patient has hiatal hernia this can also be corrected in the same surgical procedure. Fundoplication may be done using a large incision known as laparotomy or using a laparoscope, which requires only several small punctures in the abdomen. The advantage of the laparoscopic method is a speedier recovery and less post-operative pain. So, this was about the lifestyle modifications, medical and surgical treatment of acid reflux disease. In the end I would like to share with you two very effective home remedies for acid reflux disease.
No. 1 Drink 2 glasses of warm water first thing in the morning before you eat anything. This is a wonderful tip and I have tried this on myself and a number of patients suffering from acid reflux. The logic behind drinking warm water first thing in the morning is that when you wake up, your stomach is completely empty and warm water flushes the walls of your stomach and increases the blood flow in it. This increased blood flow brings in important growth factors that heal already existing erosions or minor ulcers in the stomach and also make the walls of the stomach and esophagus healthy which helps in regulating acid production. Practice this tip daily and you will observe improvement in your symptoms within 10 days. No.2 Eat lots of curd.
Curd is a wonder food for people suffering from acid reflux disease. Curd is a dairy product obtained from milk. Milk has a high amount of calcium that prevents build-up of acid by eliminating the excess amount, making it an efficient home remedy for acid reflux. So, this was all about acid reflux disorder and its management. In the coming videos I am gonna discuss about Best diet for acid reflux disease and other natural remedies so make sure to subscribe and hit the bell icon to get notified.
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