Gastro-Esophageal Reflux (GER) is a disease in which stomach contents whatever you intake come back up into your esophagus. Stomach acid may touch the esophagus wall or may create burning sensation. It is also called acid digestion, acid reflux, acid regurgitation, heartburn, reflux etc. It is the common disease among the general population. Approx. 40% people may have the complaints of GER. Initially, it is covered with the help of medication and later, Surgery may be required in case of severe issues.
What is GERD?
Gastro-Esophageal Reflux Disease (GERD) is more serious and an extended form of GER which stays for the long term. GERD affects almost 20% of the population. If GER occurs more than twice a week, it is called GERD and can be serious so one should consult the doctor immediately.
Who is more likely to have GERD?
Anyone can have the symptoms of GERD for known or unknown reasons. You may have GERD if you are:-
Obese or overweighted
Taking certain medicines causing GERD
Complications of GERD?
If not treated well, GERD patients may have the following complications:-
Esophagitis is an inflammation of the esophagus. Adults having Esophagitis for long may have precancerous changes
Esophageal stricture: When esophagus become too narrow to swallow anything
Respiratory problems: While breathing stomach acid may enter into your lungs which may cause throat & lungs irritation and may create respiratory problems such as Asthma, Chest Congestion, Sore throat, Dry & Long lasting cough, hoarseness (partial loss of voice), laryngitis (swelling in voice box), pneumonia (infection in lungs), wheezing (sharp whistling while breathing)
Barretts Esophagus: Very few may suffer from the deadly type of esophagus cancer. So to prevent such serious complications, it is advisable to consult the doctor immediately
Symptoms of GER & GERD:-
In case of having Gastro- Esophageal Reflux (GER), You may taste food or stomach acid in the back of your mouth. The most symptoms of GERD are as follows:-
Painful & burning feeling in the chest, Breastbone back & upper/middle abdomen
Problems in swallowing
You must call the doctor if you are facing other symptoms like:-
Regular projectile or forceful vomiting
Vomit fluid which looks like green or yellow and like coffee grounds and may contain blood
Breathing problems after vomiting
Facing pain in mouth & throat while eating
Causes of GER & GERD:-
GER or GERD happens when lower esophageal sphincter becomes weak or relaxes due to the following reasons such as:-
Increased pressure on abdomen due to obesity or pregnancy
Certain medicines and drugs
Calcium channel blockers -which treat the high blood pressure
Antihistamines -that treat allergy symptoms
Sleeping pills or Sedatives
Smoking, or inhaling secondhand smoke
A hiatal hernia may also cause pressure in the esophageal sphincter
Diagnosis of GER or GERD
GER can be reviewed by having a manual screening on the medical history and symptoms given above. If you change the lifestyle and take proper diets and still face the GER symptoms, you need immediate testing and treatments thereof. To diagnose the GERD, following tests are given below:-
Upper Gastrointestinal (GI) Endoscopy & Biopsy: In this procedure, an endoscope is used by the gastroenterologist or surgeon to review the upper GI tract. An intravenous (IV) needle will be placed in your arm to provide a sedative to help you relax & comfortable. In some cases, sedatives are not used. Liquid anesthesia may be given through gargle or spraying on back of the throat. The doctor will use the endoscope to view the esophagus, stomach & duodenum. A small camera attached to endoscope will send the images of close upper GI tract on a video monitor. Endoscope pumps air to stomach to have a clear picture of inside. The doctor may perform a biopsy by using the small piece of tissue from the lining of the esophagus. A pathologist will examine the tissue in the lab.
Upper GI Series: An X-Ray will be performed by the radiologist in the hospital or an outpatient center by taking the images from upper GI Tract. the procedure is performed with using No anesthesia. Before X-ray, Healthcare professional will guide you on what & when to eat or drink, how to stand or sit in front of the X-ray machine, barium will be given to drink to have a lining of your upper GI tract. The upper GI series cant show GERD in esophagus but barium shows the problems related to GERD such as hiatal hernias, esophageal strictures, ulcers. Once you go through this test, you may have to face some health issues such a bloating, nausea, white or light-colored stools etc. A healthcare professional will give you prompt instruction about eating, drinking, taking medicines.
Esophageal pH and impedance Monitoring: This is the most prompt technique to measure acid reflux. It will measure the amount of acid in your esophagus while you do normal things such as eating or sleeping. This procedure may be followed with or without anesthesia. The gastroenterologist will pass a thin tube through the nose or mouth into your stomach and will pull back into esophagus and tape into your cheek. The one end will measure when & how much acid comes up to the esophagus and the other end will record the measurements attached to the video monitor. A patient is required to wear the monitor for 24 hours to have prompt recordings and will have come to the hospital to remove the tube. You may be required to have a record of what, when and how much food you intake to know the exact symptoms of GERD. This procedure will also help to know whether acid reflux triggers any respiratory symptoms.
Bravo wireless esophageal pH monitoring: A small capsule will be attached to the wall of the esophagus during an upper endoscopy. The capsule will measure the pH levels in the esophagus and transmits the information to the receiver ( a pager type device) which is tied with waist or belt. While wearing this, you will follow your normal routine work for 48 hours. The several buttons, not the receiver will help you to know the various symptoms of GERD such as heartburn, nausea etc. The doctor may ask you to have a record of the medicine you are having, when to lie, when you walk, what & how you eat & drink. You will be required to give all the details related to your lifestyle. After 7-10 days, a capsule will fall off and will pass through the digestive tract.
Esophageal manometry: It is used to measure the muscle contractions. it may be performed in the hospital or during an office visit. A healthcare professional will spray anesthesia liquid on the back of your throat or may ask you to gargle it. The Gastroenterologist will pass a soft, thin tube through nose or stomach. You will be asked to swallow when gastroenterologist pulls the tube slowly back into the esophagus. A computer monitor will make a record of the pressure of muscle contractions in different parts of the esophagus. A healthcare professional will guide you what to eat, drink and medications.
All the diagnosis methods are slightly varied from one to each other and will give the prompt information.
How do you Treat GER and GERD?
You may be able to control gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) by:-
Not eating or drinking anything which may cause GER, such as greasy or spicy foods and alcoholic drinks
Not eating 2 to 3 hours before bedtime
Losing excess weight if you’re overweight or obese
Quitting smoking and avoiding secondhand smoke
Taking over-the-counter medicines, such as Maalox, or Rolaids
How do doctors treat GERD?
There are various methods to treat the GER or GERD depending upon the patient immune system, signs, symptoms and other factors. The Treatments are given below;-
Lifestyle Changes: This can be the perfect thing to treat the GER or GERD such as:-
Losing excess weight
Wearing loose clothes
Staying upright 3 hours after meals
Sleep at a slight angle
Better to intake healthy food, rich fiber diets, and fluids which are easy to digest. Do not consume everything at once, try at different intervals.
Over-the-counter and prescription medicines: GER-related medicines are available in the market but if still, you have not seen any changes or relief, better to see the specialist doctor. You may need a combination of GERD medicines to control your symptoms
Antacids to relieve heartburn and other mild GER and GERD symptoms.
H2 blockers decrease acid production and heal the esophagus. Types of H2 blockers include Cimetidine, Ranitidine.
If you get heartburn after eating, a doctor may recommend you to take an antacid and an H2 blocker. The antacid neutralizes stomach acid, and the H2 blocker stops creating acid. By the time the antacid stops working, the H2 blocker has stopped the acid.
Proton pump inhibitors (PPIs). It is better than H2 blockers 2 and can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment. You need to take these medicines on an empty stomach so that your stomach acid can make them work. Several types of PPIs are available by a doctor’s prescription, including Esomeprazole (Nexium), Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole etc. Talk with your doctor about taking lower-strength omeprazole or lansoprazole, sold over the counter.
PROKINETICS that helps to empty the stomach faster. these include Bethanechol, Metoclopramide. These medicines have some kind of side-effects such as Nausea, Diarrhea, Fatigue, or feeling tired, Depression, Anxiety, Delayed or abnormal physical movement. Prokinetics may be dangerous if taken with other drugs or medicine so better to consult with the doctor for better relief.
Antibiotics, including erythromycin, can help your stomach empty faster. Erythromycin has fewer side effects than prokinetics; however, it can cause diarrhea.
Surgical Treatments for GERD
GERD can be managed initially with the change of lifestyle and diets. But if you do not see any changes in the symptoms of GERD even after taking medicine and making changes in lifestyle, you are more likely to have a complication which may turn into a serious problem. The most popular GERD Surgery is Fundoplication and we will study the process & procedure.
The most popular surgery to treat the GERD and it is also helpful in controlling long-term reflux. This surgery is performed with the help of laparoscope, thin tube with a tiny video camera. In this process, a surgeon sews the top of the stomach around your esophagus to add pressure to the lower end of the esophagus and reduce reflux.
Why Fundoplication surgery is preferred:-
Fastest and easy Recovery.
Return to normal activity within 1-2 days.
Early return to home from the hospital within 1-2 day.
No repeated doctor visits.
Eating, Diet, & Nutrition
The doctor will always advise the GER or GERD patients to change the lifestyle by changing the habits of eating, walking and drinking. In short, one should adopt the healthy diets only otherwise the problems may get worse. In terms of lifestyle habits, On ensue eating healthy food in balance amount. Instead of consuming the food at once, should grab at short intervals. Rich fiber diet is advisable to the obese people so that they could lose weight. The help of weight loss dietician can be taken.
To control the problem of GER & GERD, one should avoid the fatty and spicy foods, chocolate, coffee, peppermint, greasy foods, tomatoes & related pouts and alcoholic drinks.
GER & GERD can be tried controlling with the help of healthy diet plans and taking medicine. If Home remedies and medications are not effective, surgical options can be chosen depending on the severity and as per the guidance of GERD Experts.
Hiatal Hernias are defined as the situation when the stomach is pushed up from the abdomen into the chest cavity through an opening in the diaphragm through which esophagus connects to the stomach. Treatments will be given depending on the type of Hernia and the seriousness involved.
Types of Hiatal Hernia
BASICALLY, 4 TYPES OF HIATAL HERNIA ARE FOUND:-
Type I Hiatal Hernia: The most common type of a hernia which is also called sliding Hiatal Hernia. Almost 95 % cases of a hiatal hernia belong to Type 1. In this hernia, Gastroesophageal junction is herniated into the chest cavity.
Type II (paraesophageal) a hiatal hernia: In this kind of a hernia, stomach herniates through diaphragmatic esophageal hiatus alongside the esophagus. Gastroesophageal junction remains below the hiatus and the stomach rotates in front of the esophagus and herniates into the chest. It rarely happens and it counts for 5% of all the cases. If more than 30% of the stomach herniates into the chest, the condition is called giant paraesophageal hernia. If it occurs, it may carry lots of complications.
Type III a hiatal hernia: In this kind of a hernia, gastroesophageal junction is herniated above the diaphragm and the stomach is herniated alongside the esophagus.
Type IV Hiatal Hernia: When other organs such as colon, small intestine, spleen also get herniated into the chest in addition to stomach, it is called type IV hiatal hernia.
We have mentioned the best possible reasons for weight gain & Gastric Problems and the treatments thereof. Every surgical treatments involves an amount of complications depending upon the severity of the disease and the instructions followed by the patients. At Pristyn Care Laser Clinic, Extreme care is taken to cure the patients. The perfect Human body can live a perfect life!!
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