Stop Acid Reflux Blog

According to Dr. Richard Seitz of Fremont, over-the-counter medication gor acid reflux should only be used for several weeks and then if symptoms don’t get better, or come back when medication is stopped, a doctor should be consulted. If however, it gets worse even with medication, it is best to see a physician. Prescriptions are more potent than over-the-counter medicines, but if the over-the-counter medication works well, Seitz said it can be taken long term with no adverse effects.

Sometimes, a more serious esophageal problem can develop. When the sphincter is weakened so acid flows into the esophagus, the stomach may try to protect itself.

The esophagus may develop a more acid-resistant lining and this is Barrett’s Esophagitis.

This change in the lining isn’t normal and if the lining continues to change it can lead to cancer of the esophagus eventually. If problems persist, or don’t respond to normal treatment, doctors can do an upper endoscopy.

Unexplained weight loss, trouble swallowing, passing blood in the stool or vomiting up blood, all need an upper endoscopy to make sure there is no cancer, and to see what is causing the problems.

Sometimes, Seitz said, there is also scarring in the esophagus. The endoscopy is an out-patient procedure completed under a mild sedative and used to remove scar tissue or polyps if they are evident.

“Cancer of the esophagus is rare, but there is a 120 times greater chance for cancer if Barrett’s Esophagus is evident. Depending on how severe it is, we use the scope every year or two to keep track of any changes,” Seitz said.

One of Seitz’s patients is Sandra Kiichler of Fremont. She was diagnosed eight years ago.

“I had symptoms. I would eat so much, and then my food would get caught,” Kiichler said.

What Seitz found was a narrowing of her esophagus and that led to discovering the acid reflux. Kiichler had the endoscopy and Seitz also found polyps and scarring, which he removed, and he also stretched out the sphincter muscle.

Although that has helped, Kiichler will always be on prescription medication.

“I’m careful of what I eat. I don’t eat a lot of lettuce and I stay away from spices and salsas,” she said.

Those things bother her stomach but she said otherwise she eats most everything else with no problems.

She was on Prevacid but was switched to Nexium twice a day.

“I don’t have many problems on the medication, but I also try to eat smaller bites and chew my food well because it goes down easier that way,” Kiichler said.

She goes in every three months for a general check up.

With lifestyle changes, medication, diet and endoscopy when needed, acid reflux can be controlled.

Usually Kiichler said once the sphincter is stretched it doesn’t have to be done again.

Kiichler has made the lifestyle changes and diet changes she needed to, and with her medication, she said, “So far mine is doing just fine.”

(info by Carolyn Gibbs from http://www.fremontneb.com/articles/2005/07/15/news/news6.txt)

If food causes more pain and discomfort than pleasure, acid reflux disease could be the problem.

It’s a fairly common condition according to Dr. Richard Seitz of Fremont.

“The majority of people suffer from heartburn. Most suffer occasionally and for a few it’s more persistent,” Seitz said.

He also said 15 to 20 percent of the population suffers with fairly significant acid reflux, while 10 percent suffer daily.

Acid reflux is a condition where for a variety of reasons, stomach acid and/or food contents regurgitate back into the esophagus. This causes heartburn and discomfort. Sometimes it also can cause more serious complications. Seitz said it has been implicated in asthma, chronic sinus infection and chronic hoarseness.

Acid reflux can lead to irritation of the esophagus which can be mild to moderate to severe depending on the symptoms. The condition can be caused by various things which weaken the sphincter muscle between the esophagus and the stomach. When the sphincter is weakened, it is unable to keep the stomach acid from flowing back into the esophagus.

Weight gain or obesity are offenders that cause pressure on the abdomen and force the food up through the sphincter. Chocolate, coffee, caffeine, alcohol and tobacco also weaken or lessen the pressure of the sphincter and that makes it easier to get acid reflux.

“If you’re able to make some lifestyle changes, you may not need to be on medication permanently. Sometimes losing weight will correct it, and also avoiding fatty foods, or spicy foods, chocolate and caffeine,” Seitz said.

He said some sufferers do well by also elevating the head of their bed four to six inches because there’s no gravity to keep reflux down when people lie flat. If changes can be made, sometimes it will eliminate the need for any further treatment.

Seitz said mild symptoms usually respond well to over-the-counter drugs such as Zantac, Pepcid or Prilosec. Moderate to severe symptoms need prescription medication of which the most common are Previcid or Nexium.

“We use those in varying dosages depending on how severe the reflux is and most patients get by with one pill once or twice a day,” Seitz said.

(info by Carolyn Gibbs from http://www.fremontneb.com/articles/2005/07/15/news/news6.txt)

If you have asthma, you might be at a higher risk for getting heartburn.

A new study found patients with asthma were at a higher risk for developing gastroesophogeal reflex disease or “gerd” within the first year of their asthma diagnosis.

Gerd can cause heartburn, regurgitation, chronic coughing, hoarseness and chest pain.

Researchers plan for more studies to find out what why asthma patients appear at a higher risk.

For three years, researchers followed 5,653 patents recently diagnosed with gerd and 8,105 patients without gerd or asthma. During the same time they followed 9,712 patients with newly diagnosed asthma and 19,334 control subjects without asthma or gerd for 2.8 years.

Patients with asthma were more likely to be diagnosed with gerd within the first year of their diagnosis. Patients diagnosed with gerd were not found to be at a significantly higher risk of developing asthma.

Researchers say physicians need to be aware that patients may be at a higher risk for gerd when they also have asthma.

(Info from NBC News)

Ohio State University physicians are putting new technology to use to diagnose complicated reflux disorders that don’t respond to anti-acid medications.

Though many gastroesophageal reflux disease cases can be controlled by drugs that suppress acid, some reflux sufferers find no relief from over-the-counter or prescription medicines because acid isn’t a factor in their disorder. But before this technology became available for clinical uses, such cases were difficult to diagnose.

The gold standard for detecting acid reflux is pH monitoring, a test that measures how often and for how long stomach acid enters the esophagus. This monitoring can now be combined with the use of impedance technology, which uses electrical currents to sense the movement of stomach contents upward into the esophagus.

“For a long time, we have been able to tell if acid reflux occurred because we could detect the acid,” said Dr. David Quinn, a gastroenterologist at The Ohio State University Medical Center. “This new technology can detect whether the reflux is acidic or non-acidic with minimal inconvenience to the patient.”

The impedance technology involves the presence of tiny metal strips along the pH monitoring catheter, which is inserted through the nose to the bottom of the esophagus. The impedance sensors on the catheter can detect any changes in resistance in the esophagus when bolus (material from the stomach) enters the esophagus and disrupts the sensors’ electrical current.

Patients wear the catheter for 24 hours, and also carry a paging device electronically connected to the catheter’s sensors. When patients experience heartburn and other symptoms, they press a button on the device, which also collects impedance data when reflux actually does occur.

“Because this is an ambulatory test, patients can carry out normal activities, and we actually want them to go about their daily routine so they will have their usual symptoms,” said Quinn, medical director of endoscopy in OSU’s division of digestive diseases.

The next day, information from the pager is fed into a computer, and physicians can look for a correlation between the presence of symptoms and whether reflux occurred at the same time.

“This way, we are able to detect non-acidic reflux and whether it occurs with typical or atypical symptoms,” he said. “In the past, we were only able to detect pH levels. Now, we can detect when the material is actually moving and see what’s going on in the bottom of the esophagus.”

“Antacids don’t work for these patients with non-acidic reflux. And even though they don’t have inflammation or pain associated with acid, they still have bothersome symptoms that affect their quality of life.”

Typical reflux symptoms are heartburn, an acidic taste in the mouth, chest discomfort, a sensation that food is stuck after being swallowed and chest pain. Atypical reflux symptoms include asthma, laryngitis and chronic cough.

Patients with symptomatic non-acidic reflux disease typically are candidates for a laparoscopic surgical procedure in which the upper part of the stomach is wrapped around the bottom of the esophagus. Doctors also can determine if endoscopic reflux therapies, generally designed to tighten or thicken the junction of the esophagus and stomach, could help patients with symptomatic non-acidic reflux.

The Sleuth Impedance-pH Monitoring System technology used at OSU Medical Center was developed by Sandhill Scientific, based in Highlands Ranch, Colo.

Emily Caldwell - COLUMBUS, Ohio
Medical Center Communications 614.293.3737 - http://www.medicalcenter.osu.edu/

Many patients that Dr Whelan treats are suffering from acid reflux disease, also known as GERD, gastro esophageal reflux disease. GERD is a condition in which acid, bile, and partially digested food in the stomach back up into the esophagus, the tube that carries food from the mouth to the stomach. Heartburn is one symptom of GERD.

“Thirty to 40 years ago there were very few complaints of GERD, but today 30 to 40 percent of my patients have symptoms related to GERD,” Dr Whelan said. “The sphincter muscle [between the esophagus and the stomach] opens up inappropriately at times, causing GERD. Patients get inflammation, heartburn, nausea, the feeling of a lump in your throat, the sensation that food gets stuck.”

Dr Whelan said he gets referrals of patients who complain of sore throat or sinus problems that actually are caused by GERD. Some also have pulmonary disorders, characterized by a cough that will not clear, actually caused by GERD. “You don’t necessarily need heartburn to have a diagnosis of GERD,” he said.

Not everyone needs to be treated for GERD, which is a common disorder that usually can be relieved with antacids and other over-the-counter acid reducers and neutralizers. Some patients require prescription drugs to get relief.

Stress can make a lot of symptoms worse, Dr Whelan noted. On the other hand, lifestyle changes can help, such as reducing stress, losing weight, and cutting back or eliminating alcohol, fried fatty food, coffee, chocolate, and other foods that contain caffeine. Giving up smoking also helps, as does reducing the consumption of acidic beverages like grapefruit juice and orange juice.

“Some people can make all these lifestyle changes and still need the pill,” Dr Whelan said. “The pill does have possible side affects, however, such as headaches, belly pain, and diarrhea.”

When GERD is untreated, it can cause chronic inflammation that leads to scarring of the tissue. In some cases, the changes in the lining of the esophagus can lead to ulcers there, a condition known as Barrett’s esophagus, and occasionally cancer.

Some patients of Dr Whelan are diagnosed with celiac disease, an intolerance to anything made from gluten, an allergy to a protein in grains.

“It sets off an inflammatory response in the wall of the small intestine that causes bloating, cramps, abdominal pain, and terrible diarrhea,” Dr Whelan said. “It is a genetic disease and can cause anemia. Lack of vitamin D absorption can lead to osteoporosis in women.”

The treatment is simple avoidance of anything with gluten - anything made with grains such as wheat, rye, and barley. “The more we look for celiac disease, the more we find it,” he said.

Dr Whelan said many gastrointestinal disorders cause diarrhea and one of the most helpful things for patients is acidophilus, live cultures found in some types of yogurt, that restore the bacteria flora of the digestive tract. It is often recommended for patients who are taking antibiotics, he said, because the drugs can also kill the beneficial bacteria in the intestinal tract, causing diarrhea and other problems.

(info from http://www.newtownbee.com/Features.asp?s=Features-2005-07-07-10-05-43p1.htm)

If you have a sore throat and cough that won’t go away, a new Mayo Clinic study said that the cause may surprise you, and it may be very easy to treat, Dr. Bruce Hensel reported in an exclusive story for NBC4.

Those symptoms may actually be caused by acid reflux, a form of heartburn you may not even feel, except that it gives you a chronic cough, congestion, bronchitis and even asthma.

And the cure is simple.

Mary Labrash thought her cough was caused by a flower allergy or an infection.

“(I had) bronchitis that wouldn’t go away,” Labrash said. “A lot of times it was like I had laryngitis.”

Millions of people get those symptoms and think the same thing. But doctors at the Mayo Clinic found Labrash actually had acid reflux.

“In a small subset, (acid reflux) travels even farther up and causes throat symtoms,” Dr. Yvonne Romero, of the Mayo Clinic, said.

That can happen while you sleep lying down. The next day you have a chronic cough, a feeling of something being stuck in your throat, hoarseness and a sore throat.

A simple treatment is antacids that reduce acid already in the stomach or that block some acid production.

After a few weeks of treatment, Labrash’s symptoms began to disappear.

Her voice sounds better, and she no longer coughs.

All chronic coughs and hoarseness should be worked up to make sure nothing else is causing them, Hensel reported. Some doctors don’t even think of this to diagnose acid reflux. If you have these symptoms, talk to your doctor about them. Antacids may be the simple cure.

(info from http://www.nbc4.tv/health/4696911/detail.html)

Swallowed Stress

Dietary changes are important, but if you don’t maintain emotional well-being, you’re skipping a crucial step in finding long-lasting stomach relief. GERD is worsened not only by what you eat but also by what’s eating you. Researchers have linked the disease to stress and negative coping skills. According to Yehuda Ringel, M.D., a gastroenterologist and clinical researcher at the University of North Carolina at Chapel Hill, “Time and again, it’s been shown that psychological stress can increase the symptoms of heartburn without evidence of any increase in acid exposure to the esophagus. Consequently, we have learned that a person’s psychological and emotional state greatly affects how he or she perceives GERD symptoms.”

Ringel recommends keeping a “stress diary” to see if there’s a correlation between one’s GERD symptoms and emotions. If so, he says “treatments can be directed toward reducing the effects of psychological distress. The specific treatment should be individually tailored but it can include stress-reducing techniques like yoga and biofeedback, antidepressant medications and psychological consultation. Patients should find the technique that works best for them.” This is not to suggest that psychological or stress management treatment should be the only approach to conquering GERD, but it can help give sufferers a sense of control over their symptoms and improve the eventual outcome.

As with most diseases, the best medicine is prevention. Following a healthy diet and keeping your weight within the recommended range sometimes helps prevent this disorder from developing in the first place. But if GERD is already present, stress management and dietary adjustments can help make it manageable. And this is a good thing, because if you’re staying up late, it should be for far more pleasurable reasons than heartburn.

Dos & Dont’s

* DO enjoy your meals. Chew slowly and sit up and digest afterward. Avoid lying down for two to three hours after eating.

* DO raise the head of your bed six to eight inches or place an extra pillow under your head at night. Gravity’s pull will help keep stomach acid moving down toward the intestines, an organ designed to handle it, rather than upward to the vulnerable esophagus.

* DO lose wei

ght if you need to.

* DON’T smoke, as it irritates the stomach.

* DON’T wear tight clothes, which can push against your stomach and squeeze its contents upward.

* DON’T ignore chest pain. Pain that is crushing, spreads to your left arm–or that’s accompanied by dizziness, sweating, rapid pulse or difficulty breathing–is a symptom of a heart attack. Seek medical treatment immediately.

—–
KATHRYN DRURY is a writer and editor living in New York City.
COPYRIGHT 2001 Vegetarian Times, Inc. All rights reserved.

Don’t let a burning, churning stomach keep you up at night.

You know the feeling: You’re so full that you feel as if your stomach is going to explode. Perhaps there were cheese fries involved, or spicy tomato sauce and half a bottle of red wine. Maybe the culprit was the greasy fried dough you couldn’t resist at some outdoor feast. Chances are, you’re paying for this splurge with a late-night bout of heartburn.

All, heartburn, that painful, burning and, for some, all-too-familiar sensation that lurks just behind the breastbone. It’s often accompanied by a bloated, nauseated feeling that leaves you vowing never to eat two orders of nachos again. Sufferers sometimes experience a bitter taste in their mouths or have the sense that food is “coming back up on them.” Discomfort can last as long as two hours and is often exacerbated when a person lies down.

Heartburn occurs when stomach contents (semidigested food and digestive acids) back up into the esophagus. Under normal circumstances, the lower esophageal sphincter (LES) muscle, located at the bottom of the esophagus, acts as a “gatekeeper.” It opens briefly to let food pass into the stomach and then closes tight to keep it down. But if the LES is compromised–by stress, foods that relax the muscle or physical pressures like too much food in the stomach–the valve won’t form a tight enough seal, allowing acid to sneak back into the esophagus. And because the esophagus doesn’t secrete protective mucus (like the stomach and intestines do), it is easily irritated by the acid.

More than 60 million Americans experience heartburn at least once a month, and about 25 million suffer from it daily, according to the National Institutes of Health. Occasional heartburn isn’t cause for alarm; it’s just the aftermath of a particularly spicy, rushed or heavy meal. But if you experience symptoms of heartburn two or more times a week, you should be concerned because you might be suffering from gastroesophageal reflux disease, or GERD. You may have heard this called acid reflux, dyspepsia, chronic heartburn or acid indigestion, but GERD is the most contemporary moniker.

An equal-opportunity offender, GERD affects men and women of all ages. Being pregnant or overweight or wearing tight garments makes one especially prone because the stomach has increased pressure on it. Nutrition also plays an important role: GERD is less common in countries where people eat lower-fat, higher-fiber diets–unlike in the United States. Fortunately, GERD is usually controllable with diet and lifestyle modifications and, failing that, medication. In the worst cases, patients may need to undergo surgery to tighten a too-loose lower esophageal sphincter.

If you’re suffering from frequent heartburn, your doctor will look for signs of acid damage in the esophagus and at how your LES muscle is functioning. According to Ray Clouse, M.D., a professor of gastroenterology at the Washington University School of Medicine in St. Louis, Mo., there are several diagnostic tools used to detect GERD. They include an upper GI series (in which a special X-ray is used to examine the esophagus and stomach); tests to measure the amount of acid that reaches the esophagus in a 24-hour period; and visual examination of the esophagus with a scope. “Be aware, however, that the presence of heartburn on any kind of regular basis often suggests GERD,” says Clouse, which explains why many patients are given the diagnosis based on symptoms alone.

Treatment is necessary because not only is constant heartburn unpleasant, but it can also lead to serious complications. Stomach acid may irritate the lining of the esophagus (esophagitis) to the point of scarring and narrowing, making it difficult to swallow or causing esophageal ulcers that bleed. GERD can also affect the cells lining the throat by replacing them with cells designed for the small intestine, leading to a condition called Barrett’s esophagus, which is believed to increase the risk of esophageal cancer from 1 in 100,000 to 1 in 100. Further, if stomach contents travel high enough through the esophagus to reach the top of the throat, they can affect the vocal cords (causing hoarseness) and the lungs, resulting in a chronic dry cough or asthma.

How to Spell Relief?

Most heartburn sufferers immediately reach for an over-the-counter antacid like Rolaids, Tums or Maalox to reduce stomach acidity. Antacids are mild alkalines that neutralize stomach acid for a short time. There are also drugs designed to work longer by reducing the amount of: acid your stomach secretes; these include Axid AR, Pepcide AC, Tagamet HB and Prevacid. Yet another type of drug, such as Propulsid or Reglan, speeds up digestion, making it less likely for food to creep up into the esophagus.

Interestingly, GERD is not caused by an overly acidic stomach, but rather by an esophagus that has been exposed to acid it wasn’t designed to come into contact with. “In fact, there is typically nothing wrong with acidity in patients with GERD and/or heartburn,” says Clouse. He explains that people may feel better after popping an antacid because this lowers the overall amount of time the esophagus is exposed to acid, giving it a chance to recover.

Clouse warns that while antacids are okay as a short-term fix for people with only occasional symptoms, they shouldn’t be used too frequently. “They can alter bowel habits, leading to diarrhea or constipation. Additionally, overuse of calcium-containing antacids like Tums can lead to excessive absorption of calcium and kidney stones.”

So instead of spending a lifetime popping antacids, which essentially just puts a bandage on the situation, you need to address what’s causing your distress in the first place.

Putting Out the Fire

When treating GERD, John Farrell, N.M.D., a naturopath in Greenwich, Conn., looks at several factors. “The first is environmental stressors, which greatly increase the production of stomach acid. GERD has a lot to do with how people look at life, and diet is a big consideration.” Portion control is a key weapon against GERD. “The esophagus is a tube of muscle,” Farrell explains, “so when you fill yourself past your capacity, the stomach and esophagus are stuffed like a two-pound sausage in a one-pound casing.” He recommends reducing portions so that your stomach is never bulging upward against the esophagus. “Eat five to six small meals a day rather than three big ones.”

Karta Purkh Singh Khalsa, a nutritionist in Seattle and author of Herbal Defense (Warner Books, 1997), agrees. “From a natural-healing standpoint, the cause of GERD is obvious: The stomach has lost its structural integrity.” To support the connective tissues in the stomach, Khalsa treats GERD with turmeric capsules. “Take three or four capsules [250 to 500 milligrams (mg.) total] at the onset of the heartburn. A daily regimen of about five [capsules] eventually heals the condition, and often within a few doses. Turmeric is also highly anti-inflammatory. It’s my longterm-treatment secret weapon.” Khalsa also recommends taking deglycyrrhizinated (DGL) licorice root tablets, available at natural food stores, to soothe a burning stomach. Chew two 250- to 500-mg. tablets at the onset of symptoms or, as a preventive measure, 15 to 20 minutes before meals.

Some foods are notorious for relaxing the lower esophageal muscle, causing its seal to loosen. These include fried and fatty foods, tomato products, citrus fruits and juices, coffee, chocolate, spearmint and alcoholic beverages. While peppermint, a classic digestive herb, can improve symptoms in about two-thirds of heartburn sufferers, in some people it actually relaxes the LES muscle, making the condition worse, says Khalsa. If you want to see if you can handle it, try slowly sipping a cup of peppermint tea; if it agrees with you, you can drink three cups a day, during or after meals. In Herbs for Health and Healing (Rodale Press, 1996), herbalist Kathi Keville advises making the tea with one cup boiling water and a teaspoon of peppermint leaves, steeping it for about five minutes. Strain out herbs and drink. You can also use a commercially prepared tea bag.

Many people find relief from GERD by increasing their intake of foods that help digestion, such as papaya and pineapple, as well as fiber-packed foods, such as raw vegetables, to keep things moving smoothly through the gastrointestinal system. Juices made from fresh aloe, raw potato, celery, carrot and cabbage can also reduce discomfort. “Cabbage juice is a classic remedy for stomach upsets,” explains Khalsa. “Drink about 8 to 10 ounces of cabbage juice once a day.” Cabbage contains glutamine, an amino acid that can calm irritation, so eating steamed cabbage is also effective.

to be continued…

—–
KATHRYN DRURY is a writer and editor living in New York City.
COPYRIGHT 2001 Vegetarian Times, Inc. All rights reserved.

Elaine Magee, MPH, RD, author of Tell Me What to Eat If I Have Acid Reflux and of a new DVD titled The Heartburn-Friendly Kitchen, tells that when you eat and how much have a real effect on heartburn.

If you’re prone to heartburn, Magee recommends eating six to eight hours before bedtime. “Often people won’t eat all day while they are running around in the heat,” she says. Then when they eat at night, they eat too much and then go to bed. This makes stomach contents more likely to splash up.”

If you are taking aspirin, pain meds, antibiotics, or iron, be extra cautious. These can set off heartburn.

Other ways to help drench your heartburn include:

* Exercise as usual, but don’t eat before, during, or just after.
* Lose weight if you are overweight.
* Stop smoking (it not only stimulates acid production, but loosens the valve that protects your throat and can also reduce saliva production).
* Elevate your bed with wedges.
* Take over-the-counter medication. If you find you need something more than twice a week check with your doctor. You may need a prescription.
* Relax! The stress doesn’t cause the heartburn, but it can cause you to gobble trigger foods.

If you get heartburn daily, despite lifestyle and eating changes, consult a physician.

Star Lawrence is a medical journalist based in the Phoenix area.

SOURCES: Rodger A. Liddle, MD, professor of medicine and gastroenterologist, Duke University. Elaine Magee, MPH, RD, author, Tell Me What to Eat If I Have Acid Reflux, and the DVD The Heartburn-Friendly Kitchen.

According to Elaine Magee, MPH, RD, author of Tell Me What to Eat If I Have Acid Reflux and of a new DVD titled The Heartburn-Friendly Kitchen, the key to enjoying summer foods is to know what agrees with you.

* If grease bothers you, stick with grilled or raw foods.
* Instead of tomatoes, load up your salads with carrots, beans, jicama, or other milder veggies.
* If chocolate is a trigger, eat a few Kisses instead of a double helping of Death by Chocolate cake.
* Burgers are OK, Magee says, but get the leanest cuts and dress with guacamole or something less acidic than catsup.
* If carbonated drinks lead to late-night torture, stick with iced tea.
* If Margaritas and you don’t get along, drink less or switch to a virgin strawberry type.
* Watermelon can be acid-producing. Consign it to a mixed fruit salad only.
* Eat smaller portions. Your stomach detects large amounts and pumps out more acid.