Vishwabharathi Hospital

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GERD
In medical terms, Gastroesophageal Reflux Disease, commonly termed as GERD, is a prolonged recurrence of gastroesophageal reflux. It is a disorder in which the acid available in the stomach moves to the esophagus and retains there for a longer duration. Esophagus is a ring of muscle and is the part of the tube that connects the throat with the stomach. Gastroesophageal means something related to the esophagus and the stomach.

Reflux refers to flowing back or returning of some liquid or fluid from its expected place or position. So, GERD is defined as a condition in which the liquid (acid) flows back from the stomach to the esophagus and causes adverse effects. When the acid from the stomach reaches the esophagus, it may damage the vital tissues.

Most of us suffer from acidity often. In case an individual suffers from acidity for more than twice a week for a prolonged period, the condition may be associated with GERD. Normally, a valve, known as Lower Esophageal Sphincter (LES), is placed between stomach and esophagus, which relaxes only to swallow food, water and saliva.

This LES valve prevents the stomach juices and flowing back of acid to the esophagus and the throat, especially when we lay down on the bed. When this valve stops functioning as expected and relaxes unnecessarily, the acid from the stomach may reach the esophagus. GERD is a common disease. It is believed that almost every individual experience GERD at least once in the lifetime.

As per the reports from American College of Gastroenterology, more than 15 million individuals from America experience suffer from heartburn almost every day. This count is around 20% of the America’s population. Note that the individuals of any age group may suffer from GERD. Although GERD is mainly a digestive disorder, but it is identified that individuals suffering from Asthma are more prone to suffer from it.

The reason being, since Asthma causes the LES to relax more frequently. This might allow the stomach to reflux the digestive juices along with the acid to the esophagus. Additionally, some of the asthma medicines, like theophylline, may raise the tendency of LES reflux, which could trigger GERD.

Symptoms of GERD
The various symptoms of GERD include:

- Burning sensation in the chest and throat

-  Excessive burping

- Stomach bloating

- Observing the acid taste in the mouth while burping

- Eaten food reaching to the mouth while burping

- Difficulty in swallowing food

- Constant pain in the chest for few hours after the meals

- Chest pain while swallowing the food or water

- Excessive production of saliva in the mouth

- Constant throat soaring for several days

- Hoarseness of voice

-  Inflammation in the gums

- Cavities of teeth

- Bad breath even after proper brushing of teeth

- Difficulty in breathing

- Lack of appetite

- Vomiting or nausea

- Lump feeling in the throat

- Disturbed sleep with uneasiness in the throat

- Wheezing sound while breathing

Causes of GERD
Normally, GERD is a common problem, which may occur due to numerous reasons. However, at times it occurs due to unknown reasons. The primary probable causes of this disease are mentioned below:

- Overeating

- Lying on the bed immediately after eating

- Eating too spicy food

- Weakening of esophagus due to poor muscle control or weakness in the body

- Due to certain medication comprising antihistamine, calcium channel blocker, sedative, antidepressant, and those for the treatment of asthma

- Being overweight, which induces more pressure on the stomach and abdomen causing LES to open unexpectedly

- Pregnancy also causes more pressure on the stomach and opens LES inappropriately

- Direct and passive smoking

- Overconsumption of alcohol

- Hiatal hernia, in which the diaphragm builds pressure on the stomach

Prevention of GERD
Although you may observe GERD due to multiple reasons, there are several measures that you may take to prevent it to some extent. Some of those are discussed below:

- The patients of Asthma or those who would have suffered from GERD must quit smoking.

- Elevate or raise the head side of your bed to around 6 inches than the feet side.

-  Maintain a healthy weight. Take measures to lose weight in case it is beyond the prescribed body-mass index. The excessive fat on your belly would increase the pressure on your stomach. This would forcibly open the LES on often basis, which will then allow the acid to reach at the esophagus.

- Limit the consumption of alcohol.

- Avoid heavy meals, especially in the evening. Do not go to the bed for at least three to four hours from your dinner or any other meal.

- Limit the consumption of caffeine-based products like coffee.

- Avoid consuming the theophylline drug, if possible.

- Exercise every day. However, do not work out immediately after your meals.

- Avoid eating over-spicy and junk foods.

- Consult a good dietician and eat accordingly during the pregnancy.

- Do not wear very tight clothes near to the belly. This may again increase the pressure on your stomach and open the LES, which may then allow the acid to reach at the esophagus.

- In case you are already suffering from GERD, avoid chocolates, peppermint, and tomato.

How is it diagnosed?
GERD is a common disorder that individuals often tend to ignore. Many of them assume it as a digestion disorder. The maximum that they do is to take an over the counter antacid tablet or syrup, which would ease the symptoms for a shorter duration. However, if those recur frequently or if the symptoms persist for several days, you visit your doctor.

The physician would assess the symptoms and may recommend the patient to visit the gastroenterologist for specialized treatment and investigations. One or more of the following investigations may be prescribed for the patient to confirm the occurrence of GERD:

- Esophageal pH and Impedance Monitoring: This test identifies the quantity of the acid content available in the esophagus in different states of the patient’s body, like before and after eating or sleeping.

- Upper Gastrointestinal or GI Endoscope: In this test, a camera attached with a tube is passed through the food pipe of the body. This camera captures pictures within the food pipe and the esophagus. The same process may also be used to extract a smaller piece of tissue, which would be sent to the laboratory for investigations.

- Upper Gastrointestinal or GI Series: In this test, X-ray captures pictures near to the esophagus that identify the causes of GERD.

- Esophageal Manometry: This test is based on measuring the contraction of muscles in the esophagus while swallowing food or water. It identifies the strength of the LES. In case it is found to be weaker, the individual is more likely to suffer from GERD.

- Bravo Wireless Esophageal pH Monitoring: This test involves attaching a small capsule to the esophagus for near to two days or 48 hours. This capsule measures the acidity level at the esophagus caused by the acid reflux from the stomach. In case the acidity near to the esophagus is higher continually for around two days, the individual is suffering from GERD.

Treatment of GERD
If GERD is confirmed by the doctors once after assessing the reports of the prescribed investigations, they would treat the patient based on the severity of symptoms. In normal cases, those are treated through certain course of medication. Many of these medicines focus on reducing the acid content in the stomach of the patient, which may relieve the patients from the symptoms of GERD.

Some of the common medicines used for the treatment of GERD are mentioned below:

- Proton Pump Inhibitor: These drugs are formulized to reduce the acid content in the stomach. The least acid is available in the stomach, lesser will be the chances to get it refluxed to the esophagus, which may cause GERD.

- H2 Blocker: This is another class of drugs, which would reduce the production of acid in the stomach.

- Antacid: Antacids are very common and over the counter medicines, which act by reversing the impact of acid in the stomach through multiple alkaline ingredients. Those are quite useful in the acidity and heartburn. However, those may cause multiple side effects such as constipation and diarrhea.

- Prokinetic: This medicine stimulates the digestion process of the body, which would empty the stomach faster than normal. Once the stomach is empty, the acid could not reflux to the upper side and reach the esophagus, which would avoid GERD. Since these medicines enhances digestion in the patient’s body, the individual may suffer from diarrhea. Those also cause other side effects such as anxiety and nausea.

- Erythromycin: These are the antibiotics, which treat the bacterial infection causing indigestion. Once the infection is treated, the acid formation in the stomach of the patient will be normalized, and GERD may be avoided.

In some severe cases, the patient would not be relived from the symptoms of GERD by changing the lifestyle and following the course of prescribed medication. In such cases, the gastroenterologist might recommend the patient to undergo a surgical treatment. The surgeries could be of following types:

- Fundoplication: In this process, the surgeon stitches some part of the stomach’s top near to the esophagus. This minimizes the passage between the stomach and esophagus, which reduces the chances of acid reflux. In most of the cases, this process helps in reducing the symptoms caused by GERD.

- Endoscopic Surgery: This process involves endoscopic stitching of the LES, which tightens the muscles involved in closing the valve near to the esophagus. The surgery is carried out using radiofrequencies, which produce heat for creating a burning effect for tightening of the LES muscles.

Complications of GERD
Most of the individuals suffering from heartburn take it very lightly. They often follow some home remedies or consume the over the counter medicines to get relieved from it. However, some patients of prolonged GERD may be at risk of complications. Some of such major complications are discussed below:

- Oesophageal Ulcers: This is the condition in which the acid floating from the stomach to the esophagus damages the lining of the esophagus. This further causes formation of ulcers, which may bleed and cause pain. The patients may even find it very difficult to swallow their chewed food because of the formed ulcers.

- Scarred and Narrowed Esophagus: In case a patient suffers from GERD for a long duration, the continual impairment of the esophagus caused by the refluxed acid may narrow it. This will further make very difficult for the patient to swallow anything. In such a case, a small balloon looking device is used for the widening of esophagus to ease the condition.

- Barrett's Esophagus: In case GERD is repeated frequently and not treated well, the cells in the LES lining are impacted. There is a little risk that the patient’s suffering from this condition or Barrett's Esophagus may suffer from oesophageal cancer due to the impaired cells. Around 10% of the GERD patients attain the Barrett's Esophagus condition. Further, 5 – 10% of the Barrett's Esophagus patients may suffer from the oesophageal cancer.

Myths of GERD
Myth #1: The only cause of GERD is eating spicy food.

There are lots of reasons causing GERD. Eating spicy food may be one of those.

Myth #2: Heartburn is a normal condition, which would heal either by its own or consuming the antacids.

Heartburn could be a symptom of GERD. If not treated on time, it may cause complications to the patient suffering from it.

Myth #3: Acidity is always caused by indigestion.

Acidity or heartburn could be caused by multiple reasons other than indigestion. It could also be a symptom of GERD, which must be treated by the doctor on time.

Myth #4: GERD may only affect kids and aged people

GERD can impact people of any age.

Myth #5: GERD is more likely to take place in the winters.

The patients may suffer from the symptoms of GERD in any season or month.

Myth #6: Healthy people with a robust immune system could not suffer from GERD.

Healthy immune system is not an important criterion for preventing the development of GERD in the body. However, those individuals whose esophagus muscles are weaker, are more prone to develop this disease.

Photo and natural aging occur through many mechanisms. Skin tone, color and texture are compromised by exposure to sun and tanning beds. Time induced volume and bone loss occurs, resulting in sunken in cheeks, eyes, mouth corners, etc with sagging skin and deep wrinkles as a result. Overactive muscle activity leads to upper face wrinkles.

Natural Aging Changes

• Loss of Elasticity
• Loss of Muscle Tone
• Laxity
• Roughness
• Wrinkles
• Furrows

Photo Aging Changes

• Pigment changes
• Keratoses (rough growths)
• Loss of elastic fibers and collagen
• Accentuation of natural aging
• Fine wrinkles
• Laxity
• Skin texture change (roughness)
• Thinning skin
• Dehydration
• Visible vessels

Consider non-invasive treatments to slow down the aging process.

• Topical skin care
• Microdermabrasion
• Chemical Peels
• Laser
• Botox and Xeomin
• Fillers

You will look and feel great!

Treatment Options for Anti-Aging 

Procedures

• Botox
• Chemical Peel
• Dermasweep Crystal Free Microdermabrasion
• Dermaplaning
• Halo
• Juvederm
• Laser Skin Peels
• Latisse
• BBL Photo Rejuvenation
• Profractional
• SkinTyte
• ND:Yag Laser
• Rejuvapen Collagen Induction Therapy
• Sculptra
• Xeomin
• Anti-Aging Products

Flat, grey, brown or black spots which usually occur on the sun exposed areas of the human skin are called Age spots. They are also termed as senile lentigo, liver spots, solar lentigines or sun spots.

Serious conditions of age spots include:

1. Moles
2. A malignant skin cancer condition called melanoma.
3. A type of skin cancer condition called lentigo maligna.
4. A non-cancerous skin growth called keratosis.

Noticeable characteristics of age spots that are identifiable include:

1. Darkened pigmentation
2. Irregularity in border
3. Combination in colours
4. Size increase over a short period
5. Bleeding, itching, redness or tenderness

Diagnosis-

The procedure for diagnosing is usually performed by dermatologists. If the doctor has any serious concern about the skin, a skin biopsy might be needed which would require the doctor to analyse a small sample of the skin. A local anaesthetic would be applied and a small portion of the skin would be cut away. Examination of the sample would be performed in the lab in order to determine whether there is a possibility of a condition other than solar lentiginosis.

Treatment-

Treatment is not usually required as age spots are harmless. However, for cosmetic purposes, people choose to treat the age spots. Some of the treatments include:

1. Prescription of bleaching creams, often coupled with retinoid creams and steroids are used to lighten age spots.
2. Dermabrasion is performed using a rotating brush to remove its surface layers and scour the skin. Redness and scabbing might be felt.
3. Cryotherapy is performed where liquid nitrogen is used to freeze the skin of the age spot which in turn destroys the dark colour produced by the melanin. There is a possibility of scarring during this procedure.

Oily skin is a result of overactive sebaceous glands that produce excessive oil, thus giving the skin its characteristic greasy look. Oily skin is usually caused by a number of factors such as stress, food, genetics and hormonal changes in the body. Blackheads, whiteheads and acne are some complications that can result from skin.

It is important to take care of oily skin to prevent breakouts. Mentioned below are few tips to assist you in your skincare regimen:

1. Use warm water to clean your skin
Cleaning your face with warm water opens up the pores and clears the dirt from; thus removing the layer of oil on the face more effectively than cold water. 

2. Face masks
You may use face masks such as sandalwood or fuller earth to get rid of the excessive oil on the skin. In addition to removing oil, it also cleans and removes impurities from the skin.

3. Limit scrubbing
You should restrict exfoliating your face 2-3 times a week as too much exfoliation may result in excessive oil production. Over scrubbing may cause the skin to lose its natural oils and turn dry.

4. Use a toner
You may apply toner on the skin regularly for its astringent properties that help in cooling and soothing the skin. It also reduces pore size which thus decreases oil production.

5. Diet
Diet plays an important role in the health of your skin, so consuming too many oily and fried foods can increase the chances of getting acne and pimples on your skin. Eat more vegetables and fruits to keep your skin healthy.

6. Stay hydrated
Drinking water regularly helps in replenishing the lost fluids from your body and it also improves overall body health. 

7. Use medicated pads
To freshen up your face, use wet tissues or medicated pads to soak up the oil which shall help in freshening up your face.

8. Choose makeup wisely
It is not recommended to use heavy makeup if you have an oily skin. Instead use water based makeup that is light and oily skin friendly. 
 

In the modern times, hair removal has become very common. Most people get a hair removal done for fashion reasons, although hair removal is extremely hygienic as well. The common hair removal methods are waxing, shaving or tweezing. The latest and the most effective hair removal method is laser hair removal. 

Benefits:

1. Lasers are extremely useful to remove unwanted hair from different parts of the body like the face, the legs, the arms, the underarms, the bikini line, and any other area. Here are a few benefits of laser hair removal:
2. Laser hair removal can focus on a particular portion of the skin leaving the surrounding areas. It can also remove coarse hair without affecting the skin in the area.
3. It is a very fast method as each laser pulse takes just a fraction of a second. An upper lip laser hair removal takes about a minute whereas laser hair removal of the back can take almost an hour.
4. Laser hair removals are mostly permanent after a series of minimum 3 sittings.

What to do before Treatment?
Laser hair removal is just not a method to remove hair, it is a complete treatment. Make sure the person who will conduct the treatment on you is a professional technician or a doctor. 
If you are getting a laser hair removal, abstain from waxing, plucking, or electrolysis for at least six weeks before going through the treatment. Also try to avoid the Sun as that can create certain complications.

What to expect from Treatment?
Before your unwanted hair is removed with laser, it will be trimmed to just a few millimeters right above the skin. The equipment of the laser treatment will adjust to the colour, the thickness, as well as the location of the unwanted hair being treated, along with the skin colour. The technician and you will need to wear eye protection, according to which laser will be used. Your outer skin will also be requiring a coolant gel or device before the treatment takes place. 
After the treatment is done you will be provided with ice packs and anti-inflammatory lotions to relieve the discomfort. Schedule your next sitting after at least six weeks. You will have to keep going for more sittings until hair stops growing.

Risks:
You might look sunburned after the treatment. Moisturizing will help ease the burnt feeling. Use sunscreen to prevent any colour change of your skin. Some other side effects can be blistering (which is usually very rare), swelling, scarring, or redness.