Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or 
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone 
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications. Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Causes It?

GERD or acid reflux is caused by the regurgitation of acidic liquid stomach contents back up into the esophagus. It is a long-term condition where stomach contents come back upwards from the gastro-intestinal tract resulting in either symptoms or complications. It is a commonly occurring digestion condition. A burning sensation in the chest is usually caused by acid reflux which radiates up from the stomach to the mid-chest or throat. This condition is also known as the heartburn. A sour taste in the back of the mouth is a common experience amongst the patients. Long term reflux of gastric contents causes the condition to become chronic which can lead to difficulty in swallowing. In some cases the erosion of the tract lining can also cause breathing problems.

Symptoms:

Heartburn is a burning sensation felt in the retrosternal area. Most commonly it occurs post-prandial or nocturnally. Consumption of fatty foods, spicy foods, acidic foods aggravates the condition. Burning sensation is relieved with antacids, water or milk.
Perception of gastric content reflux in the mouth or hypopharynx is termed as acid regurgitation. It is also known as water brash. A bitter or acidic taste is felt in the mouth.
Other symptoms include dysphagia, odynophagia, nausea, chest pain, dyspepsia, epigastric fullness, bloating, frequent belching
Extra-esophageal symptoms like chronic cough, hoarseness, laryngitis, dysfunction of the vocal cords, bronchospasm can also be observed.
Complications:

Peptic stricture
Ulcers of the esophagus
Metaplastic disease (Barrett s esophagus)
Dysplastic disease (Adenocarcinoma)
Laryngitis or bronchitis
Pulmonary disease
Fluid in the sinuses and the middle ear
Diagnosis:
The diagnosis of GERD is made by its most commonly presenting symptom- heartburn. To confirm the diagnosis of GERD, the physicians treat patients with medications for suppression of the production of acid by stomach. If heartburn diminishes to a large extent by the medications, diagnosis of GERD is considered confirmed.

Conditions like an ulcer caused by bacterial infection, mimic the symptoms of GERD. To get a clearer diagnosis, an endoscopy is then performed. The common diagnostic modality for GERD is Upper intestinal gastro-endoscopy. A tube containing an optical system for visualization is swallowed, the tube progresses down the gastrointestinal tract, and then the lining of the esophagus, stomach, and duodenum can be examined. A normal esophagus is observed in most patients with symptoms of reflux. 

However, sometimes the lining of the esophagus appears inflamed. If erosions (superficial breaks in the esophageal lining) or ulcers (deeper breaks in the lining) are seen, a diagnosis of GERD can be made definitely. Other complications of GERD like ulcers, strictures, and Barrett's esophagus are also identified. Biopsies also may be obtained. Other common problems that may be causing GERD like symptoms can be diagnosed (for example ulcers, inflammation, or cancers of the stomach or duodenum) with EGD. Previously, barium meal x-ray was undertaken to diagnose GERD. It is now discontinued.

Other tests that are carried out are esophageal acid testing, esophageal motility testing, gastric emptying studies and acid perfusion test.

Treatment:

Lifestyle modifications   Avoiding acidic foods, quitting smoking, weight loss, abstaining from alcohol consumption improves symptoms in people with GERD.
Medications   Proton pump inhibitors (Pantoprazole, Omeprazole, Rabeprazole), H2 receptor blockers (Ranitidine, Cimetidine) and antacids.
Surgery   In cases where the proton pump inhibitors are unsuccessful in relieving symptoms of GERD, a surgical procedure called Nissen fundo-plication is done.

GERD - Complications Associated With It!

Hectic lifestyle, unhealthy food habits, poor bowel movements, and stress can all add up to one condition called the GERD. Gastroesophageal reflux disease or GERD refers to a particular type of digestive disease, and mainly affects the LES or lower esophageal sphincter, which is a muscle ring between the stomach and the esophagus resulting in the symptoms such as burning sensation in the chest or difficulty in swallowing.

Treatment options
While the moderate or mild GERD can usually be treated with healthy lifestyle changes, diet, and medications, when the condition gets severe, surgery becomes the only option to prevent the issue from deteriorating further. Here are some of the common surgical options available for treating GERD:

Fundoplication: This surgical procedure is the most common and standard surgical option for treating GERD. It focuses on tightening and reinforcing the LES by wrapping the upper portion of the stomach around the outer side of the lower esophagus which strengthens the sphincter.
Transoral Incisionless Fundoplication: Transoral incisionless fundoplication or TIF is another surgical procedure available for treating GERD and can be performed when an open fundoplication cannot be performed. It is performed by creating a barrier between the esophagus and the stomach which prevents the stomach acid from reflux or going backwards.
Stretta: This surgical procedure is performed as an outpatient option using an endoscope. Here, a flexible tube is passed into the esophagus where the electrode present at the tip of the tube creates tiny cuts on the esophagus by heating the esophageal tissues. As a result, the scar tissues formed, block the nerves that are responsible for acid reflux.
Bard EndoCinch System: This surgical procedure also uses an endoscope to create stitches to make pleats in the lower esophageal sphincter, which strengthens the LES. However, this surgical treatment option is not as common as other GERD treating procedures.
Linx Surgery: In Linx surgery, a special device called Linx, a ring containing microbeads of magnetic titanium, is wrapped around the sphincter to make it strong. As the beads are magnetized, they help in keeping the opening between the esophagus and stomach closed, while letting the food pass normally.
Recovery
As long as the surgical option is laparoscopy, they are the least time-consuming as well as less painful with lesser downtime, but may not be ideal for everyone. When it comes to traditional surgical treatment options like fundoplication, it takes around minimum six weeks to resume the daily activities. However, for laparoscopic fundoplication, the downtime is one or two weeks. Linx surgery is a minimally invasive surgical option and therefore, the recovery time is shorter than other traditional surgeries for treating GERD. Depending on the patient's health conditions and response to surgery, the recovery time may vary for each surgical treatment options for GERD.

So, seek the advice of your gastroenterologist for the best possible treatment option to get completely cured of the condition.

Treating GERD: 5 Surgery Options That Can Help!

Indigestion spares nobody. No matter how healthy you are, at some point or the other, everyone suffers from acidity, bloating and gas. On its own these problems are rarely serious but they can leave you feeling quite uncomfortable and can be embarrassing as well.

Homeopathy can be very effective when fighting against indigestion of any kind. This form of treatment has negligible side effects and hence can be given to both children and adults. Homeopathy does not address only the symptoms but goes to the root of the problem. Thus it also stops the problem from recurring. Here are few common homeopathic medicines that can help ease indigestion.

1. Nux vomica
Nux vomica is known as the remedy for overindulgence. This homeopathic medicine can be used to treat stomach problems of all kinds. It is very effective against bloating and gas and is also often used to treat constipation. Nux vomica is also known as the best homeopathic remedy for heartburn associated with excessive alcohol or caffeine.

2. Pulsatilla
This is often used to treat gastric problems that follow eating heavy food like pastries, ice cream and food fried in ghee or butter. It can also be used to treat loose motions.

3. China
China is an effective form of treatment against bloating and build up of gas. Abdominal pain caused by gas can also be treated with china. This homeopathic remedy can also be used to treat diarrhea that is accompanied by extreme weakness.

4. Arsenic album
Gastric troubles that are triggered by food poisoning can be effectively treated with arsenic album. Some of the symptoms it treats are nausea, loose motions, abdominal pain and vomiting. Acidity and a burning sensation in the stomach can also be eased with this medicine. Arsenic album is also used in cases of chronic vomiting where the stomach does not retain any food.

5. Lycopodium
Sometimes even eating a light meal can leave you feeling bloated and with a heavy feeling in your abdomen. This bloating and excessive gaseousness accompanied by burning burps can be treated with lycopodium. It also treats acidity triggered by starchy and flatulent food.
Along with taking homeopathic medicine, making a few changes to your eating habits can also help treat chronic gastric problems. Chew your food and eat slowly. Avoid eating anything that is too hot or too cold and drink plenty of water. Ideally you should hydrate your stomach half n hour before eating a meal.

Remedies for Stomach Acid, Bloating and Gas

Cumin, also known as 'jeera' in the Indian subcontinent, is an ancient seed that has been prized for more than 3000 years. Ayurveda holds this spice in high regards and uses it for treating a host of health disorders including burning of excess fat.

Why are cumin seeds considered to aid in weight loss?

An effective detoxifier: Ayurveda considers the accumulation of toxins to cause weight gain and other medical conditions. While certain toxins are easily removed with water, fatty toxins stick to cells and disrupt cell metabolism resulting in weight gain. To detox such hard-to-remove toxins, cumin seeds are predominantly used in Ayurveda. The seeds remove excess kapha from the intestines and detox liver effectively.
Lowers cholesterol that aids in burning fat effectively: Black cumin is rich in phytosterols which are plant fats resembling cholesterol present in animal fats. When consumed, they limit the amount of cholesterol absorbed by the body. Taking a tablespoon of cumin seeds every day has been medically proven to lower the amount of cholesterol up to 10 percent and bad cholesterol up to 14 percent. This reduction in addition to the cholesterol-lowering measures that you may have adopted would be helpful in burning fat much faster. Taking about 2 grams of cumin seeds combined with light freehand or aerobic exercises can lead to subsequent weight loss in people who lead a sedentary lifestyle.
Lowers blood sugar levels and regulates metabolism: Any person with high blood sugar levels is aware that low insulin levels tend to create a craving for sweets and carbs while high insulin levels can cause extreme thirst and fatigue. Cumin seeds have been proven to lower the blood sugar levels. It lowers blood sugar levels by increasing insulin and glucose sensitivity. In this way, black cumin seeds can aid you to shed off extra pounds by improving the blood glucose levels as well as glucose absorption. In addition to all these benefits, black cumin seeds contain high amounts of oleic acid which is a fatty acid causing acceleration in the way in which the body burns fat.
Other benefits from cumin seeds: Constipation and indigestion are other common reasons for weight gain. An excellent source of fiber, antioxidants, and that has anti-flatulent properties, the cumin seeds can cure constipation, bloating and heaviness, thus, aiding in weight loss. Lack of sleep may also be causing weight gain. Cumin seeds can cure you of insomnia, thus. regulating your sleep pattern and metabolism.
Hence, cumin seeds are a simple and effective ayurvedic remedy for weight loss. Cumin seeds are more potent, and you can take a spoon of roasted or plain cumin seeds every day. Obese or normal, irrespective of your weight, taking cumin seeds regularly have quite a few benefits.

1 Tablespoon Of Cumin - Know How It Can Work Wonders!

Acidity - gastritis: understanding the symptoms and causes

Gastritis/acidity is a group of diseases or symptoms where there is excess secretion of acid by the gastric glands of the stomach.

If you have upper abdominal discomfort or pain, stomach fullness, heartburn, nausea, vomiting, indigestion, belching, waterbrash or irregular bowel movement, then you must be suffering from acidity or gastritis. It is a problem which becomes worse when an individual has poor eating habits and improper lifestyle.

Gastritis: swelling of stomach lining

Various factors like spicy food, medicines, tobacco, alcohol etc. Can cause increase in gastric acid production and disturb, weaken or damage the normal stomach lining. Gastritis occurs when there is an imbalance between the acid production and damage to the stomach lining, resulting in swelling of the stomach lining.

Gastritis a very common disorder of all age groups

Gastritis is of two types - acute gastritis (which occur suddenly) and chronic gastritis (develops over a period of time). In India gastritis is a very common disorder which occurs at any age but is more widespread in the adolescent age group (12-17 years). Adolescence is a change from childhood to adulthood, the period in which a lot of physical and psychological changes occur increasing the risk of gastritis. 

Multiple factors cause gastritis

Various factors like spicy food, medicines (pain killers), tobacco, alcohol, emotional disturbance, psychological stress, smoking, alcohol intake and bacterial infection lead to gastritis.

Besides these, the three most important factors include helicobacter pylori infection (bacterial infection), use of painkiller medicines and autoimmunity (body loses its own immunity and attacks itself). These factors in the long term may even cause an ulcer (permanent breakage of the stomach lining), acid reflux disorder (food coming back to mouth after swallowing) and stomach cancer.

What does Ayurveda suggest?

In Ayurveda, agni refers to fire like activity in alimentary canal responsible for digestion of food which is influenced by the status of doshas. When samana-vata associates with kapha in turn produces weak digestive power (agni-mandya). Consuming food against the code of dietetics i. E. Ahara-vidhi vidhana and ahara-vidhi-visheshayatana (method of taking food) lead to a number of diseases related with food. Eating food before the previous food is digested, untimely food, eating too much of spicy or oily food, eating when not hungry, drinking too much water during food and at a time unless required, very hot high fatty-fried food, stale food, heavy diet, excess consumption of horse gram, vitiate all the three body humours (tridosha) also contribute to the symptoms of gastritis.

Due to the sourness of consumed food the liquidity of pitta increases further decreasing the capacity for digestion (agnimandya). Hence, rasadi-dhatu is not formed in a proper manner. This, after a certain period, manifests as amlapitta (hyperacidity).

Symptoms of gastritis vary among individuals

Symptoms of gastritis vary among individuals, and in many people even there are no symptoms. It also depends on the duration of disease, whether it is of acute (coming on suddenly) or chronic (causing symptoms over a long period of time) type.

The most common symptoms of acute gastritis include:

Abdominal bloating or stomach fullness,

Belching (expelling air from the stomach through the mouth)

Waterbrashes (sour fluid or tasteless saliva into the mouth)

Upper abdominal pain or discomfort

Nausea/vomiting feeling

Irregular bowel movement

Recurrent indigestion,

Chest burn or gnawing feeling between meals (heartburn)

Hiccups etc.

In addition to this, symptoms of chronic gastritis may include weight loss, continuous flatulence, black stool, loss of appetite and even anemia.

How to diagnose gastritis?

To diagnose gastritis, performs a thorough physical evaluation, and may recommend a blood test for h. Pylori screening, stool test for blood in the stool. Abdominal x-rays or barium studies (upper or lower) may demonstrate the presence of thickened stomach lining and folds that are signs of inflammation in the stomach.

Sometimes, an endoscope, a thin tube containing a tiny camera, is inserted through the mouth and down into the stomach to look at the stomach lining (endoscopy). The doctor will check for inflammation and may perform a biopsy, in which a tiny sample of tissue is removed and sent for analysis of gastric lining.

If you would like to consult with me privately, please click on 'consult'.
Related Tip: 10 Things You Must Correct to Fight Acidity And Heartburn

What Causes Acidity?  Understanding its Symptoms and Causes

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