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?

Water effectively constitutes 70-75% of human bodies and keeps us protected from many harmful things. But many people have a frequent question: is it alright to drink water before you brush your teeth? Will it harm your body? Let us discuss the same in this article.

Many people believe that they should not drink water before brushing their teeth because of the bacterias present in saliva after you wake up. But this is a myth and it does not have any scientific logic. When you drink water after waking up before brushing, your saliva goes with the water down into the stomach which results in the killing of the bacteria due to the high acid content inside it. Therefore there is absolutely no harm if you drink water before brushing teeth.

If you are familiar with Japanese culture then you must know that the Japanese drink two glasses of water every morning immediately after they wake up. Drinking water immediately after you wake up without brushing your teeth does not harm you in any way. Doctors always recommend drinking two full glass or at least one, on an empty stomach. There are several benefits your body receives when you consume water every morning after you wake up.

Drinking water every morning has its own long list of benefits. Let us have a look at them-

Boosts your immunity- Drinking water every morning strengthens your immunity system. Helps you to fight diseases and germs much better.
Clears the bowels- After your drink water in the morning, you will get an urge of flushing out your bowels. This way the bowels remain clear and you do not face any constipation issues.
Speeds up metabolism- Your metabolism gets boosted when you drink water resulting in faster digestion and metabolic rate. It also keeps you hydrated through the day.
Prevents headaches and migraines effectively and it also helps in preventing colon infection because your bowels get cleared easily.
Helps in weight loss- Drinking water every morning helps you to lose weight by a significant margin due to the fact it occupies the stomach killing the desire to eat much in the morning.
Beneficial for skin- Increase in the freshness of your skin complexion which water delivers if you drink it every day in the morning. It flushes out the toxins and dead cells which helps in increase of new and fresh body cells.
Thus as you can see the long list of benefits you will receive if you drink water every day after you wake up.

Is It Alright To Drink Water Without Brushing Your Teeth?

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

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

GERD is a digestive disorder that affects the lower esophageal sphincter, which is the ring of muscle between the esophagus and stomach. Gastroesophageal reflux is the backward flow of acids from the stomach into the esophagus. Doctors believe that some people usually suffer due to a condition called hiatal hernia. Pregnant women usually suffer from heartburn or acid indigestion caused by Gastroesophageal Reflux Disease.

The primary goals in the treatment of this disease are relief from symptoms, healing of erosive esophagitis and prevention of complications of esophagitis. The symptoms include heartburn and regurgitation. The setting includes a proton pump inhibitor (PPI). Patients suspected due to GERD with non-cardiac chest pain are recommended to have diagnostic evaluation before institution of therapy. For diagnosing GERD, barium radiographs should not be used.

The other points that must be remembered to diagnose GERD are
1. Endoscopy is recommended only in case of alarming symptoms. Even in typical symptoms, the upper endoscopy is not recommended.
2. For preoperative evaluation, esophageal manometry is recommended, but it has no role in diagnosing GERD.
3. Ambulatory reflux monitoring is a test that can assess association of reflux symptoms.

Management:
The suggested lifestyle modifications for the patients with GERD are

    Weight loss is recommended for patients who are overweight. So, avoid large meals and decrease dietary fat intake.
    Avoid alcohol, chocolate, onions, garlic, acidic foods and peppermint.
    Do not lie down within 3 to 4 hours after meal (recommended for nocturnal GERD patients).
    For symptom relief and to heal erosive esophagitis, a 8-week course of PPIs is the therapy of choice.
    Medications that help in potentiating GERD symptoms, including alpha-adrenergic agonists, nitrates, calcium channel blockers and theophylline should be avoided.
    For patients without diagnostic evaluation, therapy for GERD other than acid suppression, including prokinetic therapy should not be used.
    For patients with partial response to PPI therapy, additional symptom relief can be achieved by increasing the dose twice daily or switching to a different PPI.
    It is recommended to elevate the head of the bed 10 to 20 cm.
    Avoid wearing clothes which are tight around the waist.
    If patients experience heartburn relief, Histamine-receptor antagonists (H2RA) therapy can be used as a maintenance option in patients without erosive disease.

Some surgical options
1. For long-term therapy for patients suffering with GERD, surgical therapy is the best treatment option.
2. In patients who have no evidence of erosive esophagitis, preoperative ambulatory pH monitoring in mandatory.
3. Gastric bypass is the preferred operation for patients who are suffering with obesity and are contemplating surgical therapy for GERD.

Apart from these, there are potential risks that are associated with PPIs such as switching them can be considered in setting of side effects and the therapy can be a risk factor for Clostridium difficile infection.

Management of Gastroesphageal Reflux Disease (GERD)

Heartburn is a common symptom experienced by many people, but is often overlooked as indigestion. Besides making you uncomfortable, this can be a sign of a much bigger health problem. While the occasional heartburn can be treated with antacids, chronic heartburn can be a sign of gastroesophageal reflux disease (GERD) or acid reflux. Here are three important reasons you should not ignore heartburn.

It can promote tooth decay:The acid regurgitated might not necessarily stop in the esophagus. It can often also make its way into your mouth. When this happens frequently it can promote tooth decay and wear out enamel. This can also leave your mouth with a sour taste. Acid reflux induced tooth erosion can easily be prevented by the early treatment of acid reflux,but in most cases is noticed only after the damage has been done.
It can cause cancer of the esophagus:Chronic acid reflux that persists for years can lead to changes in the cells of the esophagus. This can lead to a cancerous condition known as Barrett's esophagus. The condition has no other symptoms can if left untreated can develop into cancer of the esophagus. Women are at a higher risk of this form of cancer than men. Though esophageal cancer is relatively rare, it is not something to be trifled with. The survival rate of esophageal cancer is very low in comparison to other forms of cancer. Only 15-20% patients live longer than 5 years after this condition is diagnosed.
It can lead to breathing problems:Heartburn is caused by stomach acid flowing back into the esophagus. If it is inhaled after regurgitation, it can worsen asthmatic conditions and pneumonia. At the same time, treating acid reflux with medication like PPIs can also increase the risk of pneumonia as it can promote bacterial growth and suppress coughing. Thus, when consulting a doctor for acid reflux treatment ensure that you mention any existing asthmatic conditions so that you can be treated with your lung functioning in mind.
In addition, acid reflux can also impact a person's health and quality of life. To prevent heartburn people often find themselves avoiding certain foods. This can impact their social lives and in turn make them withdrawing into themselves. A person's sleep can also be affected by heartburn. Hence, it is important to treat heart burn as early as possible and not wait for it to become a chronic problem.

GERD / Heartburn - 3 Reasons Why You Should Not Ignore it 

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