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 laryngitis
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 Should You Know

The most common dietary problem that every vegetarian comes across is protein deficiency. It was a widely acknowledged fact that animal products are the best protein sources. However, it is no longer so, and vegetarians everywhere can now rejoice!

Here are the 13 best sources of protein for vegetarians:

Green peas: Green peas are legumes, which are a very good protein source. They contain 7.9 grams of protein per serving.

Quinoa: Grains usually contain very little protein, but quinoa is unique. It contains 8 grams of protein per serving, and contains all nine important amino acids that your body needs for repair and growth.

Nuts and nut butter: Nuts are a good source of proteins and healthy fats. However, eat them with caution, as they do contain 160 calories per serving. Butter made from nuts like peanut butter and almond butter is also a good source of protein.

Beans: Beans are available in a variety of colours and shapes, but all of them have one thing in common that is the high level of protein.

Chickpeas: Chickpeas are also from the legume family, so they also contain high amounts of protein; 7.3 grams of protein in only half of a serving.

Tofu and tempeh: Tempeh and tofu are both soy products and they have the highest amount of vegetarian proteins, about 15-20 grams per serving.

Edamame or soybean: Edamame or soybean is excellent for snacking. They contain 8.4 grams of protein in just half a cup.

Leafy greens: Vegetables usually do not contain much protein, but eating green vegetables will significantly add to your protein consumption. For example, you can eat one cup of cooked broccoli as that contains 8.1 grams of protein.

Hemp: Blend hemp seeds in smoothies or baked goods to get your daily dose of protein. Hemp contains 10 grams of protein per tablespoon.

Chia seeds: Chia seeds contain 4.7 grams of protein per two tablespoons, making them excellent sources of protein.

Seitan: This is a meat substitute made from wheat gluten and it contains 36 grams of protein per serving (about half a cup).

Non-dairy milk: Milk made from soy (best non-dairy protein source), almond, rice and hemp are good dairy substitutes.

Unsweetened cocoa powder: This will surprise you, but bitter cocoa contains nearly 1 gram of protein per serving (1 tablespoon)! 
All the above-mentioned food items are the best source of proteins for vegetarians. So, enjoy them with no worry.

Know Excellent Sources Of Protein For Vegetarians!

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

Favorite of most Indian households, ghee is indeed a superfood. Apart from being widely used in Indian cooking, it has also been used as a remedy for cough and cold. Sadly, due to the misconceptions that surround the use of ghee, it is often underutilized. While some are worried that it may make them put on weight, others feel that it is bad for their heart. Little do they know that these misconceptions are not true, and ghee actually has limitless health benefits.

Let us read on to know more about the benefits that ghee has to offer:

Packed with nutrients: Many-a-times, people love the taste of ghee but have strike it off from the diet owing to popular belief that ghee is unhealthy and fattening. However, the opposite of it is actually true and the short-chain fatty acids found in ghee offer several health benefits and keep your gut healthy. Ghee obtained from grass-fed butter consists of fat-soluble vitamins A, D, E, K. Fats present in ghee are free of oxidized cholesterol, trans-fats and hydrogenated oils, thus, the fat present in pure ghee is healthy.
Great for immunity and bone strengthening: Including ghee in your daily breakfast not only boosts your physical and mental strength, but also ensures that your body stays fit and gains the potential to fight against several illnesses. Being a rich source of fat soluble vitamins, ghee supports in the growth and development of bones. It is also known to strengthen your muscles and tendons.
Lowers cholesterol: It is considered as an excellent option for people with high cholesterol levels. Since ghee contains Vitamin K2, it prevents plaque formation in the arteries, which in turn prevents the blockag that may obstruct blood flow and lead to complication. It also increases the level of good cholesterol and lowers the level of bad cholesterol in the blood.
Promotes weight loss: An excellent source of medium chain triglycerides (MCTs), is known to boost the metabolism which in turn promotes weight loss. It also improves digestion, makes you feel full and increases the oxidation of fat; all of which help in reducing weight.
How to differentiate if the ghee is pure or not?

Ghee is stocked in every Indian household, but the thought of whether it is pure or not often crosses our minds. Adulterated ghee may contain vegetable oils and other greasy elements which are bad for your heart and health. So, here are some methods that can help you check the purity of your ghee at home.

Pure ghee normally melts at body temperature. You can check it by putting a spoon of ghee on your palm if it melts then it is pure, if not, it is best to get rid of it.
Pure ghee melts within seconds and turns brown when heated. If the ghee takes longer to melt and appears light yellow in color, it is impure.

It has been established that ghee is indeed good for your health, but only if it is pure. The simple tests mentioned above can help you determine whether the ghee is pure or not. So, eat safe and stay healthy!

Ghee In Your Daily Diet - Did You Know It Has More Benefits Than You Can Think Of?

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)

A stressful event like speaking in public, going to a job interview can give you butterflies in your stomach that may literally make you want to run to the bathroom. Stress affects every aspect of our lives including digestion. This includes indigestion, heartburn and irritable bowel syndrome. When put in a stressful situation, the body releases hormones known as corticotropin-releasing hormone or CRH. This, in turn, signals the adrenal gland to pump out adrenaline and steroids that help with the body's flight or fight response. Here are a few ways stress affects the gastrointestinal system.Here are a few ways stress affects the gastrointestinal system.

Stress kills appetite: Stress eating is a real problem that results from the contradictory reactions of hormones. The hormones released by stress kill a person's appetite, but at the same time, the steroids released by these hormones make the person crave unhealthy foods like ice-cream, chocolate or potato chips. These foods aren't easy to digest and can cause indigestion, gas buildup and heart burn.
Stress leads to ulcers: Ulcers are caused by bacteria, but stress strengthens the infection and disturbs the balance of hydrochloric acid and protective secretions in the stomach. This increases the risk of ulcer formation in the stomach. Once the ulcers are present in the stomach, stress can worsen the symptoms.
Stress alters the gastrointestinal pathophysiology: Stress can cause changes in gastrointestinal secretions and reduce the amount of oxygen available to the digestive system. It also impairs gastroduodenal motility and amount of enzymes being secreted by the pancreas. Additionally, it interferes with the passage of food through the intestinal tract and alters colonic motility. Stress also affects the absorption of nutrients from the stomach and increases the blood flow to the digestive system by four times the normal amount thus decreasing metabolism rates.
Stress affects irritable bowel syndrome: Stress in itself does not cause irritable bowel syndrome but can worsen the situation. This is because stress can make the colon contract and cause abdominal pain. These contractions are usually uncoordinated and can lead to constipation. It also makes the body more sensitive to pain thus increasing discomfort.
Stress lowers immunity: A large part of the immune system is housed in the gut. Stress reduces the secretion of enzymes in the gut and leaves the digestive system vulnerable to bacterial infections. By weakening the immune system in the gut, stress also increases the risk of suffering from infections in other parts of the body.

Stress & Its Effects on Gastroenterology

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