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)

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!

GERD or gastroesophageal reflux disease is a chronic digestive disease which occurs when the stomach acid and at times the contents in your stomach flows backwards into the food pipe. The backwash or reflux irritates the esophagus's lining and hence causes GERD. Individuals may manage GERD's discomfort by changing their lifestyle and by taking over-the-counter or OTC medications. But, certain people might also require stronger medications or surgery for reducing the symptoms.

Some of the basic signs include chest pain, burning sensation in the chest, dry cough, difficulty in swallowing, sore throat, etc. If you experience such symptoms at least twice a week or if your physician notices damage in your food pipe, then you might undergo diagnosis. Though drugs are the primary GERD treatment yet, an individual can manage it by following certain tips which may give relief.

Few ways to manage GERD- self-care tips:

One of the effective ways to help yourself is by consuming smaller meals. Instead of taking three big meals regularly, you may try having smaller meals frequently and avoid stuffing.
Almost all individuals tend to have dinner just half an hour before sleep, but this might affect GERD patients. It is best to eat 2 hours before going to bed as by doing so your stomach will get enough time to digest the food.
Due to a hectic schedule and fast paced lifestyle, people tend to eat as quickly as possible. To manage GERD, one must eat slowly and put down the spoon or fork in between each bite.
Changing the daily diet by striking off the trigger foods is beneficial in managing GERD symptoms. Though the food triggers vary from one person to another yet, it includes coffee, chocolate, peppermint, alcohol, tomato, citrus juices, onions, spicy and high- fat foods, etc.
Sleeping with the head end of the bed elevated by 6 inches is a very effective way of reducing night time reflux. It is also advisable to sleep on your left side . Never sleep on the right side as this position promotes reflux. Medications to reduce acid production are the mainstay of the medical treatment. 
One always has to ensure that they are following the various lifestyle changes along with the medication. Other medications include pro kinetic medicines which help the stomach empty. Surgery always remains the last resort in the treatment of GERD. Endoscopy is required for the diagnosis or GERD Prior to any surgery a Manometry and 24 hr ph merry test is compulsory.
If you are suffering from GERD symptoms frequently, then you may maintain a diary for figuring out which foods are giving you trouble.

When is a surgery required?
If lifestyle changing tips and other medications fail to provide any relief, then physicians recommend undergoing surgery.

Surgery is done for strengthening lower esophageal sphincter and also for reinforcing it. The surgery for reinforcing lower esophageal sphincter is performed by surgeons laparoscopically. The surgeon inserts instruments like a tiny camera and flexible tube by making 3-4 incisions in the abdomen. This surgery for managing GERD may be quite effective.
Experts state that candidates who undergo GERD surgery are those who are unwilling to take GERD drugs or are not getting relief from them. While choosing a surgeon, it is better to consider one who possesses huge experience of the particular operation which you need and also with a good track record.
So, you must visit a doctor if you experience frequent gastroesophageal reflux disease symptoms. It won't be a good decision to take OTC medications without your doctor's recommendation if you notice arm or jaw pain along with difficulty in breathing as these are signs of heart attack.

Gastroesophageal Reflux Disease - How Best Can You Manage It?

Obesity is a condition characterized by the accumulation of large quantities of fat in the body. This condition drastically increases the risks of health problems. The most important cause for obesity is the intake of larger number of calories than what are usually burned through exercises or other routine activities. One with a BMI (Body Mass Index) more than 25 is considered obese. The primary ways of treating obesity are through exercising regularly and following a healthy diet.

How can Ayurveda help?
Ayurveda is a holistic system of medicine which is free from side effects, unlike conventional methods of treatment. Ayurvedic treatments focus on getting to the root cause of the disorder instead of just focusing on the symptoms. There are multiple remedies in Ayurveda that are effective in controlling obesity. They are:

Restrict your calorie intake: While this may sound easy, it is actually difficult to implement. One of the major reasons for obesity is eating too much. The idea is to avoid overeating, so you need to be aware of your portion size. Eat frequent meals but in smaller quantities; this helps in keeping your metabolic rate elevated, that in turn is a prerequisite for greater fat burning.
Start exercising: Exercise is a great way to burn those extra calories around your middle. The best and simple way to go about it is to start jogging. Low intensity jogging done over a period of time is a great way to burn fat. If you want to gain muscle, then do weight based exercises instead of just doing cardio.
Meditate: The beneficial effects of meditation are well known. Apart from reducing your stress level, it also helps in boosting your focus and concentration. Being stressed can make you eat more and thus gain weight, so meditating on a regular basis can help manage stress effectively.
Get sufficient rest: Sleeping less than 6 hours a day? You are only setting your body for obesity. Not sleeping enough brings about hormonal changes in the body which increase your appetite.
Avoid junk food: Junk food should strictly be avoided as it can make you put on some serious pounds. Instead, opt for healthier food options, but keep in mind the portion sizes.

Obesity - How Ayurvedic Remedies Are Best For It?

The body receives its source of energy and nutrition through the blood, which is the transport medium. The blood runs through a highly complex network of blood vessels, with the aorta being the largest one. It originates in the heart, the left ventricle precisely and supplies oxygenated blood to all parts of the body. Coarctation is a condition where there is a narrowing of the aorta. The heart, therefore, has to exert extra pressure to push out blood so that blood supply to the target organs is not affected.

The exact cause of aortic coarctation is not known, though it often develops at birth and so is known as a congenital disorder. Depending on the severity of the narrowing, symptoms develop at various times in life. While some infants demonstrate symptoms, some may not show any symptoms well into adulthood. Infants with severe narrowing may manifest the below symptoms quite early in life.

Difficulty in breathing may gasp
Difficulty in feeding
Be extremely irritable
Profuse sweating
Pale skin
When these symptoms are not noticed and treated in time, the child may have heart failure or even die. If the symptoms do not manifest early in life, the infant can grow into childhood quite normally. Symptoms may then manifest which would be different, as below.

Increased blood pressure
Headaches (frequent)
Weakness in the muscles
Nosebleeds
Chest pain
Frequent fainting spells
These are generic symptoms and it is difficult to suspect coarctation of the aorta. Therefore, further imaging would be required to rule out coarctation of the aorta. There are some risk factors, most related to the heart, which puts one at increased risk of developing aortic coarctation.

Bicuspid aortic valve
Aortic valve stenosis and/or regurgitation
Mitral valve stenosis and/or regurgitation
Patent ductus arteriosus
Treatment: Diagnosis is the first step in treating coarctation of the aorta. This would include a series of imaging tests including an echocardiogram, electrocardiogram, chest x-ray, CT scan, and MRI.
Surgery is often the most definitive mode of treatment, and the approach chosen depends on the severity and stage of identification. The most common approach is to open up the narrowed portion and keep it from collapsing again, so that blood flow is restored. This is known as a balloon angioplasty and stenting. Some of the other procedures used include:

Resection with end-to-end anastomosis
Bypass graft repair
Subclavian flap aortoplasty
Patch aortoplasty
In all affected individuals, after surgery, medications are prescribed to maintain blood pressure levels, which is often increased. In addition, lifestyle changes including exercise and healthy eating habits have to be developed.

Coarctation of the Aorta - Symptoms and Treatment

Are you experiencing frequent and extended heartburn on a regular basis? This might indicate that you are having gastroesophageal reflux disease (GERD). It is a type of digestive disorder that affects your lower esophageal sphincters. The condition involves the return of the stomach s content back to your esophagus. Although heartburns are common, GERD involves chronic heartburns, which require an adequate treatment. 

Here the some important reasons why you should not ignore the symptoms of GERD:

Esophagitis: In case of GERD, the food, acid and digestive juices flow back from the stomach to the esophagus. This leads to irritation and swelling with time, which is called esophagitis. In case you have acid exposure in your esophagus for a few weeks, inflammation of the lining is indicated. This can be very painful and uncomfortable, making the esophagus more prone to scarring and further erosion.
Esophageal stricture: If esophagitis continues for a long time, scar tissues can lead to the narrowing of the esophagus. This is known as a stricture, which makes swallowing very difficult and painful. Large chunks of food may get stuck and you are more likely to choke while eating or drinking. You may tend to avoid food and water because of esophageal stricture, which may result in weight loss.
Throat and voice problems: Apart from heartburn, several other symptoms may also appear because of GERD. These are called cases of silent reflux where you may not experience heartburn. Instead, other issues are indicated which include voice hoarseness, voice changes, sore throat and chronic coughing.
Breathing problems: If stomach acid is inhaled after regurgitation, the symptoms of asthma and pneumonia may worsen because of GERD. Shortness of breath and breathing difficulties are likely, even without any lung problem.
Tooth decay: When the stomach acids and digestive juices go back to the esophagus and into the mouth, it leaves a sour taste. In case it occurs frequently, it wears away your tooth enamel and results in tooth decay. People experiencing acid reflux induced erosion may be unaware of the damage being caused until it reaches peak stages.
Esophageal ulcers: Stomach acid may result in the wearing away of the esophageal lining, resulting in ulcers and sores. These esophageal ulcers are different from stomach ulcers, which occur from bacteria. Patients with esophageal ulcers may vomit blood, and notice blood in stool. It is usually darker than its usual shade and may have the texture of coffee ground like particles.
It is important for you to visit a doctor immediately after experiencing the symptoms of GERD. This condition may cause severe distress if you let it advance, and hence, early diagnosis and treatment are very important.

GERD - Reasons Why You Should Not Ignore The Signs!

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