Gastroesophageal reflux disease (GERD), Acid reflux, esophagitis, Zollinger-Ellison syndrome occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.
India had used heartburn and/or regurgitation with symptom duration of at least once a week for at least a month as the definition of GERD.prevalnece in india is 7.6%- 25%.
CAUSES
When you swallow, a circular band of muscle around the bottom of your esophagus (lower esophageal sphincter) relaxes to allow food and liquid to flow into your stomach. Then the sphincter closes again. If the sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus. This constant backwash of acid irritates the lining of your esophagus, often causing it to become inflamed.
KEY FEATURES
- The symptoms of GER are exacerbated with increase in intra-abdominal pressure.
- The symptoms of GER are related to posture.
- Symptoms of GERD lead to sleep disturbance.
- Refractory GERD is defined as nonresponse to optimal PPI therapy over 8 weeks.
- Noncardiac chest pain can be caused by GERD.
HOW POSTURE leads to INCREASE IN HEARTBURN
Supine position predisposes to reflux due to loss of effect of gravity. This allows the refluxed contents to move orad and remain in the esophagus longer. Khan et al. found that elevating the head end of the bed with wooden blocks of 20 cm in patients with symptomatic nocturnal reflux resulted in significantly decreasing the mean (SD) supine reflux time from 15% (8.4) to 13.7% (7.2). The acid clearance time was significantly reduced from 3.8 (2) to (1.6) min. Almost two thirds of patients reported improvement in sleep disturbance. A prospective study using a position therapy device, that allowed participants to sleep in the left lateral recumbent posture and with head elevated by 15–20°, showed significant improvement in GERD Symptom Severity and Impact Questionnaire and GERD HR-QoL questionnaire scores over a period of 2 weeks.
THE FOUR STAGES OF GERD
Stage 1: Mild GERD
Patients experience mild symptoms once or twice a month. Treatment relies on lifestyle changes and over-the-counter acid suppressive medications.
Stage 2: Moderate GERD
Patients experience more frequent symptoms (2 times per week) requiring daily prescription acid suppressive medications. Untreated GERD symptoms affect patient daily activities and are associated with esophageal inflammation.
Stage 3: Severe GERD
Patients with severe GERD have poorly controlled symptoms (2-4 times per week) on prescription medications. Their quality of life is substantially lower. Patients are more likely to have erosive esophageal inflammation. A thorough evaluation by a GERD expert is highly recommended. A successful anti-reflux procedure that restores the integrity of the lower esophageal sphincter cures GERD and improves patient quality of life.
Stage 4: Reflux induced precancerous lesions or esophageal cancer
Stage 4 is the result of many years of untreated severe reflux (more than 4 times per week). 10% of patients with long-term GERD progress to stage 4.
COMPLICATIONS
Over time, chronic inflammation in your esophagus can cause:
Narrowing of the esophagus (esophageal stricture). Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing.
An open sore in the esophagus (esophageal ulcer). Stomach acid can wear away tissue in the esophagus, causing an open sore to form. An esophageal ulcer can bleed, cause pain and make swallowing difficult.
Precancerous changes to the esophagus (Barrett's esophagus). Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.
How do antacid tablets work?
Your stomach normally produces acid to help with the digestion of food and to kill germs (bacteria). This acid is corrosive so your body produces a natural mucous barrier which protects the lining of the stomach from being worn away (eroded).
In some people this barrier may have broken down allowing the acid to damage the stomach, causing an ulcer. In others there may be a problem with the muscular band at the top of the stomach (the sphincter) that keeps the stomach tightly closed. This may allow the acid to escape and irritate the gullet (oesophagus). This is called acid reflux, which can cause heartburn and/or inflammation of the gullet (oesophagitis).
Antacids work by counteracting (neutralising) the acid in your stomach. They do this because the chemicals in antacids are bases (alkalis) which are the opposite of acids. A reaction between an acid and base is called neutralisation. This neutralisation makes the stomach contents less corrosive. This can help to relieve the pain associated with ulcers and the burning sensation in acid reflux.
When antacids work on stomach acid, they can produce gas which may cause wind (flatulence). Simeticone helps to stop this foaming effect and may sometimes be included within antacid medications.
Many of the common antacids also include alginates. Most alginates work by forming a gel which floats on top of the stomach contents. The gel acts as a protective barrier, preventing stomach acid from irritating the oesophagus
What can happen if you take too much of antacids?
Serious side effects can happen with an overdose or overuse of antacids. Side effects include constipation, diarrhea, change in the color of bowel movements, and stomach cramps. Products containing calcium may cause kidney stones and are more likely to cause constipation.
Do's and Don'ts
Do's
- Follow the meal times.
- Light food, Coconut water, articles having cooling properties
- Vegetables like white pumpkin, bitter gourd, matured ash gourd, leafy vegetables except Methi
- Wheat, old rice, barley, green gram, sugar candy, cucumber,
- Fruits like gooseberry, dry grapes, black grapes, sweet lime, pomegranate, fig, dry fig,
- Take adequate amount of fluids like pomogranate juice, lemon juice, amla juice, sweetlime juice, Medicated water with ushir (wala) or coriander seeds, or laja (puffed rice). Warm water.
- Dadimpak (sweet preparation made of pomegranate). Moramla (jam made from amla), gulkand (jam made from rose petals) with milk
- A cup of lukewarm milk after every two or three hours.
- One teaspoonful of ghee with warm milk
- Take adequate sleep & rest
- Elevate the head of the bed
- Tight clothing, belts and even certain exercises that place pressure on the abdominal region can trigger heartburn.
Don’ts
- Avoid excessive spicy, sour and salty substances
- Avoid eating before exercise
- Avoid fried and junk food items
- Do not remain hungry. Avoid fast.
- Do not overeat, take small frequent meals
- Avoid untimely and irregular food habit
- Avoid foods containing excess amount of garlic, salt, oil, chillies,etc. very often.
- Avoid rice curd and sour fruits.
- Avoid lying down immediately after food and in supine position. The best recommended position is left lateral (left side).
- Avoid, smoking, alcohol, tea, coffee and aspirin type drugs.
- Avoid stress
- Avoid eating at least 3 hours prior bedtime
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SOURCE -
Indian consensus on gastroesophageal reflux disease in adults: A position statement of the Indian Society of Gastroenterology
Prevalence of Gastroesophageal Reflux Disease And Its Correlates in Adults Residing in an Urban Resettlement Colony of East Delhi
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Untouched topic very useful thanks
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