Heartburn and More

[Guest guest]

Causes of Reflux and GERD

By Harvard Health Reports

 

Heartburn is an expression of a condition known as gastroesophageal

reflux disease (GERD), a phenomenon in which acid and pepsin rise from

the stomach into the esophagus.

 

What is GERD?

 

You enjoyed the meal -- but now you're paying for it, big time. You've

got an uncomfortable burning sensation radiating up the middle of your

chest. It can hit after eating spicy foods, when you lie down to take a

nap, or perhaps at bedtime. Many women experience this sensation during

pregnancy. Sometimes the pain is so intense that you may think you are

having a heart attack. But in most cases, you're simply experiencing

heartburn, the most common gastrointestinal malady.

 

About one-third of Americans have heartburn at least once a month, with

10 percent experiencing it nearly every day. A recent survey revealed

that 65 percent of people with heartburn may have symptoms both during

the day and at night, with 75 percent of the nighttime heartburn

patients saying that the problem keeps them from sleeping, and 40

percent reporting that nighttime heartburn affects their job performance

the following day. This epidemic leads people to spend nearly $2 billion

a year on over-the-counter (OTC) antacids alone. Clearly, it's a major

problem.

 

The burning sensation is usually felt in the chest just below the

breastbone and often extends from the root of the neck to the lower end

of the chest cage. It can last for hours and may be accompanied by the

very unpleasant, stinging sensation of highly acidic fluid rushing into

the back of the throat. It can also be accompanied by a sour taste in

the mouth.

 

But the heart of heartburn is the burning behind the sternum. A variety

of foods; certain emotions such as anxiety, anger, or fear; and even

particular positions, like reclining or bending forward, can aggravate

it. While heartburn is obviously a nuisance for many, others seem to

live with it quite well. It's usually not a sign of serious illness.

Still, people spend countless hours and untold sums of money looking for

a way to spell relief.

 

Causes of Reflux

 

GERD is a digestive disorder that affects the lower esophageal sphincter

(LES), the muscle connecting the esophagus and stomach. The LES is a

high-pressure zone that acts as a barrier to protect the esophagus

against the backflow of gastric acid from the stomach.

 

Normally, the LES works something like a dam, opening to allow food to

pass into the stomach and closing to keep food and acidic stomach juices

from flowing back into the esophagus. Scientists aren't sure exactly why

this happens. But if the LES loses its tone, it can't close completely

after food empties into the stomach. The LES is a complex segment of

smooth muscle under the control of nerves and various hormones. As a

result, dietary substances, drugs, and nervous system factors can impair

its function.

 

Factors other than malfunctions of the LES contribute to reflux. In one

study, about half of reflux patients exhibited abnormal nerve or muscle

function in the stomach, which caused impaired motility -- that is, the

ability of the stomach muscles to contract in a normal fashion. This

might delay the emptying of the stomach, increasing the risk that acid

will reflux back into the esophagus. A failure of peristaltic

contractions to clear the esophagus of acid that has refluxed, a

lessening of the esophageal lining's ability to resist damage, or a

shortage of saliva (which has a neutralizing effect on acid), may play a

part as well.

 

Episodes of reflux often go unnoticed, but when reflux is excessive, the

gastric acid irritates the gullet and may produce pain, experienced as

heartburn. Sometimes acid regurgitates as far as the mouth and may come

up forcefully as vomit or as a " wet burp. " Most symptoms of

gastroesophageal reflux disease are transient and only occur, for

example, after a big meal or when a person bends over or lies down.

 

Overweight people and pregnant women may suffer more heartburn spells

because increased abdominal pressure contributes to reflux. Pregnant

women are also more prone to heartburn because higher progesterone

levels relax the LES. Generally, though, GERD is uncommon in people

under age 40.

 

Other medical conditions can also contribute to GERD. About half of

asthma patients also have reflux. It's not clear, however, whether

asthma is a cause or effect. Still, asthma may improve when GERD is

treated. Other illnesses that may contribute to reflux include diabetes,

peptic ulcers, and some types of cancer.

 

Foods That Cause Heartburn

 

Diet can contribute to LES dysfunction. Coffee, tea, cocoa, and cola

drinks are all powerful stimulants of gastric acids. Mints and

chocolate, often served to cap off a meal to aid in digestion, can

actually make things worse. Both relax the LES and can induce heartburn,

as can fried and fatty foods. Some people say that onions and garlic

give them heartburn. Others have trouble with citrus fruits or tomato

products. If you notice that a particular food leads to episodes of

heartburn, by all means stay away from it.

 

Lifestyle Causes

By Harvard Health Reports

 

Skipping breakfast or lunch and then consuming a huge meal at day's end

can increase gastric pressure and the possibility of reflux.

 

Eating Habits

 

How you eat can also be as important as what you eat. Skipping

breakfast or lunch and then consuming a huge meal at day's end can

increase gastric pressure and the possibility of reflux. And lying down

right after eating will only make the problem worse. It is best to wait

three hours after eating before going to bed. And stay away from

late-night snacks, too. Even a modest weight gain may induce heartburn,

so a low-fat diet is a good idea for more than just one reason.

 

Smoking

 

Smoking can irritate the entire GI tract. Frequent sucking on a

cigarette causes air to be swallowed, increasing stomach pressure and

encouraging reflux. Smoking sometimes also relaxes the LES muscle.

 

Medications That Cause Heartburn

 

Some prescription drugs can exacerbate heartburn. Oral contraceptives

or postmenopausal hormone preparations containing progesterone are known

culprits. Aspirin and other nonsteroidal anti-inflammatory drugs

(NSAIDs) can also pose problems. Corticosteroids, used to treat a

variety of medical conditions, are also known to cause heartburn. Other

drugs -- such as alendronate (Fosamax), used to prevent and treat

osteoporosis -- can irritate the esophagus. And some antidepressants,

tranquilizers, calcium channel blockers, and the asthma medication

theophylline can contribute to reflux by relaxing the LES.

 

Diagnosing Acid Reflux

By Harvard Health Reports

 

One possible cause of heartburn is a common condition called hiatal

hernia in which a portion of the stomach protrudes through the opening

in a weak diaphragm, the band of muscle that separates the chest from

the abdomen.

 

The Hiatal Hernia Connection

 

Hiatal hernia is a common condition in which there is an opening, or

hiatus, in the diaphragm, the muscle that separates the chest from the

abdomen and helps with breathing. This hiatus permits part of the

stomach to protrude into the chest.

 

A hiatal hernia represents a weakness of the diaphragm. The resulting

protrusion changes the angle at which the esophagus joins the stomach,

weakening the ligaments that hold these organs in proper alignment and

impairing the LES's ability to prevent reflux. Studies indicate that a

hiatal hernia promotes the retention of acid and other stomach contents

above the opening or hiatus in the diaphragm. These substances can

reflux easily into the esophagus.

 

While people with small hiatal hernias (less than 3 cm) often have no

symptoms, others report significant heartburn discomfort. Almost all

people with large hiatal hernias have reflux. And hiatal hernias are

almost always present in people with GERD who have moderate or severe

esophagitis (inflammation of the esophagus). While the hiatal hernias

and reflux occur independently, there is strong evidence that the two

are related.

 

Diagnosing Reflux

 

Many people can manage heartburn on their own, without seeking medical

care. A doctor may be helpful when the symptoms are worrisome to the

patient or if they interfere with daily life. But usually, it's

reasonable to try to relieve symptoms without a doctor's intervention.

If you do seek your physician's help, providing a detailed account of

your symptoms will help him or her make the diagnosis.

 

The doctor will evaluate your medical history and ask detailed questions

about the nature of the pain and its pattern of onset. For example, he

or she may ask whether symptoms are worse after you eat a heavy meal or

if they are associated with known dietary troublemakers such as high-fat

foods or dairy products. Your doctor will want to know if bending over

to tie your shoelaces or lying down aggravates the symptoms and whether

the pain can be linked to anxiety or stress.

 

A physician may ask whether regurgitated stomach contents leave a bitter

or acidic taste in your mouth. A sudden outpouring of salty fluid in the

mouth, called water brash, can result from salivary secretions

stimulated by reflux.

 

For typical reflux symptoms, doctors usually forgo diagnostic tests and

proceed straight to treatment, starting with antacids or OTC histamine

H2-receptor antagonists, also known as H2 blockers, and modifications in

diet and lifestyle. If a patient obtains relief, the odds are that the

diagnosis of GERD was correct.

 

Your doctor will be alert for other symptoms, such as frequent

nonburning chest pain, bleeding into the gastrointestinal tract,

dysphagia (difficulty in swallowing), hoarseness, or chronic coughing

and wheezing. Such symptoms may be associated with GERD, but could have

other causes and might warrant tests to gain more information.

 

For example, gastroesophageal reflux can cause respiratory problems such

as asthmatic wheezing, coughing, or hoarseness. When asthma strikes

adult nonsmokers with no history of lung disease or allergies, pH

monitoring studies sometimes suggest that GERD is the culprit.

Researchers speculate that when caustic acid refluxes into the esophagus

it triggers a nerve reflex that constricts the bronchial tubes (the

branches of the trachea that lead into the lungs) and produces wheezing.

Aspiration of acid into the bronchi may also play a role in causing

these symptoms.

 

On the other hand, asthma may lead to gastroesophageal reflux, rather

than vice-versa. It seems particularly significant that GERD affects

only 10 percent of the general population, but fully half of those with

asthma. The coughing and wheezing of asthma create pressure shifts in

the chest that can produce reflux. In addition, theophylline and other

bronchodilators, medications used to treat asthma, may weaken the LES.

 

Is This Test Necessary?

 

Doctors ordinarily don't put heartburn patients through costly

diagnostic evaluations. However, more serious reflux symptoms, such as

bleeding from the esophagus or swallowing problems, may warrant further

investigation. Common tests include:

 

Barium studies. The patient drinks a liquid barium mixture and then

undergoes an x-ray examination of the chest and upper abdomen. The

barium, a contrast medium, defines the upper GI tract on the x-ray image

and can help the physician identify problems such as a hiatal hernia,

esophageal lesions, or strictures.

 

Upper GI endoscopy. The physician inserts a flexible tube down the

throat, having first sedated the patient and depressed the gag reflex

with a local anesthetic spray. The tube contains a light and camera,

which allow the doctor to inspect the lining of the esophagus, assess

injuries such as ulcers or strictures, and take a biopsy (a tissue

sample), if necessary.

 

pH monitoring. Used less frequently, this test monitors an individual's

reflux episodes over 24 hours via a thin acid-sensing probe inserted

through the nose and positioned just above the lower esophageal

sphincter. Although moderately expensive and somewhat uncomfortable,

this is the best method for documenting reflux in patients who have

unexplained chest pain, coughing, wheezing, or hoarseness. It's also

used to assess the adequacy of acid-suppressing therapy when symptoms

persist. Should symptoms continue despite raising the medication dose,

they are probably not caused by reflux.

 

Complications of Reflux

 

Though simple reflux is uncomfortable, it doesn't usually pose a danger

to healthy individuals. From half to three-quarters of those with reflux

disease have mild symptoms that generally clear up in response to simple

measures. Over time, however, serious problems can develop when

persistent gastroesophageal reflux disease with frequent relapses goes

untreated. These can include severe narrowing (stricture) of the

esophagus, erosion of its lining, precancerous changes in its cells, and

esophageal ulcers.

 

Another complication, known as reflux esophagitis, is an inflammation

that occurs when acid and pepsin, released from the stomach, erode areas

of the mucosa, the surface layer of cells that line the esophagus.

Besides the burning sensation of heartburn, patients with esophagitis

may also complain of pain behind the breastbone spreading into the back

or up to the neck, jaw, or even the ears. The pain can be so intense

that you may have trouble swallowing and may even think you are having a

heart attack.

 

In esophagitis, foods feel like they stick in your throat before going

down the gullet. Hot drinks are unpleasant to swallow, and you may have

some nausea. You may also regurgitate some acid fluid into your throat,

resulting in a cough. The cause is an aggressive inflammation of the

esophagus, which can even lead to bleeding. Endoscopy or a barium study

may be necessary to confirm the diagnosis of esophagitis and locate any

strictures.

 

Bleeding ulcers in an inflamed esophagus may require aggressive

treatment, such as blood transfusions and, to stop the bleeding, a probe

passed through an endoscopic tube to apply electricity or heat and

coagulate the blood. Strictures may need to be dilated through

endoscopy, using a balloon or special dilator. About one-third of

patients who need this procedure require a series of treatments to fully

open the passageway.

 

Another complication of chronic inflammation is Barrett's esophagus, an

abnormality in which taller cells resembling those that line the small

intestine replace the squamous or flat cells that normally line the

lower esophagus. The condition, a product of severe GERD, is caused by

chronic and severe exposure to acid from the stomach and bile from the

small intestine. Barrett's esophagus can, over time, develop into

cancer, so patients are urged to have regular endoscopic evaluations

(including biopsies) to identify very early malignant changes. But this

cancer only occurs in a small number of all GERD patients. Persons most

at risk are those -- usually middle-aged white men -- who developed GERD

at an early age and have had it for many years.

 

A recent study reported a higher risk for esophageal cancer in GERD

patients, whether or not they have Barrett's esophagus. Some experts

think it's the reflux of bile, in addition to acid, that heightens the

risk for esophageal cancer.

 

GERD can also result in dental problems, including loss of dental

enamel. And it can cause spasms of the vocal cords (larynx), blocking

the flow of air to the lungs. One study has reported that such spasms

may cause sleep apnea, a condition in which breathing frequently stops

for brief moments during sleep.

 

Heartburn or Heart Attack?

By Harvard Health Reports

 

Here's how to tell if your chest pain is serious.

 

Symptoms associated with the digestive condition called gastroesophageal

reflux disease (GERD), or reflux, can mimic the pain of heart attack or

angina -- which is chest pain caused by diminished blood flow through

the coronary arteries -- especially when the sensation is constricting

rather than burning in nature.

 

But it can be dangerous to assume that any chest pain is caused by acid

reflux. Even people with known reflux disease should always seek medical

attention if they experience chest discomfort brought on by exercise,

which may signal either angina or a heart attack.

 

How can you be sure that you have heartburn, not a heart attack?

 

The main thing to determine is the severity and length of your chest

pain. If the sensation is a severe, pressing, or squeezing discomfort,

it may be a heart attack. Also, heart attack pain lasts a while. If the

pain goes away in 5-10 minutes, it's probably not a heart attack. It

could be angina, however, which does require a visit to the doctor --

and treatment. So it's important not to dismiss chest tightness,

especially if it follows physical exertion.

 

Heart Attack Signs:

 

# Severe discomfort

# Pressing sensation

# Squeezing pain

# Pain following exercise or exertion

# Pain that is lasting and does not diminish after 5-10 minutes

 

Avoiding Reflux

By Harvard Health Reports

 

Your goal is to prevent the problem by keeping stomach contents where

they belong and staying away from foods that loosen the lower esophageal

sphincter.

 

Modifying one's diet and lifestyle remains the foundation for treating

the symptoms of reflux.

 

Here are some prevention tips for people troubled by heartburn.

 

* Eat smaller meals and eat more slowly. A large meal remains in

the stomach for several hours, increasing the chances for

gastroesophageal reflux. Therefore, anyone who suffers from this problem

should distribute his or her daily food intake over three, four, or five

smaller meals.

 

* Relax when you eat. Stress increases the production of stomach

acid, so make meals a pleasant, relaxing experience. Sit down. Eat

slowly. Chew completely. Play soothing music.

 

* Relax between meals. Relaxation therapies such as deep breathing,

meditation, massage, tai chi, or yoga may help prevent and relieve

heartburn.

 

* Remain upright after eating. You should maintain postures that

reduce the risk for reflux for at least three hours after eating. During

this period, don't bend over or strain to lift heavy objects.

 

* Avoid bedtime snacks. Avoid eating within three hours of going to

bed.

 

* Lose weight. Excess pounds increase pressure on the stomach and

can push acid into the esophagus.

 

* Loosen up. Avoid tight belts, waistbands, and other clothing that

puts pressure on your stomach.

 

* Avoid foods that burn. Abstain from food or drink that increases

acid secretion, decreases LES pressure, or slows the emptying of the

stomach. Known offenders include high-fat foods, spicy dishes, tomatoes

and tomato products, citrus fruits, garlic, onions, milk, carbonated

drinks, coffee (including decaf), tea, chocolate, mints, colas, and

alcohol. The list is long, but you're likely to see a substantial

improvement if you cut out such foods.

 

* Snuff the butts. Nicotine stimulates stomach acid and impairs LES

function.

 

* Chew gum. It can increase saliva production, soothing the

esophagus and washing acid back down to the stomach.

 

* Consult your pharmacist or doctor. Drugs that can predispose you

to reflux include aspirin and other NSAIDs, estrogen, narcotics, certain

antidepressants, and some asthma medications. If a drug you take causes

heartburn, ask your pharmacist or doctor about an effective substitute.

 

* Raise your head at night. If you're bothered by nighttime

heartburn, elevate the head of your bed by placing six-inch blocks under

its legs or by putting a wedge (available in medical supply stores)

under your upper body. But don't elevate your head with extra pillows.

That makes reflux worse by bending you at the waist and compressing your

stomach.

 

* Exercise smartly. Before engaging in vigorous physical activity,

wait at least two hours after a meal, giving your stomach time to empty.

 

Antireflux Drug Therapy

By Harvard Health Reports

 

An overview of antireflux medications, from antacids to H2 blockers to

proton pump inhibitors.

 

Acid Relief

 

Antacids

 

These inexpensive over-the-counter remedies neutralize digestive acids

in the stomach and esophagus, at least in mild cases of heartburn.

While many people find tablets more convenient, liquids provide faster

relief. Tablets must be chewed thoroughly in order to be effective. The

best time to take an antacid is after a meal or when symptoms occur.

The usual recommended dosage is 1-2 tablespoons each time.

 

There are three basic salts used in antacids: magnesium, aluminum, and

calcium. Some consider magnesium- and aluminum-based antacids (including

Di-Gel, Maalox, and Mylanta) to be the most cost-effective heartburn

drugs. A major side effect of magnesium hydroxide is diarrhea, while the

most common side effect of antacids containing aluminum hydroxide is

constipation. Antacids high in calcium (Tums, Rolaids, Titralac, and

Alka-2) are probably the strongest, but they, too, can be constipating

if consumed in sufficient quantities.

 

Calcium carbonate products, used for centuries in the form of chalk

powder and oyster shell, are probably the most powerful antacids. Sodium

bicarbonate, or baking soda, which is less powerful than other antacids,

is the active ingredient in many seltzer antacids (Alka-Seltzer,

Bromo-Seltzer) and is present in mineral water.

 

Because no single agent is perfect, many antacids combine several

ingredients that are designed to balance their respective side effects.

Maalox, for example, combines magnesium and aluminum. Gaviscon combines

antacids with alginic acid, a substance derived from marine algae. Its

unique action creates a " raft " that floats on the gastric sea, and helps

block reflux.

 

Histamine H2-Receptor Antagonists

 

For chronic reflux, histamine H2-receptor antagonists (H2 blockers) are

now widely available either by prescription or, in smaller doses, over

the counter. They are often effective for GERD symptoms that don't

respond to antacids or changes in eating habits.

 

H2 blockers work by countering the effect of histamine (which stimulates

gastric acid), thereby decreasing the amount of acid that the stomach

produces. They act directly on the stomach's acid-secreting cells to

stop them from making hydrochloric acid, particularly at night when acid

gathers in the stomach and can wash back into the esophagus. Cimetidine

(Tagamet) was the first H2 blocker on the market. Others that are

available in the United States include ranitidine (Zantac), famotidine

(Pepcid), and nizatidine (Axid).

 

For people whose heartburn is only troublesome at night, a single dose

taken in the evening may suffice; but if symptoms occur during the day

and night, more frequent treatments will be needed. The four H2 blockers

are equally effective, so switching to another if one fails to work is

likely to be fruitless. Increasing the dose, however, may be helpful.

 

While considered relatively safe, H2 blockers can have side effects.

Some doctors warn that self-treating with over-the-counter H2 blockers

may cause sufferers to mistake serious conditions for heartburn,

delaying diagnosis and proper treatment.

 

Prokinetic Agents

 

Prokinetics -- or gastrokinetics, as they're occasionally called -- are

a wide-ranging group of drugs that help empty the stomach of acids and

fluids. They can also strengthen esophageal peristalsis and improve LES

tone. These medications are only used for severe cases of GERD, either

with or in place of H2 blockers.

 

Cisapride (Propulsid), the newest of these agents, was pulled from the

U.S. market in 2000 after it was linked to more than 300 reports of

heart rhythm abnormalities, including more than 80 deaths. Its

predecessors, bethanechol (Urecholine) and metoclopramide (Reglan) are

available by prescription, but have a variety of side effects.

 

Proton Pump Inhibitors

 

Proton pump inhibitors are the newest class of anti-reflux drugs and are

more effective than H2 blockers at lowering the production of gastric

acid and other gastric secretions. Proton pump inhibitors, also known as

acid pump inhibitors, work by inactivating a specific enzyme responsible

for the final step of acid release in the stomach.

 

Currently, proton pump inhibitors are only available by prescription.

Omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex),

pantoprazole (Protonix), and esomeprazole (Nexium) can reduce gastric

acid secretion by more than 95 percent without causing systemic side

effects.

 

These medications are the drugs of choice for erosive esophagitis,

although this condition usually recurs when the drug is stopped.

Omeprazole, which -- like all of these medications -- is impressive in

its ability to heal esophagitis and alleviate heartburn, is the only one

approved by the FDA for repeated courses of treatment for erosive

esophagitis.

 

Although they have numerous advantages, the proton pump inhibitors are

expensive. In addition, they may make the GI tract more susceptible to

bacterial infections. Despite these concerns, however, proton pump

inhibitors have become the preferred medication for reflux esophagitis

and for patients with unremitting GERD-derived respiratory symptoms.

 

Combination Therapies

 

Several studies have looked at combining various anti-reflux drugs. One

suggested that a combination of over-the-counter antacids and H2

blockers could be the best solution for people who experience heartburn

after meals. For more severe cases, some doctors prescribe either H2

blockers or proton pump inhibitors in combination with prokinetic drugs.

 

Herbal Remedies for Acid Reflux

By Harvard Health Reports

 

Catnip, fennel, marshmallow root, and papaya tea have all been said to

aid in digestion and act as a buffer to stop heartburn.

 

A number of herbs and other natural remedies have proven helpful in the

treatment of heartburn symptoms.

 

Chamomile. A cup of chamomile tea is known to have a soothing effect on

the digestive tract.

 

Ginger. The root of the ginger plant is another well-known herbal

digestive aid and has been a folk remedy for heartburn for centuries.

 

Licorice. This remedy has been proven effective in several studies.

Licorice is said to increase the mucous coating of the esophageal

lining, helping it resist the irritating effects of stomach acid.

Deglycyrrhizinated licorice, or DGL, is available in pill or liquid

form. It is safe to take indefinitely.

 

Other herbs. A variety of other remedies have been used over the

centuries but there is little or no scientific evidence to confirm their

effectiveness. Eating fresh papaya is also known as an effective

digestive aid. Some people swear by raw potato juice, three times a

day. Naturopathic followers also tout a homeopathic remedy with the

unappetizing name of vomit nut, or nuxvomita, as a heartburn fix.

However, herbal remedies do not undergo safety testing by the federal

government and are not FDA approved. (Which is a catch all statement

used by all the medical field .. because they want to sell more of their

damned expensive pharmaceutical products.)

 

Surgery is the next option .. which they also like. ;-)

 

Fundoplication

 

The most common antireflux operation is the Nissen (360-degree)

fundoplication. Also known as a stomach wrap, the operation creates a

vacuum effect that prevents stomach acid from surging upward.

 

The procedure involves grabbing a portion of the top of the stomach and

looping it around the lower end of the esophagus and LES to create an

artificial sphincter or pinch valve. It prevents stomach acid from

backing up into the esophagus. The wrap must be tight enough to prevent

the acid from coming back up but not so tight that food can't enter and

a satisfying belch can't escape. In addition to curing heartburn and

GERD-induced respiratory symptoms, the procedure may enhance stomach

emptying and improve abnormal peristalsis in some patients.

 

Over time, however, the stomach wrap can loosen. At this point, the

patient would need to undergo surgery to redo the procedure or would

have to resume medications. A recent study in the Journal of the

American Medical Association found that 62 percent of patients who had

undergone the Nissen fundoplication procedure 10 years earlier were

regularly using antireflux medications.

 

Increasingly, surgeons are performing fundoplication as a laparoscopic

procedure, in which special instruments and cameras are inserted into

tiny incisions in the upper abdomen. Patients recover much faster from

laparoscopy than from open surgery. Most patients go home in two days

and within a week or two, are able to swallow without pain or the

feeling that food is catching on the way down.

 

Radiofrequency Catheter Ablation

 

The FDA recently approved radiofrequency catheter ablation to treat

GERD. Also known as the Stretta procedure, it involves applying

controlled radiofrequency energy through a flexible catheter that

extends to the lower esophageal sphincter muscle. The procedure, which

takes less than an hour, " zaps " the LES and the upper part of the

stomach, causing the lining of the lower esophagus to expand slightly.

As a result, the valve tightens, creating a more effective barrier

between the esophagus and stomach. Patients undergoing this procedure

can expect to get back to their regular activities the next day.

 

Results of a six-month follow-up study found that 70 percent of those

who underwent this minimally invasive procedure were able to stop taking

all GERD medications. However, its long-term rate of success is still

unknown. (Opps .. so its not just herbal treatments that we are unsure

of .. no suprise.)

 

Endoscopic Suturing System (Also experimental)

 

Another new, minimally invasive procedure that achieves results

comparable to radiofrequency catheter ablation is known as the Bard

Endoscopic Suturing System. The technique consists of a thin, flexible

endoscopic tube with something that resembles a mini sewing machine at

its tip. The device is inserted down the patient's throat and is used to

place stitches on either side of the LES. The doctor then ties the

sutures together to tighten the valve.

 

Like the Stretta system, patients go home the same day. After six

months, 75 percent of patients no longer needed anti-GERD medications.

But once again, physicians don't know the long-term prospects for

patients undergoing this procedure.

 

What is Dyspepsia?

 

The term " functional dyspepsia " (FD) is used to describe chronic and

persistent upper abdominal pain that's often related to eating, and for

which there is no identifiable cause.

 

Symptoms

 

You're having trouble with your stomach. You feel uncomfortable. It's

not heartburn, but it may be related to eating. You feel bloated and

full. You complain of nausea or sometimes you even vomit. You think you

might be having " indigestion. "

 

Doctors call it dyspepsia -- literally, " bad digestion. " It is derived

from the Greek dys, which means bad, and peptein, which means " to cook "

or " to digest. "

 

The term " functional dyspepsia " (FD) is used to describe chronic and

persistent upper abdominal pain that's often related to eating, and for

which there is no identifiable cause such as peptic ulcer disease.

Because peptic ulcer disease produces similar symptoms, functional

dyspepsia is sometimes called nonulcer dyspepsia.

 

In most cases, the uncomfortable upper abdominal symptoms appear after

eating, but there's no difficulty in swallowing. Sometimes the

discomfort begins during the meal, sometimes about half an hour later.

It tends to come and go in spurts over a period of about three months.

 

This condition affects about a quarter of the population -- twice as

many as have peptic ulcer disease -- and it hits men and women equally.

It's responsible for a significant percentage of visits to primary care

doctors. Many people suspect they're suffering from ulcers, but are

found not to be. The cause of FD is unknown. Even more frustrating,

there's no sure-fire cure.

 

What is Dyspepsia? Is It an Ulcer?

 

The first question on most people's minds is, " Do I have an ulcer? " It's

not an unreasonable question, considering that 10 percent of Americans

develop a peptic ulcer at some time in their lives. And it's important

to answer it quickly. Ulcers can have serious complications, while FD

generally does not. Ulcers can be treated with medications; but, in most

cases, medications don't do much to remedy FD.

 

Peptic ulcers are raw, crater-like breaks in the mucosal lining of the

digestive tract. They occur in the stomach and duodenum and are linked

to the erosive action of gastric acid and sometimes to a reduction in

protective mucus. In essence, the stomach, which is designed to digest

foods, is digesting a part of its own lining. These localized, generally

circular craters are rarely more than an inch in diameter.

 

In the early 1980s, researchers made a major discovery. They identified

Helicobacter pylori, a spiral bacterium with an affinity for the

stomach, as a major culprit in ulcer disease. H. pylori is the cause of

many peptic ulcers. At least 90 percent of people with duodenal ulcers

and 75 percent-85 percent of those with gastric ulcers are infected with

this organism.

 

Other causes include irritating substances such as aspirin, ibuprofen,

and other NSAIDs. Cigarette smoking impairs the healing of ulcers, and

stress appears to aggravate ulcer symptoms. Studies show there's also a

genetic component, as peptic ulcers sometimes run in families. They

occur more often in people with type O blood than in those with other

blood types.

 

Acid Relief

 

How do you spell relief? Nonstop advertisement has acquainted most

people with antacids, the most convenient and least expensive treatment

for heartburn. These work by reducing the acidity of refluxed material.

Less well-known are histamine H2-receptor antagonists (H2 blockers) and

proton pump inhibitors. The former cost a little more than antacids, but

are generally more convenient, and some can be purchased over the

counter. The newer proton pump inhibitors are more effective than either

antacids or H2 blockers, but don't come cheap and are available only by

prescription.