By Dr.Moret
Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates into the esophagus which is the tube that takes food and drink from the mouth to the stomach. At the bottom of the esophagus where it enters the stomach there is a ring of thick muscles that seals off the stomach when it is working to digest food. In some people this muscle is weak and GERD occurs. The liquid can inflame and damage the lining of the esophagus.
I think everybody has had this happen occasionally. Suddenly you feel the stomach contents come into your mouth. It tastes very bitter, you swallow and it goes away. Usually you do not feel the stomach cramping that accompanies normal vomiting. The regurgitated liquid contains acid and may also contain bile that has backed-up into the stomach from the intestines.
It is the acid is the nasty part of the refluxed liquid. Gerd is not as common in Asian people as in westerners. Once GERD begins, it may continue for life; after the esophagus has healed the treatment usually will need to be continued indefinitely although in some patients with intermittent symptoms treatment can taken only during symptomatic periods. There flux of the stomach’s liquid contents into the esophagus occurs in most normal individuals. One study found that reflux occurs as frequently in normal individuals as in patients with GERD symptoms. In patients with GERD, however, the refluxed liquid contains more acid more and the acid remains in the esophagus longer. It has also been found that liquid refluxes to a higher level in the esophagus in patients with GERD than normal individuals. Acid often the case, the body has ways to protect itself from the harmful effects of reflux and acid. Most reflux occurs during the day when individuals are upright. In the upright position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. In addition, while individuals are awake, they repeatedly swallow, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, the salivary glands in the mouth produce saliva, which contains bicarbonate. With each swallow, bicarbonate-containing saliva travels down the esophagus.
The bicarbonate neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid. Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when individuals are in the upright position. At night during sleep, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus. A doctor friend of mine had continuous cough and sore throat. After years of suffering it was found that it was night-time GERD that was the problem. Certain conditions make a person susceptible to GERD.
It can be a serious problem during pregnancy. The elevated hormone levels cause reflux by lowering the effectiveness of the lower esophageal muscle ring. At the same time, the growing baby increases the pressure in the abdomen. Both of these effects will increase reflux. Thediagnosis is usually made from the story that the patient tells the doctor andtreatment can be started. Most patients will work out for themselves whichfoods tend to bring on an attack and make suitable adjustments. In morecomplicated or severe cases investigation of the amount of acid and thepressures in the esophagus may be needed. It may also be necessary to look downthe esophagus with a gastroscope. These tests can be performed in Hua Hin. The goal of treatment is to manage it by reducing the amount of acid in the stomach and the amount of reflux that occurs. For mild GERD, this can sometimes be accomplished by using over-the-counter antacids and making certain lifestyle changes.
If more treatment is needed, other types of drugs, either over-thecounter or prescription, are available. Only very rarely will surgery be needed. Some dietary changes may be needed spicy food should be avoided and beer, because of the volume of fluid, will exaggerate symptoms There are 3 types of drugs used to treat GERD. Antacids such as Maalox, Rolaids, and Tums Histamine H2-blockers such as Tagamet, and Zantac Proton pump inhibitors such as Prevacid, Prilosec, Nexium and Protonix Taking antacids when needed may be appropriate for the initial treatment of minor symptoms.H2-blockers help cut the stomach’s production of acid and work best for people with mild GERD. They are available in prescription strength and as over-the-counter drugs.
For moderate or severe GERD, another type of drug known as a proton pump inhibitor, which is stronger than H2-blockers, may be needed. These drugs turn off the acid pumps that stimulate the production of acid from the stomach. They are all available in prescription strength, and Prilosec OTC,Prevacid 24hr, and Zegerid OTC are available over the counter. For complicated or chronic GERD, proton pump inhibitors are often taken indefinitely. A doctor needs to be consulted if these medications are used because, the drugs may interfere with other drugs being taken, have serious sideeffects and other problems may be overlooked. If you feel that you have this problem, try using antacids between meals and at bedtime. If it doesn’t improve see an Internist Doctor.Dr Michael Moreton is British/Canadian Hospital Consultant living in Hua Hin. He was the International Medical Coordinator at Bangkok Hospital for 5 years. drmjmoreton@gmail.com
