Heartburn/GERD...part 1
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Heartburn/GERD...part 1
by jkakashi01 Sat Feb 16, 2008 2:06 pm
Introduction
You've just eaten a big meal and leaned back in your favorite chair. Then it happens. Your chest starts to hurt so much it feels like it's on fire.
Heartburn is common, and an occasional episode is generally nothing to worry about. However, many people battle heartburn regularly, even daily. Frequent heartburn can be a serious problem, and it deserves medical attention. Frequent or constant heartburn is the most common symptom of gastroesophageal reflux disease (GERD).
GERD is a disease in which stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). This constant backwash of acid can irritate the lining of your esophagus, causing it to be irritated and inflamed.
Most people can manage the discomfort of heartburn with lifestyle modifications and over-the-counter medications. But if heartburn is severe, these remedies may offer only temporary or partial relief. If you have GERD, you may need newer, more potent medications to reduce symptoms.
Signs and symptoms
The most common symptom of GERD is heartburn — that burning sensation in your chest, which sometimes spreads to the throat, along with a sour taste in your mouth. Other signs and symptoms of GERD include:
Chest pain, especially at night while lying down
Difficulty swallowing (dysphagia)
Coughing, wheezing, asthma, hoarseness or sore throat
Regurgitation of food or sour liquid
Causes
When you swallow, the lower esophageal sphincter (LES) — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.
However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn and disrupting your daily life. The acid backup is worse when you're bent over or lying down.
This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, producing bleeding, or narrow the esophagus, causing difficulty swallowing or even breathing problems. When there's evidence of esophageal irritation or inflammation, you have GERD.
Some factors that can make GERD worse include:
Certain foods, such as fatty foods, spicy foods, chocolate, caffeine, onions, tomato sauce, carbonated beverages and mint
Alcohol
Large meals
Lying down soon after eating
Certain medications, including sedatives, tranquilizers and calcium channel blockers for high blood pressure
Cigarette smoking
In heartburn, the sphincter at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus.
Risk factors
Conditions that cause difficulty with digestion can increase the risk of heartburn or GERD. These include:
Obesity. Excess weight puts extra pressure on your stomach and diaphragm — the large muscle that separates your chest and abdomen — forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects.
Hiatal hernia. In this condition, also called diaphragmatic hernia, part of your stomach protrudes into your lower chest. If the protrusion is large, a hiatal hernia can worsen heartburn by further weakening the lower esophageal sphincter muscle.
Pregnancy. Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter.
Asthma. Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways.
Diabetes. One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn.
Peptic ulcer. An open sore or scar near the valve (pylorus) in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus.
Delayed stomach emptying. In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus.
Connective tissue disorders. Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux.
Zollinger-Ellison syndrome. One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux.
When to seek medical advice
Most problems with heartburn are fleeting and mild. But if you have severe or frequent discomfort, you may be developing complications that need more intensive medical treatment and prescription medications. Talk to your doctor if you have:
Heartburn several times a week
Heartburn that returns soon after your antacid wears off
Heartburn that wakes you up at night
You may need further medical care, possibly even surgery, if you experience any of these:
Symptoms that persist even though you're taking prescription medications
Difficulty swallowing
Regurgitated blood
Stool that's black
Weight loss
Screening and diagnosis
Usually a description of your symptoms will be all your doctor needs to establish the diagnosis of heartburn. However, if your symptoms are particularly severe or don't respond to treatment, you may need to undergo other tests:
Barium X-ray. This procedure requires you to drink a chalky liquid that coats and fills the hollows of your digestive tract. The coating allows your doctor to see a silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum). X-rays can then reveal whether a hiatal hernia may be contributing to your heartburn. They can also reveal an esophageal narrowing or stricture, or a growth, which may cause difficulty swallowing.
Endoscopy. A more direct test for diagnosing the cause of heartburn is esophagogastroduodenoscopy (EGD). In this test your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to see if you have an ulcerated or inflamed esophagus or stomach (esophagitis or gastritis, respectively). It can also reveal a peptic ulcer. During an EGD, your doctor can take tissue samples to test for Barrett's esophagus — a condition in which precancerous changes occur in cells in your esophagus — or esophageal cancer, two potential complications of severe heartburn. Analysis of these samples may also reveal the presence of a bacterium that may cause peptic ulcers.
Ambulatory acid (pH) probe tests. These tests use an acid-measuring (pH) probe to identify when, and for how long, stomach acid regurgitates into your esophagus. This information can help your doctor determine how best to treat your condition. In the standard tube test, a nurse or technician sprays your throat with a numbing medication while you're seated. Then a thin, flexible tube (catheter) is threaded through your nose into your esophagus to insert the probe. The probe is positioned just above the lower esophageal sphincter. A second probe may be placed in your upper esophagus. Attached to the other end of the catheter is a small computer that you wear around your waist or with a strap over your shoulder during the test. It records acid measurements. After the probe is in place, you go about your business and then come back one or two days later to have the device removed. A test called a Bravo pH probe may be more comfortable than the standard test, because it eliminates the need for a tube in your nose. In the Bravo test, the probe is attached to the lower portion of your esophagus during endoscopy. The probe transmits a signal to a small computer that you wear around your waist for about two days, and then the probe falls off to be passed in your stool. Another benefit of the Bravo test is that you can shower and sleep more comfortably than with the standard test.
Esophageal impedance. Rather than measuring acid, this test can measure whether gas or liquids reflux back into your esophagus. It's helpful for people who have regurgitation or reflux of materials in the esophagus that aren't acidic and wouldn't be detected by a pH probe. The test works by placing a catheter through your nose and into your esophagus, similar to a standard pH probe tube test. However, because the test is new, its role in helping people with GERD hasn't been clearly defined.
Complications
In addition to irritation and inflammation of your esophagus (esophagitis), chronic reflux of stomach acid into your esophagus can lead to one or more of the following conditions if left untreated:
Esophageal narrowing (stricture). Strictures occur in some people with GERD. Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing large chunks of food to get caught up in the narrowing, and can interfere with swallowing.
Esophageal ulcer. Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
Barrett's esophagus. This is a serious, though uncommon, complication of GERD. In Barrett's esophagus, the color and composition of the tissue lining the lower esophagus change. Instead of pink, the tissue turns a salmon color. Under a microscope, the tissue resembles that of the small intestine. This cellular change is called metaplasia. Metaplasia is brought on by repeated and long-term exposure to stomach acid and is associated with an increased risk of esophageal cancer. The risk of cancer is low, but you'll need regular endoscopies to look for early warning signs of cancer if you're diagnosed with Barrett's esophagus.
You've just eaten a big meal and leaned back in your favorite chair. Then it happens. Your chest starts to hurt so much it feels like it's on fire.
Heartburn is common, and an occasional episode is generally nothing to worry about. However, many people battle heartburn regularly, even daily. Frequent heartburn can be a serious problem, and it deserves medical attention. Frequent or constant heartburn is the most common symptom of gastroesophageal reflux disease (GERD). GERD is a disease in which stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). This constant backwash of acid can irritate the lining of your esophagus, causing it to be irritated and inflamed.Most people can manage the discomfort of heartburn with lifestyle modifications and over-the-counter medications. But if heartburn is severe, these remedies may offer only temporary or partial relief. If you have GERD, you may need newer, more potent medications to reduce symptoms.
Signs and symptoms
The most common symptom of GERD is heartburn — that burning sensation in your chest, which sometimes spreads to the throat, along with a sour taste in your mouth. Other signs and symptoms of GERD include:
Chest pain, especially at night while lying down Difficulty swallowing (dysphagia) Coughing, wheezing, asthma, hoarseness or sore throat Regurgitation of food or sour liquid Causes
When you swallow, the lower esophageal sphincter (LES) — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again.
However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn and disrupting your daily life. The acid backup is worse when you're bent over or lying down.
This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, producing bleeding, or narrow the esophagus, causing difficulty swallowing or even breathing problems. When there's evidence of esophageal irritation or inflammation, you have GERD.
Some factors that can make GERD worse include:
Certain foods, such as fatty foods, spicy foods, chocolate, caffeine, onions, tomato sauce, carbonated beverages and mint Alcohol Large meals Lying down soon after eating Certain medications, including sedatives, tranquilizers and calcium channel blockers for high blood pressure Cigarette smoking In heartburn, the sphincter at the lower end of your esophagus relaxes at the wrong time, allowing stomach acid to back up into your esophagus.
Risk factors
Conditions that cause difficulty with digestion can increase the risk of heartburn or GERD. These include:
Obesity. Excess weight puts extra pressure on your stomach and diaphragm — the large muscle that separates your chest and abdomen — forcing open the lower esophageal sphincter and allowing stomach acids to back up into your esophagus. Eating very large meals or meals high in fat may cause similar effects. Hiatal hernia. In this condition, also called diaphragmatic hernia, part of your stomach protrudes into your lower chest. If the protrusion is large, a hiatal hernia can worsen heartburn by further weakening the lower esophageal sphincter muscle. Pregnancy. Pregnancy results in greater pressure on the stomach and a higher production of the hormone progesterone. This hormone relaxes many of your muscles, including the lower esophageal sphincter. Asthma. Doctors aren't certain of the exact relationship between asthma and heartburn. It may be that coughing and difficulty exhaling lead to pressure changes in your chest and abdomen, triggering regurgitation of stomach acid into your esophagus. Some asthma medications that widen (dilate) airways may also relax the lower esophageal sphincter and allow reflux. Or it's possible that the acid reflux that causes heartburn may worsen asthma symptoms. For example, you may inhale small amounts of the digestive juices from your esophagus and pharynx, damaging lung airways. Diabetes. One of the many complications of diabetes is gastroparesis, a disorder in which your stomach takes too long to empty. If left in your stomach too long, stomach contents can regurgitate into your esophagus and cause heartburn. Peptic ulcer. An open sore or scar near the valve (pylorus) in the stomach that controls the flow of food into the small intestine can keep this valve from working properly or can obstruct the release of food from the stomach. Food doesn't empty from your stomach as fast as it should, causing stomach acid to build up and back up into your esophagus. Delayed stomach emptying. In addition to diabetes or an ulcer, abnormal nerve or muscle functions can delay emptying of your stomach, causing acid backup into the esophagus. Connective tissue disorders. Diseases such as scleroderma that cause muscular tissue to thicken and swell can keep digestive muscles from relaxing and contracting as they should, allowing acid reflux. Zollinger-Ellison syndrome. One of the complications of this rare disorder is that your stomach produces extremely high amounts of acid, increasing the risk of acid reflux. When to seek medical advice
Most problems with heartburn are fleeting and mild. But if you have severe or frequent discomfort, you may be developing complications that need more intensive medical treatment and prescription medications. Talk to your doctor if you have:
Heartburn several times a week
Heartburn that returns soon after your antacid wears off
Heartburn that wakes you up at night
You may need further medical care, possibly even surgery, if you experience any of these:
Symptoms that persist even though you're taking prescription medications
Difficulty swallowing
Regurgitated blood
Stool that's black
Weight loss
Screening and diagnosis
Usually a description of your symptoms will be all your doctor needs to establish the diagnosis of heartburn. However, if your symptoms are particularly severe or don't respond to treatment, you may need to undergo other tests:
Barium X-ray. This procedure requires you to drink a chalky liquid that coats and fills the hollows of your digestive tract. The coating allows your doctor to see a silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum). X-rays can then reveal whether a hiatal hernia may be contributing to your heartburn. They can also reveal an esophageal narrowing or stricture, or a growth, which may cause difficulty swallowing.
Endoscopy. A more direct test for diagnosing the cause of heartburn is esophagogastroduodenoscopy (EGD). In this test your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to see if you have an ulcerated or inflamed esophagus or stomach (esophagitis or gastritis, respectively). It can also reveal a peptic ulcer. During an EGD, your doctor can take tissue samples to test for Barrett's esophagus — a condition in which precancerous changes occur in cells in your esophagus — or esophageal cancer, two potential complications of severe heartburn. Analysis of these samples may also reveal the presence of a bacterium that may cause peptic ulcers.
Ambulatory acid (pH) probe tests. These tests use an acid-measuring (pH) probe to identify when, and for how long, stomach acid regurgitates into your esophagus. This information can help your doctor determine how best to treat your condition. In the standard tube test, a nurse or technician sprays your throat with a numbing medication while you're seated. Then a thin, flexible tube (catheter) is threaded through your nose into your esophagus to insert the probe. The probe is positioned just above the lower esophageal sphincter. A second probe may be placed in your upper esophagus. Attached to the other end of the catheter is a small computer that you wear around your waist or with a strap over your shoulder during the test. It records acid measurements. After the probe is in place, you go about your business and then come back one or two days later to have the device removed. A test called a Bravo pH probe may be more comfortable than the standard test, because it eliminates the need for a tube in your nose. In the Bravo test, the probe is attached to the lower portion of your esophagus during endoscopy. The probe transmits a signal to a small computer that you wear around your waist for about two days, and then the probe falls off to be passed in your stool. Another benefit of the Bravo test is that you can shower and sleep more comfortably than with the standard test.
Esophageal impedance. Rather than measuring acid, this test can measure whether gas or liquids reflux back into your esophagus. It's helpful for people who have regurgitation or reflux of materials in the esophagus that aren't acidic and wouldn't be detected by a pH probe. The test works by placing a catheter through your nose and into your esophagus, similar to a standard pH probe tube test. However, because the test is new, its role in helping people with GERD hasn't been clearly defined.
Complications
In addition to irritation and inflammation of your esophagus (esophagitis), chronic reflux of stomach acid into your esophagus can lead to one or more of the following conditions if left untreated:
Esophageal narrowing (stricture). Strictures occur in some people with GERD. Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing large chunks of food to get caught up in the narrowing, and can interfere with swallowing.
Esophageal ulcer. Stomach acid can severely erode tissues in the esophagus, causing an open sore to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
Barrett's esophagus. This is a serious, though uncommon, complication of GERD. In Barrett's esophagus, the color and composition of the tissue lining the lower esophagus change. Instead of pink, the tissue turns a salmon color. Under a microscope, the tissue resembles that of the small intestine. This cellular change is called metaplasia. Metaplasia is brought on by repeated and long-term exposure to stomach acid and is associated with an increased risk of esophageal cancer. The risk of cancer is low, but you'll need regular endoscopies to look for early warning signs of cancer if you're diagnosed with Barrett's esophagus.
jkakashi01- Tech Moderator
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Re: Heartburn/GERD...part 1
by nices Wed May 28, 2008 8:05 am
nice tips and info on how to prevent heartburn... thank you bro jkakas for sharing and more posting!!! keep it up!!! 
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