Stop Acid reflux Now
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Symptoms
A. Gastroesophageal reflux disease (GERD) in Adult
A.1. Symptoms
1. Heartburn
Heart burn is one of common symptom of Gastroesophageal reflux disease (GERD) in adult, as a result of acid reflux cause of burning sensation or pain in the middle of the chest mostly after meal.
2. Regurgitation
In gastroesophageal reflux disease (GERD), regurgitation is the expulsion of a small amount of digested foods to the mouth from esophagus. frequent or prolonged regurgitation can lead to acid-induced erosion of the teeth, bad breath or damage to the esophagus.
3. Trouble swallowing
It is caused by damage of the muscles and tissues that must flex for swallowing, as a result of prolonged period of acid reflux that has left untreated.
It is one of uncommon of Gastroesophageal Reflux Disease (GERD), but is is associated to some people with the disease.
5. Pain when swallow
It may be caused by the damage or infection of the esophagus.
6. Asthma
In a study of The association between gastro-oesophageal reflux disease and asthma: a systematic review" by B D Havemann, C A Henderson, H B El-Serag, posted in a international journal of gastroenteroloy and hepatology, researchers found that this systematic review indicates that there is a significant association between GORD and asthma, but a paucity of data on the direction of causality.
7. Etc.
A.2. Complication
In some severe cases as a result of frequent acid reflux.
1. Ulcers
Damage of the esophagus can lead to result of ulcers as a result of inflammation forming of scar.
2. Esophageal strictures
Prolonged period and frequent acid reflux, if keft untreated can lead to inflammation cause of narrowing of the esophagus
3. Barrett's esophagus
In a study of . "Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus" by Kenneth K. Wang, M.D. and Richard E. Sampliner, M.D.
The Practice Parameters Committee of the American College of Gastroenterology, researchers wrote that screening for Barrett’s esophagus remains controversial because of the lack of documented impact on mortality from EAC. The large number of patients that lack reflux symptoms but have Barrett’s esophagus provides a diagnosis challenge. The highest yield for Barrett’s is in older (age 50 or more) Caucasian males with longstanding heartburn.
4. Esophageal adenocarcinoma
In GICS 2009: EGF Genetic Variant Increases Risk for GERD-Associated Esophageal Adenocarcinoma " by Roxanne Nelson posted by Medscape Newa Today, the author wrote that January 16, 2009 (San Francisco, California) — Specific mutations in the epidermal growth factor (EGF) gene appear to increase the risk for esophageal cancer in patients with gastroesophageal reflux disease (GERD), according to research presented here at the 2009 Gastrointestinal Cancers Symposium. Compared with the EGF wild-type A/A genotype, presence of the G/G variant was associated with an odds ratio (OR) of 1.90 for esophageal cancer, but the correlation between the G/G genotype and esophageal cancer risk was evident only among patients who also had GERD.
5. Etc.
B. Gastroesophageal reflux disease (GERD) in Children
According to statistic, over 35% of 4 million babies born in the U.S. each year have some kinds of splitting up after feeding in the first few months of their life.
1. Vomiting
Acid reflux can cause repeated vomiting in children
2. A sore, raw throat or hoarse voice
These may be result of acid reflux causing damage of the voice box.
3. Sour taste of acid
Frequent acid reflux that lead sour taste in the mouth
4. Trouble swallowing
It may be caused by inflammation of the the esophagus
5. Bad breath
6. Frequent coughing
It can be caused by foods entering the air way during acid reflux
7. Failure to gain weight
As a result of loss of appetite
8. Etc.
Causes
1. Slower in emptying of the stomach after eating
Most uncommon causes of Gastroesophageal reflux disease (GERD) is due to the distention of the stomach with food over prolonged period of time that can lead to reflux. Approximately 20% of Gastroesophageal reflux disease (GERD) are caused the reason above.
2. Cardia
Cardia is the area between the part of the stomach and the esophagus. It is angle where the esophagus enters the stomach and acts as a valve to prevent foods and others to reflux back to the esophagus. If the cardia is not functioning well, it can cause Gastroesophageal reflux disease (GERD with burning sensation of the esophagus.
3. Esophageal contractile defection
If the esophageal contraction fails to performed its function of proper swallowing food, it may not generate enough waves of contractions to push the foods down to the stomach after swallowing and the acid back into the stomach.
4. Hiatal hernia
Hiatal hernia is a condition of a portion of the stomach protrudes upward into the chest, through a tear or weakness in the diaphragm. According to the study of Nocturnal Reflux Episodes Following the Administration of a Standardized Meal. Does Timing Matter?Michael Piesman, M.D.; Inku Hwang, M.D.; Corinne Maydonovitch, B.S.; Roy K.H. Wong, M.D, posted in Medscape news Today, researchers found that GERD patients consuming a late-evening meal had significantly greater supine acid reflux compared to when they consumed an early meal, especially in overweight patients, and in patients with esophagitis or HH. These findings support the recommendations to our GERD patients to eat dinner early and to lose weight.
5. Obesity
Obesity increase the risk of Gastroesophageal reflux disease (GERD). In a sudy of "The association between gastroesophageal reflux disease and obesity." by Friedenberg FK, Xanthopoulos M, Foster GD, Richter JE., the authors wrote that weight loss, through caloric restriction and behavioral modification, has been studied infrequently as a means of improving reflux. Bariatric surgery and its effects on a number of obesity-related disorders have been studied more extensively. Roux-en-Y gastric bypass (RYGB) has been consistently associated with improvement in the symptoms and findings of GERD.
6. Esophageal mucosa
In a study of "Halimeter ppb Levels as the Predictor of Erosive Gastroesophageal Reflux Disease." by Kim JG, Kim YJ, Yoo SH, Lee SJ, Chung JW, Kim MH, Park DK, Hahm KB. posted in US National Library of Medicine National Institutes of Health, researchers found that Erosive changes in the esophageal mucosa were strongly associated with VSC levels, supporting the hypothesis that halitosis can be a potential biomarker for the discrimination between ERD and NERD, reflecting the presence of erosive change in the lower esophagogastric junction.
7. Medication
The use of medication such as prednisolone acetate ophthalmic suspension, an adrenocortical steroid product can increase the risk of Gastroesophageal reflux disease (GERD).
8. Chronic diseases
Chronic diseases, including cough, pulmonary fibrosis, earache, and asthma are also associated with the higher risk of develop Gastroesophageal reflux disease (GERD)
9. Infection
Infection caused by H. pylori can increase the risk of Gastroesophageal reflux disease (GERD). According to the study of "Helicobacter pylori infection and chronic gastric acid hyposecretion" by EM El-Omar, K Oien, A El-Nujumi, D Gillen, A Wirz, S Dahill, C Williams, JE Ardill, KE McColl posted in Gastroenterology, researchers concluded that in some subjects, chronic H. pylori infection produces a body-predominant gastritis and profound suppression of gastric acid secretion that is partially reversible with eradication therapy. (Gastroenterology 1997 Jul;113(1):15-24).
10. Etc.
If you are experience some of the above symptoms, after recording your family history and physical exam, the following test may be recommended by your doctor
1. Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy (EGD) also known as upper gastrointestinal endoscopy is a diagnosis procedure allowing your doctor to check for any abnormality in the lining of the esophagus, stomach, and upper duodenum after a flexible endoscope inserted down the throat.
If any abnormality is found, your doctor order further examinations.
2. Barium swallow
Barium swallow is a medical imaging procedure which allows your doctor to examine the upper GI (gastrointestinal) tract, to exam the lining of the esophagus and the stomach, after you have drunk a suspension of barium sulfate.
3. Chest X-rays
A chest x-ray is an x-ray of the chest that allows your doctor to examine the lining of the esophagus, stomach, and upper duodenum.
4. Biopsy
A biopsy is a test of removal sample of cells or tissues for examination and determination of the grade and type of the tumors by examining them under a microscope by a pathologist or chemically, if the location of the tumor allows the test to be done without major risk to the patient.
4. Esophageal manometry
Esophageal manometry is a test with the use of a pressure-sensitive tube-like thin instrument passed through your mouth or nose and into your stomach to allow your doctor to examine the motor function of the Upper Esophageal Sphincter (UES), Esophageal body and Lower Esophageal Sphincter (LES).
5. Etc.
Prevention
A. GERD Diet
According to the The GERD Diet (Gastroesophageal Reflux Disease) in McKinley Health Center of The university of Illinois at Urbana-Champaign
Dietary modifications are recommended to lessen the likelihood of reflux and to avoid irritation of sensitive or inflamed esophageal tissue. Listed below are several recommendations that may help to manage GERD:
1. Decrease total fat intake - High fat meals and fried foods tend to decrease LES pressure and delay
2. Avoid large meals - Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
3. Decrease total caloric intake if weight loss is desired - Since obesity may promote reflux, weight loss
may be suggested by your healthcare provider to control reflux. Reducing both total fat and caloric intake will aid in weight loss.
4. Avoid chocolate - Chocolate contains methylxanthine, which has been shown to reduce LES pressure by causing relaxation of smooth muscle.
5. Avoid coffee depending on individual tolerance - Coffee, with or without caffeine, may promote gastroesophageal reflux. Coffee may be consumed if it is well tolerated.
6. Avoid other known irritants - Alcohol, mint, carbonated beverages, citrus juices, and tomato products all may aggravate GERD. These products may be consumed depending on individual tolerance.
B. Other modifications for treating GERD
7. Maintain upright posture during and after eating.
8. Stop smoking.
9. Avoid clothing that is tight in the abdominal area.
10. Avoid eating within 3 hours before bedtime.
11. Lose weight if you are overweight.
12. Sleep on your left side.
13. Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
14. Elevate the head of your bed 4-6 inches by placing bricks under the headboard. (Source)
Treatments
A. Conventional medicine
A.1. Medication
1. Proton-pump inhibitors
Proton-pump inhibitors including omeprazole, esomeprazole, pantoprazole, are used to reduce the production of gastric acid in the stomach.
2. H2 receptor blockers
H2 receptor blockers include ranitidine, famotidine, cimetidine, etc.. In a study of " Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies." by Tran T, Lowry AM, El-Serag HB., posted in US National Library of Medicine National Institutes of Health , researchers found that Over-the-counter medications are effective in treating symptomatic gastro-oesophageal reflux disease. Compared with the placebo response, which ranged between 37% and 64%, the relative benefit increase was up to 41% with histamine-2 receptor antagonists, 60% with alginate/antacid combinations, and 11% with antacids.
3. 5HT4 agonist
According to the study of "The effect of mosapride, a novel prokinetic, on acid reflux variables in patients with gastro-oesophageal reflux disease." by Ruth M, Hamelin B, Röhss K, Lundell L., posted in US National Library of Medicine National Institutes of Health, researchers found that
Mosapride 40 mg q.d.s. is effective in decreasing acid reflux in the oesophagus in patients with GERD and therefore has the potential to be effective in the treatment of this disease.
4. GABA-B Receptor Agonists
In an article of "Medical Management of GERD" From Medscape Gastroenterology by Ronnie Fass, MD, FACP, FACG., the author wrote that Richard Holloway from Adelaide, Australia, reviewed the current studies assessing the role of baclofen, a GABA-B agonist, in the treatment of patients with GERD. He emphasized that the drug inhibits 34% to 60% of the TLESRs and improves basal lower esophageal sphincter pressure.
Antacids are oral medicine used to relieve symptom of heartburn of gastroesophageal reflux disease (GERB).
4. Promotility Agents
Promotility Agents are used to improve GERD symptoms for patients with slow gastric emptying by stimulating the muscles of the gastrointestinal tract to reduce acid reflux into the esophagus.
5. Etc.
A.2. Surgery
1. Fundoplication Surgery
The aim of the sugery is to reduce heartburn caused by acid reflux, in severe case of inflammation, hiatal hernia, damage of esophagus, etc.. Fundoplication surgery is the procedure to treat Gastroesophageal Reflux Disease (GERD) by strengthening the valve between the esophagus and stomach as the upper curve of the stomach is wrapped and satured around the lower end of the esophagus to prevent acid from backing up into the esophagus with a laparoscopic with a small tunnel made from the stomach muscle to allow foods of the lower part of the esophagus to pass through. The sugery is also by times for the esophagus to heal. Acccording to the artilce of "Barrett's esophagus: the role of laparoscopic fundoplication" by Abbas E. Abbas MD, Claude Deschamps MD, Stephen D. Cassivi MD, Mark S. Allen MD, Francis C. Nichols, III MD, Daniel L. Miller MD and Peter C. Pairolero MD, posted in ScienceDirect, researcher found that laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with BE. While disappearance of BE may occur in some patients, the possibility of developing esophageal adenocarcinoma is not eliminated by laparoscopic fundoplication. Therefore, endoscopic surveillance should continue.
1. Deglycyrrhizinated licorice
Deglycyrrhizinated licorice has been used by people with gastric and peptic ulcers for nearly a hundred years. in a study of "Secretin as a potential mediator of antiulcer actions of mucosal protective agents." by Takeuchi T, Shiratori K, Watanabe S, Chang JH, Moriyoshi Y, Shimizu K., posted in US National Library of Medicine National Institutes of Health, researcher found that the three antiulcer agents FM 100, plaunotol, and teprenon have been shown to increase the content of endogenous prostaglandins in the gastric mucosa, endogenous secretin released by these agents may play a significant role in their mucosal protective action. It is concluded that the antiulcer effect of these drugs could in part be attributable to their unique ability to release endogenous secretin, and that secretin is a potential mediator of the antiulcer actions of mucosal protective agents
2. Aloe Vera
According to the article of "Effect Of Orally Consumed Aloe Vera Juice On Gastrointestinal Function In Normal Humans, excerpts By Jeffrey Bland, Ph.D. (Linus Pauling Institute of Science & Medicine) involved ten healthy subjects - five men (median age: 42; standard deviation: 14 years), and five women (median age: 32; standard deviation: 5 years) - engaged in a semicontrolled Aloe vera juice oral supplementation study protocol., researchers found that The function of Aloe vera juice in promoting, proper gastrointestinal function, based upon the
information from this preliminary study, may be to regulate gastrointestinal pH while improving
gastrointestinal motility, increasing stool specific gravity, and reducing populations of certain fecal micro-organisms, including yeast.
3. Mastic gum
According to the article of Strategies to Protect Against Potential Bone-Destroying Effects"By Chris D. Meletis, ND, the aithor wrote that While much of the research on mastic gum revolves around its ability to support the health of patients with ulcers and its ability to inhibit the bacteria H. pylori, clinically it has been equally useful in patients with GERD and acid reflux.
4. Ginger
Ginger has been used for thousands of years to enhance the function of digestive system and treat stomach distress including nausea, vomiting, diarrhea and in digestion, acid reflux, motion sickness, dyspepsia, etc. due to its due to its anti-inflammatory, antimicrobial and analgesic properties. According to the study of " Ginger (Zingiber officinale Roscoe) and the gingerols inhibit the growth of Cag A+ strains of Helicobacter pylori." by Mahady GB, Pendland SL, Yun GS, Lu ZZ, Stoia A., researchers found that The methanol extract of ginger rhizome inhibited the growth of all 19 strains in vitro with a minimum inhibitory concentration range of 6.25-50 micrograms/ml. One fraction of the crude extract, containing the gingerols, was active and inhibited the growth of all HP strains with an MIC range of 0.78 to 12.5 micrograms/ml and with significant activity against the CagA+ strains.
5. Peppermint
According to the study of A review of the bioactivity and potential health benefits of peppermint tea (Mentha piperita L.)." by McKay DL, Blumberg JB. posted in , researchers wrote that In vitro, peppermint has significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential. Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic and anesthetic effects in the central and peripheral nervous system... However, human studies of peppermint leaf are limited and clinical trials of peppermint tea are absent. Adverse reactions to peppermint tea have not been reported, although caution has been urged for peppermint oil therapy in patients with GI reflux, hiatal hernia or kidney stones.
6. Etc.
C. Traditional Chinese medicine
a. Ban Xia Xie Xin Wan, also known as "Pinellia Drain Epigastrium Pills" was recorded in classic texts around 210 C.E. Though often referred to as heartburn in classical Chinese medical literature, has been used in TCM to treat various gastrointestinal disorders such as gastritis, enteritis, gastric ulcer, gastralgia. In a study of "The effects of hange-shashin-to on gastric function in comparison with sho-saiko-to." by , , , , researchers suggested that suggest that TJ-14 exhibits an anti-ulcer action (probably based on its ability to protect the gastric mucosa), improvement of gastric emptying and an anti-emetic action. TJ-9 also showed anti-ulcer effects, probably based on its ability to suppress gastric secretion and to protect the gastric mucosa. Thus, the present study demonstrated the effectiveness of TJ-14 and TJ-9 against gastric disease, and provided basic data which explain the differences in clinical application between these two kampo medicines.
b. Ingredients
b.1. Ban Xia (Pinellia Tuber)
Main use: Dries Dampness, Transforms Phlegm, Stops vomiting, Resolves masses, Disperses nodules....
b.2. Huang Qin (Skullcap Root)
Main use: Clears Heat, Dries Dampness, Expels toxins, Stops bleeding...
b.3. Dang Shen (Codonopsis Root)
Main use: Tonifies the Middle Burner, Strengthens Qi, Promotes generation of Body Fluids, Nourishes Blood....
b.4. Gan Cao ( Licorice Root)
Main use: Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Calms cough...
b.5. Huang Lian (Coptis Rhizome)
Main use: Clears Heat, Dries Dampness, Expels toxins...
b.6. Bai Shao
Main use: Nourishes Blood, Preserves the Yin, Nourishes the Liver, Calms pain....b.7. Chen Pi
Main use: Regulates the Qi, Regulates the Middle, Dries Dampness, Transforms Phlegm...
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