When to Seek Medical Care

When to Seek Medical Care

Although many people can relieve their reflux disease symptoms by changes in their habits and lifestyle, others need to consult their health care provider.

Call your health care provider when symptoms of GERD occur frequently, disrupt your sleep, interfere with work or other activities, or are not relieved by self-care measures alone.

Make your health care provider aware that you are using self-care measures so that he or she can monitor how well they work and how often you need to use them.

If you have any of the following, go immediately to the closest emergency department:
Severe chest pain or pressure, especially if it radiates to your arm, neck, or back

Vomiting followed by severe chest pain

Vomiting blood

Dark, tarry stools

Difficulty swallowing solids or liquids

Reflux Disease (GERD) Symptoms

Persistent heartburn is the most common symptom of GERD.
Heartburn is a burning pain in the center of the chest, behind the breastbone. It often starts in the upper abdomen and spreads up into the neck.

The pain can last as long as 2 hours.

Heartburn is usually worse after eating.

Lying down or bending over can bring on heartburn or make it worse.

The pain usually does not start or get worse with physical activity.

Heartburn is sometimes referred to as acid indigestion.

Not everyone with GERD has heartburn.

Other symptoms of GERD include the following:
Regurgitation of bitter acid up into the throat while sleeping or bending over

Bitter taste in the mouth

Persistent dry cough

Hoarseness (especially in the morning)

Feeling of tightness in the throat, as if a piece of food is stuck there

Wheezing

The most common symptoms in children are repeated vomiting, coughing, and other respiratory problems.

Reflux Disease (GERD) Causes

No one knows the exact cause of gastroesophageal reflux. The following are several contributing factors that weaken or relax the lower esophageal sphincter, making reflux worse:
Lifestyle - Use of alcohol or cigarettes, obesity, poor posture (slouching)

Medications - Calcium channel blockers, theophylline (Tedral, Hydrophed, Marax, Bronchial, Quibron), nitrates, antihistamines

Diet - Fatty and fried foods, chocolate, garlic and onions, drinks with caffeine, acid foods such as citrus fruits and tomatoes, spicy foods, mint flavorings

Eating habits - Eating large meals, eating soon before bedtime

Other medical conditions - Hiatal hernia, pregnancy, diabetes, rapid weight gain

Hiatal hernia is a condition when the upper part of the stomach protrudes up above the diaphragm (the strong muscle that separates the organs of the chest from those of the abdomen).
Normally, the diaphragm acts as an additional barrier, helping the lower esophageal sphincter keep acid from backing up into the esophagus.

A hiatal hernia makes it easier for the acid to back up.

Hiatal hernia can be caused by persistent coughing, vomiting, straining, or sudden physical exertion. Obesity and pregnancy can make the condition worse.

Hiatal hernia is very common in people older than 50 years.

Hiatal hernia usually requires no treatment. In rare cases when the hernia becomes twisted or is making GERD worse, surgery may be required.

Reflux Disease (GERD) Overview

Reflux Disease (GERD) Overview

Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The esophagus or food pipe is the tube stretching from the throat to the stomach. When food is swallowed, it travels down the esophagus.

The stomach produces hydrochloric acid after a meal to aid in the digestion of food.
The inner lining of the stomach resists corrosion by this acid. The cells that line the stomach secrete large amounts of protective mucus.

The lining of the esophagus does not share these resistant features and stomach acid can damage it.

The esophagus lies just behind the heart, so the term heartburn was coined to describe the sensation of acid burning the esophagus (see Media file 1).

Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid.
This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction.

With GERD, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus.

GERD affects nearly one third of the adult population of the United States to some degree at least once a month. Almost 10% of adults experience GERD weekly or daily. Not just adults are affected; even infants and children can have GERD.

Night-Time Acid Reflux Can Impact Sleep, New Studies Reveal

According to results of a survey presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, nighttime acid reflux, along with some of the less typical manifestations or symptoms of gastroesophageal reflux disease (GERD), is associated with significant sleep impairment.

In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.

Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.

"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.

Tips for Calming Nighttime Acid Reflux Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances, including arousal from sleep, increased wakefulness and overall poor sleep quality.

Here are several tips to help reduce nighttime acid reflux so you can sleep better:

* Sleep with your head and shoulders elevated
* Wear loose-fitting clothes
* Wait 2 to 3 hours after eating to go to sleep
* Avoid foods that trigger heartburn

Obesity Linked To Acid Reflux Disease

According to a new article in The American Journal of Gastroenterology, gastroesophageal reflux disease (GRD), more commonly known as, acid reflux, is linked to obesity. Since (GRD) is strongly associated with more serious conditions, such as esophageal ulcers and cancer, weight reduction therapy may be useful in treatment and prevention of these conditions.

"The condition is very common, but previous studies have not been successful at pinpointing risk factors for the condition," says Douglas Corley, author of the study. "Because we reviewed the results of 20 studies on the subject, we were able to better identify and understand the association between obesity and acid reflux."

In a nation becoming increasingly aware of the dangers of obesity, this new finding provides yet another reason to discuss weight management with a physician. "We know that an increase in body weight increases the chance of having heartburn and acid reflux, which can increase the risk of esophageal ulcers and cancer," says Corley. "While we can't say at this time that weight loss therapy is definitely the solution to this condition, it certainly warrants further research as a treatment."

Preventing Infant Reflux

Many babies have spitting up problems that don't require treatment. Referred to as "happy spitters," their symptoms usually disappear after six to eight months. For some infants, however, their symptoms are a sign of something more serious, and they need medical attention.

The tips below can help reduce your baby's reflux. You should consult your baby's doctor before making any major changes in your infant's feedings, positions, etc. The doctor will be able to tell you if the reflux is normal spitting up, or a chronic problem that needs medical treatment, and give you advice on the best treatment for your baby.

Hold Baby Upright

Keep infants upright during feedings, and for at least 30 minutes after feedings. This will decrease the amount of gastric reflux.

Lay Baby Down When Awake

If you lay your baby down after feeding, place the baby on his stomach (prone position) on an incline of at least 30 degrees.

This can reduce regurgitation. But only place the infant in this position if he is awake. Also, this is not recommended during sleep for infants from birth to 12 months because of the link between this position and sudden infant death syndrome. Based on guidelines set forth by the American Academy of Pediatrics, positioning the infant on his/her back (supine position) during sleep is generally recommended.

In infants with GERD, the risk of SIDS generally outweighs the potential benefits of prone sleeping. Prone positioning during sleep is only considered in unusual cases where the risk of death from complications of GERD outweighs the potential increased risk of SIDS. It is very important to discuss this with your infant's doctor before undertaking any changes in sleeping positions.

Nighttime Sleep Position

As noted above, position your infant on his back, and elevate the head of the bed 30 degrees. Gravity will help keep stomach contents where they belong.

Try Smaller, More Frequent Feedings

Feedings every two to three hours when the infant is awake will reduce the occurrence of gastric reflux. Overfeeding can increase abdominal pressure, which can lead to gastric reflux.

Rice Cereal May Help

This can reduce the amount an infant will regurgitate. Start with one teaspoon of rice cereal to each ounce of formula. If the baby is breast-feed, try pumping and then adding rice cereal to the breast milk.

Diet Modifications for Mothers who Breastfeed

Certain foods -- such as caffeine, chocolate, and garlic -- can promote reflux, so if you breastfeed your infant, you should consider cutting these foods out of your diet.

Infant Seats and Car Seats

The way the infant is positioned in the car seat can cause regurgitation to increase. If the infant slouches over, it causes abdominal compression, increasing the risk of reflux. Using simple supports to keep the infant upright will prevent this.

Burping the Infant

Burping your infant several times during the feeding will help minimize gastric pressure, and the reflux it can cause. Waiting to burp your infant until after she has a full stomach can increase the chances of regurgitation.

Other Things You Can Do

Avoid tight elastic around your baby's waist, and keep diapers loose. Also, don't give your infant caffeinated beverages, orange juice or other citrus juices.

If none of the above methods work, there are a number of medications that often help. Keep in contact with your doctor as you make any of these lifestyle changes. Your doctor will advice you as to the next steps to take. ——————

_{Sources:
"Gastroesophageal Reflux in Infants." NIH Publication No. 06–5419 August 2006. National Digestive Diseases Information Clearinghouse (NDDIC). 28 Dec 2006 .
Marsha Kay, M.D., Vasundhara Tolia, M.D.. "COMMON GASTROINTESTINAL PROBLEMS IN PEDIATRIC PATIENTS." The American College of Gastroenterology. 28 Dec 2006 .}