Treatment of acid reflux may cure asthma in some patients and decrease the need for asthmatic medications in others. Ear, Nose, and Throat Problems: Acid reflux may be a cause of chronic cough, sore throat, laryngitis with hoarseness, frequent throat clearing, or growths on the vocal cords.
If these problems do not get better with standard treatments, think about GERD. Peptic Stricture: This results from chronic acid injury and scarring of the lower esophagus. Patients complain of food sticking in the lower esophagus. Heartburn symptoms may actually lessen as the esophageal opening narrows down, preventing acid reflux.
Stretching of the esophagus and proton pump inhibitor medication are needed to control and prevent peptic strictures. In patients with chronic heartburn, an endoscopy will often be recommended to identify any suspicious or pre-malignant lesions, such as Barrett's esophagus. So, do not ignore your heartburn. If you are having heartburn two or more times a week, it is time to see your physician. Increasingly, we are becoming aware that the irritation and damage to the esophagus from continual presence of acid can prompt an entire array of symptoms other than simple heartburn.
Experts recognize that often the role of acid reflux has been overlooked as a potential factor in the diagnosis and treatment of patients with chronic cough, hoarseness and asthma-like symptoms. In some instances, patients have never reported heartburn, and in others the potential causal link between reflux and the onset of these so-called "extra-esophageal manifestations" has not been fully recognized.
Physicians are increasingly becoming aware that it is good clinical practice to evaluate the possible presence of reflux in patients with chronic cough and asthma-like symptoms, as well as the importance that acid suppression and treating underlying reflux can have in potentially improving the symptoms in these patients.
Esophageal disease may be perceived in many forms, with heartburn being the most common. Since the esophageal lining is sensitive to stomach contents, persistent and prolonged exposure to these contents may cause changes such as inflammation, ulcers, bleeding and scarring with obstruction.
A pre-cancerous condition called Barrett's esophagus may also occur. Barrett's esophagus causes severe damage to the lining of the esophagus when the body attempts to protect the esophagus from acid by replacing its normal lining with cells that are similar to the intestinal lining. Research was conducted to determine whether the duration of heartburn symptoms increases the risk of having esophageal complications.
The study found that inflammation in the esophagus not only increased with the duration of reflux symptoms, but that Barrett's esophagus likewise was more frequently diagnosed in these patients. Those patients with reflux symptoms and a history of inflammation in the past were more likely to have Barrett's esophagus than those without a history of esophageal inflammation. Persistent symptoms of heartburn and reflux should not be ignored.
By seeing your doctor early, the physical cause of GERD can be treated and more serious problems avoided. How significant is your heartburn? What are the chances that it is something more serious? If you need a yardstick, here's a simple self-test developed by a panel of experts from the American College of Gastroenterology. Remember, if you have heartburn two or more times a week, or still have symptoms on your over-the-counter or prescription medicines, see your doctor.
If you said yes to two or more of the above, you may have GERD. To know for sure, see your doctor or a gastrointestinal specialist. They can help you live pain free. Gastroesophageal reflux disease GERD is a chronic condition where fluids in the stomach reflux into the esophagus causing bothersome symptoms such as heartburn, and regurgitation. This can also cause serious symptoms such as chest pain mimicking heart attack, hoarseness, asthma, difficulty swallowing and even esophageal cancer. Acid in the stomach is the first line of defense against the food-borne pathogens that we ingest.
Moreover acid in the stomach plays a role in absorption of vitamins Vitamin B12 , the digestion of proteins, and initiation of peristalsis which causes the food to move through the digestive tract.
Advancing age, obesity, pregnancy, regular use of aspirin and non-steroidal anti-inflammatory drugs, loss of physical mobility, and an incompetent valve between the stomach and esophagus Lower Esophageal Sphincter or LES are found to be among the many associated risk factors for GERD.
Decreased physical mobility secondary to multiple medical problems including arthritis increases the risk of becoming overweight and increase the risk of GERD. Many take aspirin or other medications that may contribute to the increased occurrence of GERD symptoms in the elderly. Aging also decreases the force of swallowing contractions, which causes delayed clearance of acid when refluxed into the esophagus. Thus there is potential for increased exposure of the esophageal lining to the regurgitated acid and thus increases the risk of damage.
The management guideline for GERD in the elderly remains the same as in a young patient. However, the physician may individualize the treatment based on the patient's overall condition.
The treatment can be broadly classified into lifestyle modifications, over-the-counter medications and prescribed medications. Lifestyle modifications include raising the head end of the bed to use gravity as a leverage to allow early clearance of regurgitated acid from the esophagus.
Avoiding tight fitting clothes to decrease abdominal pressure, decrease fats, chocolate, peppermint, coffee, and alcohol from the diet to try to help reduce reflux. They have to be taken frequently after meals such as hours.
One of the main disadvantages is the inability of these products to heal any areas of esophageal inflammation caused by the acid reflux. Antacids contain aluminum and magnesium which can cause constipation and diarrhea in some patients. Constipation occurs in fewer than 2 percent of persons in the nonelderly population but affects as many as 26 percent of men and 34 percent of women over 65 years of age.
Patients with chronic kidney disease CKD should be careful with these medications as the mineral ingredients may worsen kidney function. You consult with your care provider if you have chronic kidney disease. Another class of anti-reflux medications is histamine-2 receptor antagonists H2 blockers. Cimetidine, ranitidine and famotidine, are available over-the-counter. Although they act more slowly compared to antacids, they remain active longer compared to the latter.
Cimetidine and ranitidine may increase the blood concentrations of anti-seizure medications, blood thinners, and anti-arrhythmic medications. Newer generations of this class of drugs do not cause this problem. If the symptoms of GERD persist even after using these medications for more than two weeks, you should consult your doctor. A proton pump inhibitor is a medication that is designed to decrease the amount of acid your stomach makes by inhibiting both meal stimulated and night-time acid secretion and has better effect than H2 blockers.
This type of medication is also better at healing ulcers in the esophagus and stomach. PPIs are mostly well tolerated. The only known contraindication is very rare allergy to this drug group. The most commonly noted side effects are headache, nausea, diarrhea, abdominal pain and in some cases constipation. Very few persons need to stop taking the medication because of side-effects. There have been a number of reported side effects of PPI in the press including dementia, kidney disease and bone disease.
At this time, there has never been a convincing study to show that this class of medications is directly responsive for any of these diseases.
It is thought to be an association rather than a true causation. This really depends on the severity of your symptoms and response to therapy. For example mild cases may respond to treatment and therapy can be stopped after a short course of treatment. There have been many studies addressing this issue because of concern of an interaction between PPIs and Clopidogrel. Current data suggests that it is safe to use a PPI and Clopidogrel together in patients who need both compounds.
It is possible that some PPIs will have less effect on interactions with Clopidogrel and this may affect which of the PPIs your care provider will prescribe. Some PPIs have label recommendations regarding their use with Clopidogrel. Please discuss this with your care provider.
It has been suggested that people who take a PPI for a long period of time at high doses have an increased risk for fractures of the hip, wrist and spine. No evidence exists to suggest that PPIs cause or accelerate osteoporosis. If there is an increased risk of fractures on PPI it is in patients who are at increased risk because of other conditions predisposing to osteoporosis and fractures.
In fact, nearly everyone will experience heartburn at some point in their life. Of people who experience heartburn, 40 percent say that nighttime heartburn affects their job performance the next day. Hospitalizations for GERD increased by percent between and People often confuse heartburn symptoms with more serious conditions. When in doubt, check it out. Between and , GERD in babies increased by 42 percent. No need to fret, most tots outgrow their infantile heartburn.
People who do not experience acid reflux account for 34 percent of the esophageal cancer incidences in the U. In some cases, GER may cause heartburn , also called acid indigestion. Gastroesophageal reflux disease GERD is a more severe and long-lasting condition in which GER causes repeated symptoms that are bothersome or leads to complications over time.
Esophagitis is inflammation in the esophagus. Esophagitis may cause ulcers and bleeding in the lining of the esophagus. An esophageal stricture happens when your esophagus becomes too narrow. Esophageal strictures can lead to problems with swallowing.
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