Gastroesophageal reflux| GERD| Heartburn and its management


Gastroesophageal reflux is a chronic disease that occurs when stomach contents flow back (reflux) into the food pipe (esophagus). It is usually caused by failure of the muscle valve (called the lower esophageal sphincter) between the stomach and the esophagus to close properly. The backwash of stomach acid irritates the lining of the lower esophagus and causes the symptom of heartburn.
Heartburn is the most common symptom of gastroesophageal reflux disease (GERD), also known as acid reflux. Heartburn occurs when acid or other stomach contents back up in the esophagus. Usually feels like a burning sensation behind the breastbone, moving up to the neck and throat.
Heartburn occurs when acid or other stomach contents back up in the esophagus


Foods that can trigger GERD

Some foods are known to trigger symptoms of GERD. By keeping a food diary, you can identify your trigger foods and change your diet to reduce discomfort. Below is a list of some foods recognized to trigger symptoms of GERD and how they affect the digestive tract:
• Coffee (with or without caffeine) and caffeinated beverages relax the lower esophageal sphincter.
• Citrus fruits and juices such as orange, grapefruit and pineapple have high acid content.
• Tomatoes and processed tomato-based products such as tomato juice, and pasta and pizza sauces are highly acidic.
• Carbonated beverages (fizzy drinks) cause gaseous distension of the stomach (bloating) which increases pressure on the lower esophageal sphincter causing acid reflux.
• Chocolate contains a chemical called methylxanthine from the cocoa tree, which is similar to caffeine. It relaxes the lower esophageal sphincter, which causes acid reflux.
• Peppermint, garlic and onions relax the lower esophageal sphincter causing acid reflux.



• Fatty, spicy or fried foods relax the lower esophageal sphincter as well as delay stomach emptying and therefore cause acid reflux.

Steps to Manage Your Heartburn

• Remain sitting upright during meals and for 45 to 60 minutes after eating.
• Avoid eating two to three hours before bedtime.
• Avoid eating large amounts of food at one time.
• Raise the head of your bed six to eight inches when sleeping. Try “bed blocks”, special foam wedgies or a hospital bed. Pillows may not be adequate as they raise only your head. Your esophagus should be higher than your stomach.
• Achieve and maintain a healthy weight.
• Avoid clothing that is tight across the stomach.
• Limit or avoid beverages that contain alcohol.
• Limit or avoid drinks with caffeine such as coffee, tea or cola drinks.
• Limit or avoid foods that may trigger symptoms such as spices, peppermint, chocolate, citrus juices, onions, garlic and tomato products.

Medicines

Medicines used for indigestion, heartburn and gastro-oesophageal reflux disease include:
• Antacids and alginates – Antacids (e.g., Mylanta, Gastrogel, Rennie) neutralise stomach acid. Alginates (e.g., Gaviscon) form a coating on top of stomach contents, which reduces acid reflux. Antacids and alginates are usually used for quick relief of occasional symptoms.
• H2 antagonists (e.g., ranitidine, famotidine, nizatidine) – They reduce gastric acid production in the stomach
• Proton pump inhibitors (PPIs) (e.g., esomeprazole,omeprazole, pantoprazole, lansoprazole, rabeprazole) – They reduce gastric acid production in the stomach. PPIs are usually the best treatment for heartburn
• Prokinetic medicines (e.g., domperidone, metoclopramide) – They speed up the passage of food through the stomach.

PPIs and H2 antagonists are also used to protect the inner lining of the stomach and oesophagus during treatment with non-steroidalanti-inflammatory drugs (e.g., aspirin, ibuprofen, naproxen, diclofenac).




Reference

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