GAS TROUBLE-GERD

GAS TROUBLE-GERD
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Old trouble with new name!! ‘Dr,will you write on GERD?I suffer just that’....a friendly request reached me once.My friend didn’t meet a doc.Google was her homely inexpensive consultant.Like any other of my fraternity I too got irritated with such patients but of late I started taking advantage of the Google-provided awareness of my patients to the extent that I asked them to ‘google out’ more details of their concerns before their next visit with a warning of course that Google should never treat them. Yes,our good old gas trouble is now branded as GERD-Gastro Esophageal Reflux Disease.Gastro means stomach,Esophagus means food pipe which extends from throat to upper part of stomach,and Reflux is back flow. The food we take,mixed with saliva- the watery mouth secretion,is gulped via throat into the food pipe.It reaches the stomach in about half an hour.There is a circular muscle around the lower end of the food pipe(Lower Esophageal Sphincter-LES).This muscle opens for the food to pass from the food pipe to the stomach and closes. Normally LES never allows backflow of food or other stomach contents like acid and bile into the food pipe.(Stomach acid is produced in the stomach itself.Bile is the fluid secreted by liver,stored in gall bladder and released into the upper part of intestine.These are needed for digestion). If LES is weak or malfunctioning,the backflow (reflux) happens.This exactly is GERD.Sometimes a small part of stomach gets herniated into the chest.This gets aggravated with cough,strain,full stomach or pregnancy.This is called Hiatus Hernia and this also weakens the LES. Do you get acid(sour)burps? Does the middle of your chest burn?(heartburn) Does your chest ,mostly the middle part, ache? The ache does not aggravate with exercise and does not subside with rest? Something rolls up from upper tummy to throat? Something obstructs your throat? You have a food-coming back to mouth feeling? You feel like vomiting or you just vomit? You feel very uncomfortable after a full meal,more so if it is spicy/sour/fried/non veg? You feel heartburn and nausea when you are stressed? You cough frequently without cold or respiratory infection?Your asthma is worsened? No doubt,need not google,you have GERD.The symptoms may occur twice or thrice a week,sometimes more frequent,may last for weeks and subside self and reappear soon.A Physician is to be consulted who may refer you to a Gastroenterologist. As do many other diseases,GERD too is kept away by proper lifestyle and foodstyle. Obesity is the result of unhealthy food ,overeating and sedentary life.GERD is very common in the obese.So proper weight maintenance important. Avoid eating to the full stomach.Small frequent feeds are ideal to avoid the nasty backflow.Do not relax while in full stomach.Have supper at least 2hours before you go to bed.Avoid spicy and fried food to some extent at least in the day to day life.Avoid them in a big way if you already have indigestion due to GERD.Try to keep food timings as far as possible. Coffee,chocolates,pepper,citrus fruits like orange and lime; alcohol and tobacco add to the reflux and better keep them away. Medications with painkillers,aspirin etc worsens GERD. Tense hard work neglecting food adds fuel to fire.Mental calmness at home,workplace and outside keeps away the gas trouble in a big way.Proper sleep is essential.Calm and clear mind only can provide good sleep. Head end of the bed kept raised by 6 inches with a suitable block gives good relief of symptoms.Upright position always gives a lighter feeling. GERD is very common in pregnancy.Pregnant women are advised easily digestible food which is taken frequently in smaller quantities than usual. Even in infants and children who often refuse food,let out burps and hiccups,vomit or cough or cry incessantly,and are irritated while feeding , GERD is diagnosed. Antacid liquids and tablets like Gelusil and Digene neutralise the acid that backflows to the foodpipe.Some antacids contain a foaming agent that forms a foamy layer along the inside of the foodpipe.Some have a local anaesthetic to reduce pain.There are other medicines like Ranitidine and Cimetidine which reduce the production of stomach acid .Pantoprazole,Omeprazole,Lansoprezole etc are medicines that block the acid production and allow healing of the foodpipe.Domperidone helps to subside vomiting sensation. If symptoms do not subside with life style and food style changes and the usual medicines,doctors do tests. The main test is endoscopy.A thin flexible tube fitted with light and camera is passed through the foodpipe to see the inside of it and the upper part of stomach.Biopsy can be taken from a suspected part if needed. There are tests by which the doctor can visualise the upper part of intestines also. There are tests to detect the acid level in the foodpipe and upper part of stomach. Test to measure the strength of muscles especially the LES ,is available. Another test measures the movement of substances in the foodpipe. If medicines fail to heal the ulcers,very rarely the doctor thinks of surgery. Fundoplication is a form of surgery where the upper part of stomach is stitched like a cuff to the lower end of the foodpipe to strengthen the LES. Electrodes are used via endoscopy to promote scarring on the LES and strengthen it. Too much of acid inside the foodpipe can damage its lining causing infections and ulcers.Ulcers can cause bleeding.Ulcers heal by scarring and narrowing (stricture) of the foodpipe can happen.Some ulcers can be precancerous.

GERD can aggravate asthma , tooth infection and gum disorders.
Anyway apart from the” trouble “ one suffers,GERD is never life-threatening.