No More Heart Burn - Part 2 GERD

No More Heartburn
Part 2 - Digestive Issues & Health

GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD)

There is no question that digestive ailments influence overall health.

A recent government report indicates hospitalizations due to chronic acid reflux increased sharply from 1998 to 2005. The report by the Agency for Healthcare Research and Quality found that hospitalizations for complications of gastroesophageal reflux disease, or GERD, increased 103 percent during that time frame. GERD happens when stomach acid backs up in the esophagus causing chronic heartburn.

Hospitalizations for GERD in children also increased - 42 percent for those under age 2 and 84 percent for children 2 to 17. [www.cleveland.com]

GERD is only one manifestation of a digestive dysfunction. The symptoms for GERD often manifest obscurely, leading some individuals to be treated for the wrong symptom. Some, in a long list of reflux symptoms, follow and may be slightly different in each individual.

Bloating and gas after meals, burning in the stomach or up farther in the esophagus (heartburn), persistent cough, hoarseness, feeling of a lump in the throat, feeling of extended fullness, nausea, belching, burping, gas, flatulence, rippling, gurgling sensations, pain in the chest or around the heart or even in the back between the shoulder blades, undigested food, persistent/chronic difficulty swallowing and even erosion of tooth enamel, diarrhea and constipation. Some or all can be part of the digestive process that is malfunctioning.

While some symptoms can be mild, it is important to determine the cause because when linked to GERD, the risk for esophageal erosions is high and with erosion, the concern is then for esophageal adenocarcinoma. The introductory referenced report indicates a 195% rise in this cancer in patients hospitalized with acid reflux. Barrett’s esophagus or esophagitis can be a precursor to this cancer. Lung damage can also occur from the reflux acid.

[www.aafp.org] (good photo of Barrett’s esophagus and other detail)
[www.medhelp.org] (diagram of location stomach and esophagus)

CAUSES OF HEARTBURN/GERD

As with symptoms, there are numerous suspects as the cause of GERD and some go unrecognized as a solution.

Obesity ranks high on the list of contributory causes and the relationship should be obvious. Adipose tissue in the abdomen crowds the stomach so that food isn’t able to settle down totally into the stomach area or pouch, but additionally, along with obesity comes overeating and both, individually or collectively, can cause the contents of the stomach to be pushed up into the area of the lower esophageal sphincter (LES)...the valve that keeps stomach contents from flowing upward or back into the esophagus again.

However, not everyone with GERD is obese. Many people do, however, overeat. Lying down after a meal often promotes reflux of stomach acid as does eating or drinking too late and going to bed. That night cap to relax before bedtime can have an adverse affect because alcohol relaxes the LES and allows acid from the stomach to flow back. GERD is prevalent in those harboring H. Pylori in the stomach. Candida overgrowth contributes to digestive ailments. Lack of stomach acid is well acknowledged to contribute to reflux along with those who have overproduction of acid from ulcers or rebound from long-term use of OTC antacids or Rx acid blockers.

From her book, No More Heartburn, Sherry Rogers, MD, offers this on Hiatus Hernia, GERD, Acid Heartburn, Reflux Esophagitis: pp131-132 (Quoting and paraphrasing)

“The symptoms of these conditions, all of which are similar, can range from nausea, chest pain, chest burning to a feeling of fullness or of undigested food. Because they can mimic a heart attack, always be cautious and rule out that first. Sometimes coughing or asthma at night will be the only symptom of reflux.

The diaphragm is a thick, flat muscle that separates the lungs from the gut. There is a small hole in the diaphragm that the esophagus slips through. Sometimes, being over-weight or with heavy lifting, the muscles around the hold can be torn. If enough damage occurs, the opening become sloppy and a corner of the stomach slides up into the lung area. If trapped there, it can cause such sever paints you would swear you were having a heart attack.

Another problem arises when the stomach partly slides up into the lung side of the diaphragm. To do this, the valve between the stomach and the esophagus has to tear loose from its connection. With the loss of the muscular attachment and control, the valve becomes loose or sloppy. Now the strong acid from the stomach and even some of the undigested food can slide up into the esophagus. Since the delicate lining of the esophagus was never meant to tolerate acid, it burns. Since the esophagus passes right in front of the heart, no wonder this is called ‘heartburn’.

If the valve is leaky, then elevating the bed to prevent backwash during sleep is recommended. Also avoid large meals which help to stretch the valve and do not eat for three hours before going to bed.

She also comments that in addition to GERG, Gastritis, heartburn, esophagitis, nonulcer dyspepsia (NUD) and acid indigestion are similar in their effects. With minor variations, they make your gut feel lousy. Symptoms can overlap with hiatus hernia or in gallbladder disease. These symptoms can include a dull ache, uncomfortable fullness, the feeling everything you’ve eaten is sitting there and ballooning. Or it can be an overt burning or pain or both with or without nausea and vomiting.

Food allergy or overload (glutinous overeating and eating processed foods) are the most common causes. "

[Remember as you read this, irritation/inflammation of the vagus nerve which enervates the heart, diaphragm and stomach can contribute to the onset of afib. Many afibbers have GERD- type related symptoms of heartburn etc. prior to the onset of afib.]

Let’s stop here. “Digest” this. The next segment is forthcoming.

Jackie

Jackie,

Thanks for the info.

Does She recommend DGL as a treatment for GERD? If yes how would the protective mechanism work?

Dennis

Dennis - the mechanism on how it works is described in this first post..

<[www.afibbers.org]. Rogers>

I'll be covering more as I go on with this. It's hard not to re-write the many books on the topic in a few posts but I'm trying to summarize the highlights.

The most important thing to do is determine if there is under or over-stomach acid production... and also if you have H.pylori which contributes to over secretion.

You can start by trying the DGL and digestive enzymes with each meal and snack. In a few weeks if that isn't working, then some people definitely are overproducing acid and will need to take another approach.

Jackie

Thanks Jackie.