<h1 id="pe_category">REFLUX<h3>Reflux is an irritation of the swallowing tube, called the esophagus by acid that comes up from the stomach which causes troublesome symptoms and/or complications. It happens because the junction between the gullet and the stomach does not function normally, resulting in reflux.</h3>What Causes Reflux?
During swallowing, food passes down the throat and through the swallowing tube into the stomach. Normally, a muscle valve at the end of the swallowing tube (lower esophageal sphincter)
opens to allow food into the stomach; then it closes again.
When this muscle
opens too often or does not close tight enough, stomach acid can reflux, or wash back into the swallowing tube, causing damage to its lining.VIEW IMAGEWhat Are the Symptoms?
Some people have heartburn pain when reflux happens. Some people feel nothing. Other symptoms include burping, belching, bitter taste in your mouth, coughing at night, dry throat, sore throat, hoarseness in the morning, or worsening asthma.What Are the Complications of Reflux?
Long standing reflux can cause:VIEW IMAGEEsophagitis
is an inflammation of the esophagus; it may be associated with ulcers of the esophagus.Stricture
is the narrowing of the swallowing tube as a result of long standing inflammation.Barrett’s Esophagus
may occur in long standing inflammation which may lead to changes of the cells of the lower esophagus. Patients with Barrett’s esophagus have higher risk of esophageal cancer compared to general population.How Is Reflux Detected?
In the simplest case, when symptoms are typical and the patient responds to medication, no diagnostic tests are requisite.
If the symptoms do not improve with medication, further investigation is mandatory. Diagnostic Tests Include:
1. Gastroscopy (please refer to section on “Procedures Provided: Gastroscopy”) – allows the detection of inflammation at the lower esophagus and biopsy which will provide further testing for cell changes to rule out Barrett’s esophagus
2. 24-hour pH monitoring – to test the acidity of the swallowing tube (esophagus)
3. Manometry – to test the motility (contraction) of the swallowing tube and the pressure at the muscle valve (lower esophageal pressure)Treatment of Reflux
The first treatments usually recommend for reflux are lifestyle and dietary changes. The purpose of these changes is to reduce the amount of reflux or reduce the potential for damage to the esophageal lining from refluxed substances. Inappropriate diet and certain habits can cause or worsen reflux by relaxing the lower esophageal sphincter and allowing it to
open, increasing the amount of acid in the stomach, increasing stomach pressure, or by making the esophagus more sensitive to acids. Dietary Habits That Improve Reflux
• These foods can relax the lower esophageal sphincter (muscle valve at the end of the swallowing tube), allowing stomach contents to reflux into the esophagus<blockquote>
• chocolate, sweet deserts, high-fat or spicy foods, curry, citrus fruits, garlic, onion and tomatoes or tomato-based products </blockquote><blockquote>
• certain beverages, including citrus juices, alcohol, coffee, black tea </blockquote>
• Eating regular meals and small portions at each time
• Avoid eating or drinking for 2-3 hours before going to bed Lifestyle Habits That Improve GERD
• Lose weight (if you are overweight)
• Stop smoking
• Avoid wearing tight-fitting clothing or belts
• Avoid lying down or prolonged bending over, especially after eating
• Avoid straining and constipation
• Elevate the head of your bed 6 to 8 inches
• Avoid Stress What Medications Are Used to Treat reflux?
• Medication targeting acid secretion: proton pump inhibitors, H2 blockers
• Medication neutralizing gastric acid: antacids
• Medication improving peristalsis and stomach emptying: prokineticsIs There Any Role for Surgery?
Most patients with reflux do not need surgery.
GASTRITIS / DYSPEPSIA<h3>‘Gastritis’ is a term often used by general public to describe indigestion and refers to symptoms of chronic or recurrent pain or discomfort centered in the upper part of the abdomen. The medical term for these symptoms is dyspepsia. The medical definition of gastritis however refers more specifically to inflammation of the lining of the stomach.</h3>What are the common symptoms?
Most people do not suffer of pain in the upper abdomen all the time and the pain tends to come and go. For some, the pain often occurs when they are hungry and seems to be relieved by food, although for others the pain or discomfort tends to occur after eating.
In some people the stomach may feel full soon after starting to eat, so that it is difficult to finish a meal, or there may be an uncomfortable sense of fullness or bloating after a meal. The word ‘indigestion’ may also be used to describe nausea, retching or even vomiting after food.
However it is important to realize that these symptoms may not always be due to the gastritis, and very often no obvious cause can be found. What are the possible causes of dyspepsia?
Most indigestion symptoms are harmless but may affect your quality of life. Very often tests are not needed. When tests are performed and no specific cause is found you may suffer of ‘non-ulcer dyspepsia’ or ‘functional dyspepsia’. Some of the causes in these cases include irregular meal times and certain types of food.
10% of cases, indigestion may be caused by an ulcer. An ulcer is a break in the lining of the stomach or duodenum (the first part of the small intestine).VIEW IMAGE
Some of the causes of ulcers or gastritis are as a result of smoking, over-indulgence in alcohol, the use of aspirin or painkillers containing aspirin like drugs, or due to a specific type of bacterial infection known as Helicobacter Pylori.VIEW IMAGE
Other causes of indigestion besides gastritis or ulcers may include disorders of the intestine, gallbladder or pancreas. What can I do to avoid dyspepsia?
Although dyspepsia or indigestion is still incompletely understood, these are a few simple measures which should help.
• Avoid skipping meals
• Eat meals at regular times and do not rush meals
• Avoid those foods you associate with your symptoms
• Learn to manage stress in your lifeWhen should I seek help?
Many people who suffer occasional indigestion can obtain relief from simple antacid tablets which are available from the pharmacy. You should consult your doctor if:
• your indigestion symptoms persist for more than two weeks, especially if this is a new symptom, do not respond to antacids, interfere with work, leisure and/or sleep
• over 40 years old
• have a family history of gastric problems
• drink or smoke heavily
• take aspirin or pain killers containing non-steroidal anti-inflammatory medication regularly You should consult your doctor urgently if you experience:
• prolonged or severe pain
• red or altered blood (like coffee grounds) in vomit
• black ‘tarry’ stools
• loss of appetite or weight loss
• recurrent vomiting
• difficulty in swallowing
• low hemoglobin (low blood count/anemia)
• yellowing of the skin (jaundice)What investigations may be necessary?
Many people with mild symptoms do not require investigation, but as persistent indigestion may suggest a more serious underlying complaint, the doctor may arrange any of these tests:
- which involves swallowing a slim flexible tube with a light and a camera at the end (gastroscope) that enables the doctor to look into the stomach, check for gastritis, ulcers or any other findings and test for bacteria Helicobacter pylori
• barium meal
- which involves swallowing a liquid which enables the outline of the stomach to show up on X-ray
• ultrasound scan
- a technique using reflected sound-waves to show the structure of abdominal organs, may detect stones in gallbladder and kidneys.
• blood test
to detect anemia or other abnormalityWhat treatment is available?
The appropriate treatment will be discussed after the doctor examine you and complete the necessary tests.
If the results of the test are normal, general advice, an explanation of the symptoms and reassurance will be offered. Advice will be given if there are factors in your lifestyle which may be contributing to the difficulties.
Medicine may be prescribed, ranging from antacids to more powerful medication which reduces gastric acid secretion, or a course of antibiotics to treat bacteria if it was found in your stomach.
However, it is important to understand that in some people, especially those where no obvious cause is found (functional dyspepsia), symptoms may recur intermittently over the course of time and they may require medication during these episodes of exacerabation.www.andrea-digestive-clinic.com/index.php/services/endoscopy/
Post Edited By Moderator (opnwhl4) : 6/20/2012 4:19:11 PM (GMT-6)