Cradle To The Grave, Acid Reflux Affects Nearly Everyone

Some form of gastrointestinal (GI) problem strikes everyone at least once in their life. However, some people experience Gastro Esophageal Reflux Disease GERD), one of the most common GI problems, on a regular basis. An estimated 33 to 35 percent of the population suffers from this condition due to having an abnormal esophagus. Since the number of people suffering from this
potentially serious condition is extremely high, GERD is the most expensive GI problem in the country, costing 10 billion dollars each year.

While many people might recognize the term GERD, just as many may not understand what it is, according to the National Institute of Diabetes and Digestive and Kidney Diseases, GERD is a very serious form of gastro esophageal reflux, also called acid reflux. Very common among Americans of all ages, it occurs when the lower esophageal sphincter (LES), does not close properly or opens spontaneously. The LES is a ring of muscle that acts like a valve between the lower esophagus and the stomach.

When this happens, it allows stomach contents and digestive juices, called acids to flow back up the esophagus, thus creating a burning feeling and sour taste in the mouth.

However, just because someone has acid reflux does not automatically mean it is GERD, an occasional reflux does not quantify as GERD, which is a persistent condition, characterized by occurrences of acid reflux at least three times a week for more than two weeks. People who experience this type of reflux should see their doctor for available treatment options, and if left untreated, GERD can lead to other potentially deadly conditions.

The Symptoms and Causes of GERD
The most common symptom of GERD in adults is heartburn, which is a burning pain that occurs in the lower chest area at the bottom of the sternum. Other symptoms include a sour taste in the mouth, dry cough, raspy voice, wheezing, trouble swallowing, and some of these symptoms are more common in children under the age of 12.

To date, the research has not identified any single reason for the cause of it; however, some research suggests that in people with GERD, the LES relaxes while the esophagus works normally. Other abnormalities such as hernias, obesity, and pregnancy, are considered causes of GERD. A hiatal hernia occurs when the LES and upper part of the stomach get wedged above the diaphragm, since it is often quite painful, the symptoms are similar to a heart attack.

GERD In Children
GERD occurs in all ages, even newborn infants. In fact, researchers now know that what doctors called “colic” for generations, is actually GERD. According to Dr. William Sears, a world-renowned pediatrician, colic was a doctor’s way of saying, “We don’t know what is wrong with your baby.” Dr. Sears refuses to use the term “colic,” and instead uses the phrase “the hurting baby,” since it is a much more accurate description.

As a particularly distressing disease in babies and children, for a number of reasons, including the fact that during their first year of life, children grow tremendously and require extra nutrition to grow properly. However, babies with GERD often cannot keep enough of their food down to grow well, which leads to a failure to thrive. This not only creates a physical problem, but also possible long-term psychological problems for the child, in regards to food. When a child learns that feeding is painful, and it is likely to come back up anyway, they will learn to avoid food altogether to avoid the pain, making meal times difficult at best, and impossible at the worst.

The symptoms of GERD in babies, differ from those of children and adults because babies cannot communicate that their tummy hurts, so parents find it is much harder to discern the symptoms their children may exhibit. As children get older, they may say their “tummy hurts,” which is frustrating for parents because it does not really provide enough clues as to what is causing the hurt.

The most obvious sign that something is wrong is the crying, and even though all babies cry, the baby with GERD will exude a high-pitched wail of pain, which seemingly comes out of nowhere, and correlates with feeding times. Some babies with GERD may not even make it through a feeding, particularly if they are breast fed, because the pain starts as soon as they start feeding. The shrieking may go on for hours, thus compounding the problem because as the baby continues to cry they suck additional air into their tummy that makes the pain worse.

Babies with GERD may spit up or vomit frequently and forcefully. This is where the long-term problems really start because the acid that comes up with their food is what causes the burning, and teaches the child to avoid eating.

Other symptoms include a hard, distended belly, drawing the knees up, and arching the back, excessively gassy, poor sleeping patterns, frequent upper respiratory infections, slow growth, weight loss, and asthma symptoms.

Tests For GERD
Most testing is to determine the severity of the condition, not necessarily a diagnosis of it, but these tests are the same for everyone, infant to senior, which normally includes an endoscopy where a flexible scope passes through the mouth and down the esophagus into the stomach. The test, normally done under sedation, and fairly quick, visually examines the tissues to ensure there is not another problem occurring, and takes tissue samples to test for pre-cancerous or cancerous cells.

Often with the patient sedated for the endoscopy, the doctor will also perform a pH test, which involves inserting a nasogastric probe through the nose, and down the esophagus to about two inches above the LES. This probe has an acid sensing instrument on the end that monitors both how often, how long a patient refluxes. This test lasts between 24 to 48 hours, with patients recording information such as when they eat and when they sleep. This is one of the tests performed on infants and children, but due them wanting to pull the probe out, it is more difficult. During the test, doctors often recommend covering the child’s hands with scratch mittens or socks to keep them from pulling on it.

Doctors may suggest other tests such as x-rays, and barium swallow tests, depending on what they feel is most effective.

Treatment For GERD
The treatment is often very simple, and the same for everyone, although some may not apply to infants and small children.

Typically, lifestyle changes and medication will help to treat GERD, things like quitting smoking, weight loss if obese, and most commonly, dietary changes will help to relieve the symptoms. Certain types of foods aggravate GERD, such as spicy food, acidic foods (tomatoes and citrus fruits), chocolate, alcohol, fatty or greasy foods, onions, mint, and caffeine.

Medications come in a variety of forms, with the most common including over-the-counter antacids, which typically use three different salts; magnesium, calcium and aluminum, and mixed with hydroxide or bicarbonate ions, all working together to reduce acid in the stomach.

Other medications include foaming agents that cover the stomach contents with foam to prevent reflux from occurring, or the H2 blocker that comes in both over-the-counter formulas, and by prescription to decrease acid production in the stomach. Also available is the Proton Pump Inhibitors, most of these medications require a prescription, but a couple are available over-the-counter. These medications offer the added benefit of healing any erosion damage to the esophagus caused by long-term reflux. Prokinetics help strengthen the LES and cause the stomach to empty faster, but the side effects usually limit their usefulness for most patients.

A number of homeopathic remedies, such as gripe water, which is a mixture of several herbs and sodium bicarbonate, are remarkably effective in infants and small children. Many health food stores carry it.

Complications
If left untreated, the long-term complications from GERD can be serious. These include things like bleeding and ulcers, strictures in the esophagus that cause difficulty swallowing, and esophageal cancer, which is quite often fatal, it may also be a contributor health problems like asthma and pulmonary fibrosis. Though annoying and painful, patients who work with their doctor on a plan to treat GERD often find relief and even heal the damage.

Sources:
http://www.nlm.nih.gov/medlineplus/gerd.html
http://my.clevelandclinic.org/services/esophageal_ph_test/hic_24-hour_es...
http://www.nlm.nih.gov/medlineplus/ency/article/001134.htm
http://www.livestrong.com/article/85469-statistics-acid-reflux-disease/
http://www.askdrsears.com/HTML/5/T051300.asp