Treatment of Acid Reflux

Acid reflux, also known as gastroesophageal reflux (GER), is when your stomach contents back up into your esophagus (food pipe that connects the esophagus to the stomach). If acid reflux symptoms occur more than twice a week, you may have developed acid reflux disease, known as gastroesophageal reflux disease (GERD).

Our current Western dietary and lifestyle habits have made acid reflux pretty common. Around 50% of all adults report reflux symptoms at some time. The good news is that acid reflux can be controlled by a few lifestyle and dietary modifications as well as acid-suppressing medications. 

What causes Acid Reflux?

At the point where your esophagus joins the stomach is a valve-like ring of muscle called the lower esophageal sphincter (LES). The LES is a powerful acid-reflux barrier that shuts off as soon as food travels through it. If the LES doesn't close completely or if it opens too often, the food will start flowing back up into your esophagus.

Various factors increase your likelihood of developing acid reflux. 

• Hiatal hernia: A condition in which your stomach (upper part) and LES are pushed up into the chest region through a hole in the diaphragm — a dome-shaped muscle that separates your chest from your tummy.

• Eating fatty, fried, and spicy foods, or drinking alcohol, citrus juices, coffee, and tea. These foods hinder the LES from shutting off all the way, causing leakage of acid.

• Obesity: Puts more pressure on your tummy, aggravating the acid reflux.

• Lack of physical activity 

• Smoking (active or passive)

• Eating large meals or lying down right away after meals

• Medications like painkillers, asthma medications, and antidepressants

What are the Symptoms of Acid Reflux?

• Heartburn: a burning pain or discomfort in your chest (according to the American College of Gastroenterology, over 60 million Americans have heartburn at least once every month, and at least 15 million experience it daily).

• Regurgitation and water brash: a sour-tasting acid backing up into your throat and mouth and mixing with the excess saliva

• Nausea

• Burping

• Bloating

• Stomach pain

• Chronic cough and sore throat: due to the acid continually irritating your throat and respiratory tract

How do you Treat Acid Reflux?

Treatment of acid reflux is a combination of lifestyle, dietary, and medical therapies. 

Lifestyle Tips to Control Acid Reflux

Remember, when it comes to acid reflux, prevention is worth a pound of cure. Avoiding the triggers is the key strategy to fixing your acid reflux. 

• Avoid foods and drinks that prevent the LES from closing off all the way.

• Take 6 small meals spread throughout your day rather than 3 large meals.

• Avoid lying down two to three hours after meals to allow some time for your stomach to be emptied by the time you’re ready to hit the sack.

• Exercise and maintain a healthy body weight.

• Quit smoking.

• Elevating the head-end of your bed by at least 6–8 inches using an acid reflux wedge sleeping pillow. If this doesn’t help, you may also raise your entire bed frame by placing wooden blocks or bed risers between your mattress and its box spring. These strategies allow gravity to clear the acid reflux.

Medical therapy 

1. PPIs (Proton pump inhibitors): are the most effective therapy for both acid reflux or GERD. They work best if taken 30 to 60 minutes before meals. They reduce the amount of acid produced from the cells lining the stomach. Common drugs in this category include: 

   1. Esomeprazole (Nexium)

   2. Omeprazole (Prilosec)

   3. Pantoprazole (Protonix) 

   4. Rabeprazole (AcipHex)

2. H2 (histamine) blockers: These medicines target a chemical called histamine to prevent the release of too much acid. These include:

   1. Cimetidine (Tagamet)

   2. Ranitidine (Zantac)

   3. Famotidine (Pepcid)
      

3. Antacids, available as over-the-counter aids

4. Alginate drugs like Gaviscon

Role of Surgery in Acid Reflux Disease

In patients with hiatal hernia when medical and lifestyle strategies fail, a minimally-invasive surgery called Nissen fundoplication can be performed. It is effective in 80% to 90% of patients. This technique involves wrapping the upper part of your stomach around the LES to strengthen the sphincter, repair a hiatal hernia, and thereby prevent acid reflux.

Ulcerative Colitis

Ulcerative colitis, or UC, is a type of chronic inflammatory bowel disease (IBD) that causes widespread inflammation and sores (ulcers) in the lining of your colon (large intestine). It typically begins in your rectum and spreads upward along a variable length of your colon. About one in 1000 people in the Western world have colitis. In the United States, the disease is responsible for over a quarter million physician visits every year.

Although UC can affect people of any age, it tends to follow a bimodal pattern, with one peak at 15 and 30 years, and a second, smaller one, at 50 and 65 years.

WHAT CAUSES ULCERATIVE COLITIS?

We don’t know the exact cause. However, an overactive and faulty immune system bear much of the blame, especially if you’re already genetically susceptible. This means you have an altered gene from your parent that will boost your risk of developing UC when your body mistakes food and normal gut bacteria as harmful invaders and launches an immune attack on your own intestinal tissues.

Genes play quite an important role in UC, which is why roughly 10% to 20% of patients with UC are found to have at least one family member with IBD.

WHAT ARE THE SIGNS AND SYMPTOMS OF UC?

Patients with UC typically experience periods of active disease (aka flare-ups) and periods of remission (when there are fewer or no symptoms). Several factors can cause the disease to flare up. But the commonly used pain-relieving, anti-inflammatory pills called non-steroidal anti-inflammatory drugs and more interestingly quitting smoking typically exacerbate UC.

The most common signs and symptoms of ulcerative colitis include:

• Diarrhea, often with blood or pus

• Abdominal cramps

• Straining at stools due to a feeling of incomplete bowel emptying

• A constant, irresistible need to have a bowel movement

• Fatigue

• Weight loss

• Fever

• Loss of appetite

HOW IS UC DIAGNOSED?

When patients show up with signs and symptoms suggestive of ulcerative colitis, I generally run a battery of tests to confirm or rule out the diagnosis.

The most useful of these tests often include: 

• Stool test: A sample of your stool is examined for blood, bacteria, and parasites.

• Colonoscopy: This test involves passing a long tube into your rectum to analyze the interior of your colon.

• Biopsy: A tissue sample is taken from your colon for evaluation during colonoscopy.

• CT scan: If need be, your entire abdomen will be scanned for abnormalities to get a clearer picture.

HOW DO YOU TREAT ULCERATIVE COLITIS?

UC can lead to complications as serious as colon cancer, so seeking help on time is crucial.

The treatment of UC varies from one patient to another depending on the:

• disease stage (active, remission)

• extent (left-sided colon, right-sided colon, entire colon)

• severity (mild, moderate, severe)

Hence, the treatment is tailored to an individual patient’s needs in a highly patient-centered way. Medications are the mainstay of treatment for controlling the inflammation in UC. The goal of treatment is to get the inflammation under control, mitigate your symptoms, and induce remission. Medications from the following categories are generally used for this condition:

• Aminosalicylates, which limit inflammation in mild to moderate UC.

• Corticosteroids are used to induce remission during the flare-ups and tame inflammation quickly. That said, we do not prescribe these medications for long term use, as they work by suppressing your immune system and can thus cause serious side effects.   

• Immunosuppressants are safer for long term use, as they work to calm the overactive immune system but take time to work.

• Janus kinase inhibitors block a particular molecular pathway in your body that promotes inflammation and thus curb a moderate-to-severe degree of colonic inflammation.

• Antibiotics are used to avert a life-threatening infection that may occur in patients with UC.

In addition to medicines, focusing on your diet and busting your stress may help bring your symptoms under control. Evidence shows that probiotics may also help attain remission.   

We recommend surgery when medical treatment fails or when a critical complication (like perforation of the colon) emerges. Surgical options include removing the entire colon (known as total colectomy) and bringing the lowest part of the small intestine to your belly by creating an opening (called ileostomy) in your belly skin.

If you experience any of the above signs and symptoms, contact my office at 310-360-6807 or click the button below to schedule an appointment.

Celiac Disease Symptoms

“Think you may have celiac disease? Here’s a good reference for symptoms.”

— Dr. Dale

From Celiac Disease Symptoms

Celiac disease can be difficult to diagnose because it affects people differently. There are more than 200 known celiac disease symptoms which may occur in the digestive system or other parts of the body. Some people develop celiac disease as a child, others as an adult. The reason for this is still unknown.

Some people with celiac disease have no symptoms at all, but still test positive on the celiac disease blood test.  A few others may have a negative blood test, but have a positive intestinal biopsy. However, all people with celiac disease are at risk for long-term complications, whether or not they display any symptoms.

Does Your Child Have Celiac Disease?

Digestive symptoms are more common in infants and children. Here are the most common symptoms found in children:

• abdominal bloating and pain

• chronic diarrhea

• vomiting

• constipation

• pale, foul-smelling, or fatty stool

• weight loss

• fatigue

• irritability and behavioral issues

• dental enamel defects of the permanent teeth

• delayed growth and puberty

• short stature

• failure to thrive

• Attention Deficit Hyperactivity Disorder (ADHD)

Do You Have Celiac Disease?

Adults are less likely to have digestive symptoms, with only one-third experiencing diarrhea.  Adults are more likely to have:

• unexplained iron-deficiency anemia

• fatigue

• bone or joint pain

• arthritis

• osteoporosis or osteopenia (bone loss)

• liver and biliary tract disorders (transaminitis, fatty liver, primary sclerosing cholangitis, etc.)

• depression or anxiety

• peripheral neuropathy ( tingling, numbness or pain in the hands and feet)

• seizures or migraines

• missed menstrual periods

• infertility or recurrent miscarriage

• canker sores inside the mouth

• dermatitis herpetiformis (itchy skin rash)
  

Classical, Non-Classical and Silent Celiac Disease

According to the World Gastroenterology Organization, celiac disease may be divided into two types: classical and non-classical.

In classical celiac disease, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea (pale, foul-smelling, fatty stools), and weight loss or growth failure in children.

In non-classical celiac disease, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or may have seemingly unrelated symptoms. They may suffer from abdominal distension and pain, and/or other symptoms such as: iron-deficiency anemia, chronic fatigue, chronic migraine, peripheral neuropathy (tingling, numbness or pain in hands or feet), unexplained chronic hypertransaminasemia (elevated liver enzymes), reduced bone mass and bone fractures, and vitamin deficiency (folic acid and B12), late menarche/early menopause and unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis (itchy skin rash), etc.

Silent celiac disease is also known as asymptomatic celiac disease. Patients do not complain of any symptoms, but still experience villous atrophy damage to their small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet they report better health and a reduction in acid relux, abdominal bloating and distention and flatulence. First-degree relatives (parents, siblings, children) , whether or not experiencing symptoms, should always be screened, since there is a 1 in 10 risk of developing celiac disease.

The number of ways celiac disease can affect patients, combined with a lack of training in medical schools and primary care residency programs, contributes to the poor diagnosis rate in the United States. Currently it is estimated that 80% of the celiac disease population remains undiagnosed.

Celiac Disease Symptoms Checklist

CDF offers a Symptoms Checklist to help you and your physician determine if you should be tested for celiac disease.

Complete the Symptoms Checklist

Who Should Be Screened for Celiac Disease?

According the the Celiac Disease Center at Columbia University Medical Center, “anyone who suffers from an unexplained, stubborn illness for several months, should consider celiac disease a possible cause and be properly screened for it.”

First-degree relatives (parent, child, sibling) should also be screened since they have a 1 in 10 risk of developing celiac disease compared to the general population risk of 1 in 100.

Non-Celiac Wheat Sensitivity

Some people experience symptoms found in celiac disease, such as “foggy mind”, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease. The terms non-celiac gluten sensitivity (NCGS) and non-celiac wheat sensitivity (NCWS) are generally used to refer to this condition, when removing gluten from the diet resolves symptoms.

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