Gastroesophageal Reflux Disease (GERD)

What is GERD ?

GERD (gastroesophageal reflux disease, or chronic acid reflux) is a condition in which acid-containing contents in your stomach persistently leak back up into your esophagus, the tube from your throat to your stomach. Acid reflux happens to nearly everyone at some point in life. Having acid reflux and heartburn now and then is totally normal. But, if you have acid reflux/heartburn more than twice a week over a period of several weeks, constantly take heartburn medications and antacids yet your symptoms keep returning, you may have developed GERD. Your GERD should be treated by your healthcare provider. Not just to relieve your symptoms, but because GERD can lead to more serious problems.

Why does Acid Reflux occur ?

Acid reflux happens because a valve at the end of your esophagus, the lower esophageal sphincter, doesn’t close properly when food arrives at your stomach. Acid backwash then flows back up through your esophagus into your throat and mouth, giving you a sour taste.

What are the causes of Acid Reflux?

  1. Bulging of the top of the stomach up into the diaphragm (hiatal hernia)
  2. Pregnancy
  3. Smoking
  4. Obesity
  5. Eating large meals or eating late at night
  6. Eating certain foods (triggers) such as fatty or fried foods
  7. Drinking certain beverages, such as alcohol or coffee
  8. Taking certain medications, such as aspirin

What are the symptoms of Acid Reflux?

  1. A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
  2. Chest pain
  3. Difficulty swallowing
  4. Regurgitation of food or sour liquid
  5. Sensation of a lump in your throat
  6. Chronic cough
  7. Laryngitis
  8. New or worsening asthma
  9. Disrupted sleep

What are the lifestyle modifications to prevent Acid Reflux?

  1. Avoiding foods that trigger a reflux
  2. Elevation of the head end of the cot
  3. Not lying down immediately after meals
  4. Avoiding smoking and alcohol

How is Acid Reflux treated?

Acid Reflux is treated with medications which decrease acid secretion and improve the movement of the stomach.

Is there surgery to treat GERD (chronic acid reflux)?

Laparoscopic antireflux surgery (or Nissen fundoplication) is the standard surgical treatment. It’s a minimally invasive procedure that fixes your acid reflux by creating a new valve mechanism at the bottom of your esophagus. The surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus. This reinforces the lower esophageal sphincter so food won’t reflux back into the esophagus

Achalasia Cardia

What is Achalasia Cardia ?

What is Achalasia Cardia ? Achalasia is a rare disorder in which your esophagus is unable to move food and liquids down into your stomach. Your esophagus is the muscular tube that transports food from your mouth to your stomach. At the area where your esophagus meets your stomach is a ring of muscle called the lower esophageal sphincter (LES). This muscle relaxes (opens) to allow food to enter your stomach and contracts (tightens to close) to prevent stomach content from backing up into your esophagus. If you have achalasia, the LES doesn’t relax, which prevents food from moving into your stomach.

What causes Achalasia Cardia?

Why your esophageal muscles fail to contract and relax normally is unknown. One theory is that achalasia is an autoimmune disease (your body attacks itself) that is triggered by a virus. Your immune system attacks the nerve cells in the muscle layers of the walls of your esophagus and at the LES. Your nerve cells, which control muscle function, slowly degenerate for reasons that are not currently understood. This results in excessive contractions in the LES. If you have achalasia, the LES fails to relax and food and liquids can’t pass through your esophagus into your stomach.

What are the symptoms of Achalasia?

Achalasia symptoms generally appear gradually and worsen over time. Signs and symptoms may include:

  1. Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat
  2. Regurgitating food or saliva
  3. Heartburn
  4. Belching
  5. Chest pain that comes and goes
  6. Coughing at night
  7. Pneumonia (from aspiration of food into the lungs)
  8. Weight loss
  9. Vomiting

What is the treatment for Achalasia?

The goal of treatment is to relieve your symptoms by relaxing your lower esophageal sphincter (LES). Several treatments are available for achalasia including balloon dilation, medications, and botulinum toxin injection. The gold standard treatment for Achalasia is the Surgical procedure, Heller’s Myotomy

What is Heller’s Myotomy?

Heller’s Myotomy is the surgery used to treat Achalasia. The surgeon cuts the muscle at the lower end of the esophageal sphincter to allow food to pass more easily into the stomach. The procedure can be done non-invasively (Laparoscopic Heller Myotomy). Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD).

To avoid future problems with GERD, a procedure known as fundoplication might be performed at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of your stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back (GERD) into the esophagus. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure.

Ulcer Disease (Peptic Ulcers)

What is Ulcer Disease?

Ulcer disease is a condition in which painful sores or ulcers develop in the lining of the stomach or the first part of the small intestine (the duodenum). Normally, a thick layer of mucus protects the stomach lining from the effect of its digestive juices. But many things can reduce this protective layer, allowing stomach acid to damage the tissue.

What causes Ulcer disease?

There are two main causes of ulcers:

  1. Helicobacter pylori (H. pylori) bacteria
  2. Pain-relieving medications

H. pylori bacteria

H. pylori commonly infects the stomach. About 50% of the world’s population has an H. pylori infection, often without any symptoms. The H. pylori bacteria stick to the layer of mucus in the digestive tract and cause inflammation (irritation), which can cause this protective lining to break down. This breakdown is a problem because your stomach contains strong acid intended to digest food. Without the mucus layer to protect it, the acid can eat into stomach tissue.

Pain relieving medications

Another major cause of peptic ulcer disease is the use of NSAIDs, a group of medications used to relieve pain. NSAIDS can wear away at the mucus layer in the digestive tract. These medications have the potential to cause peptic ulcers to form

Other medications

Taking certain other medications along with NSAIDs, such as steroids, anticoagulants, low-dose aspirin, selective serotonin reuptake inhibitors (SSRIs), alendronate and risedronate can greatly increase the chance of developing ulcers

Rare causes

Infrequently, other situations cause peptic ulcer disease. People may develop ulcers after:

  1. Being seriously ill from various infections or diseases.
  2. Having surgery.
  3. Taking other medications, such as steroids.

Peptic ulcer disease can also occur if you have a rare condition called Zollinger-Ellison syndrome.This condition forms a tumor of acid-producing cells in the digestive tract. These tumors can be cancerous or noncancerous. The cells produce excessive amounts of acid that damages stomach tissue.

What are the risk factors for Ulcer disease?

  1. Frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs), a group of common pain relievers
  2. Regularly drinking alcohol.
  3. Smoking.

What are the symptoms of Ulcer disease?

Some people with ulcers don’t experience any symptoms. But signs of an ulcer can include:

  1. Gnawing or burning pain in your middle or upper stomach between meals or at night.
  2. Pain that temporarily disappears if you eat something or take an antacid.
  3. Bloating.
  4. Heartburn.
  5. Nausea or vomiting

In severe cases, symptoms can include:

  1. Dark or black stool (due to bleeding).
  2. Vomiting.
  3. Weight loss.
  4. Severe pain in your mid- to upper abdomen.

How are ulcers diagnosed?

  1. Endoscopy : A thin, lighted tube is inserted through your mouth and into the stomach and the first part of the small intestine. This test is used to look for ulcers, bleeding, and any tissue that looks abnormal.
  2. Endoscopic biopsy: A piece of stomach tissue is removed so it can be tested for the presence of H.pylori

What is the treatment for ulcer disease?

Once a peptic ulcer is diagnosed majority of the patients respond very well to medications. In patients who have been diagnosed to have H.Pylori infection, a course of antibiotics is useful to prevent recurrence of ulcers.In a small group of patients who have complicated ulcers there may be a need for surgery to decrease the acid secretion

What are the complications of Ulcer disease?

  1. Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit or black or bloody stools.
  2. A hole (perforation) in your stomach wall. Peptic ulcers can eat a hole through (perforate) the wall of your stomach or small intestine, putting you at risk of serious infection of your abdominal cavity (peritonitis).
  3. Obstruction. Peptic ulcers can block passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight either through swelling from inflammation or through scarring.
  4. Gastric cancer. Studies have shown that people infected with H. pylori have an increased risk of gastric cancer.

What is the role of surgery in the treatment of Ulcer disease?

In very rare cases, complicated ulcer disease will require surgery. This may be the case for ulcers that:

  1. continue to return
  2. don’t heal
  3. bleed
  4. tear through the stomach
  5. keep food from flowing out of the stomach into the small intestine Surgery may include:
  6. removal of the entire ulcer
  7. taking tissue from another part of the intestines and patching it over the ulcer site
  8. tying off a bleeding artery
  9. cutting off the nerve supply to the stomach to reduce the production of stomach acid

How can ulcer disease be prevented?

  1. Protect yourself from infections. It's not clear just how H. pylori spreads, but there's some evidence that it could be transmitted from person to person or through food and water.You can take steps to protect yourself from infections, such as H. pylori, by frequently washing your hands with soap and water and by eating foods that have been cooked completely.
  2. Use caution with pain relievers. If you regularly use pain relievers that increase your risk of peptic ulcer, take steps to reduce your risk of stomach problems. For instance, take your medication with meals.If you need an NSAID, you may need to also take additional medications such as an antacid, a proton pump inhibitor, an acid blocker or cytoprotective agent.
  3. Stop smoking and Alcohol consumption