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By
Kyle J. Norton Health article writer and researcher; Over 10.000
articles and research papers have been written and published on line,
including world wide health, ezine articles, article base, healthblogs,
selfgrowth, best before it's news, the karate GB daily, etc.,.
Named
TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by
Disilgold.com Named 50 of the best health Tweeters Canada - Huffington
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Nominated for shorty award over last 4 years
Some
articles have been used as references in medical research, such as
international journal Pharma and Bio science, ISSN 0975-6299.
Upper gastrointestinal (GI) diseases
The prevalence of upper gastrointestinal (GI) diseases
is increasing in subjects aged 65 years and over. Pathophysiological
changes in esophageal functions that occur with aging may, at least in
part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3. H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4. Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
Gastro-esophageal reflux disease (GERD)
Gastroesophageal
reflux disease (GERD), also known as gastro-oesophageal reflux disease
(GORD), gastric reflux disease, or acid reflux disease, is a chronic
condition of liquid stomach acid refluxing back up from the stomach
into the esophagus, causing heartburn. According to the study of
“Updated guidelines for the diagnosis and treatment of gastroesophageal
reflux disease.” by DeVault KR, Castell DO; American College of
Gastroenterology, GERD is defined as symptoms or mucosal damage
produced by the abnormal reflux of gastric contents into the esophagus.
I. The Symptoms
1. Heartburn
Heart
burn is one of common symptom of Gastroesophageal reflux disease
(GERD) in adult, as a result of acid reflux cause of burning sensation
or pain in the middle of the chest mostly after meal(3)(4)(5).
2. Regurgitation
In
gastroesophageal reflux disease (GERD), regurgitation is the expulsion
of a small amount of digested foods to the mouth from esophagus.
frequent or prolonged regurgitation can lead to acid-induced erosion of
the teeth, bad breath or damage to the esophagus(3)(5).
3. Trouble swallowing(dysphagia)
It
is caused by damage of the muscles and tissues that must flex for
swallowing, as a result of prolonged period of acid reflux that has left
untreated(6).
4. Pain when swallow
It may be caused by esophageal motility disorders, due to deglutitive contraction waves that die out in the upper esophagus(6a).
5. Asthma
Approximately, 59% of patients with GERD are experiences symptoms in asthma, according to the Baylor College of Medicine(7).
7. Other symptoms according to Texas A&M University(6) include
a, Stomach pain,
b. Stomach discomfort when eating,
c. Food and drink limits,
d. Nausea and vomiting,
e. Gas and bloating,
f. Constipation,
g. Blood, and
h. Diarrhea
II. The Causes
1. Slower in emptying of the stomach after eating
Most
uncommon causes of Gastroesophageal reflux disease (GERD) is due to
the distention of the stomach with food over prolonged period of time
that can lead to reflux(7). Approximately 20% of Gastroesophageal
reflux disease (GERD) are caused the reason above.
2. Cardia
Cardia
is the area between the part of the stomach and the esophagus, a
angle where the esophagus enters the stomach acted as a valve to
prevent foods and others to reflux back to the esophagus. If the
cardia is not functioning well(8), it can cause Gastroesophageal
reflux disease (GERD with burning sensation of the esophagus(9).
3. Esophageal contractile defection(11)
If
the esophageal contraction fails to performed its function of proper
swallowing food, it may not generate enough waves of contractions to
push the foods down to the stomach after swallowing and the acid back
into the stomach(6a)(10).
4. Hiatal hernia
Hiatal
hernia is a condition of a portion of the stomach protrudes upward into
the chest, through a tear or weakness in the diaphragm. Hiatal hernia of the esophagus and GERD
had been shown to induce hemorrhage(13). GERD patients consuming a
late-evening meal had significantly greater supine acid reflux
compared to when they consumed an early meal, especially in
overweight patients, and in patients with esophagitis or HH(12).
5. Obesity
Obesity
increase the risk of Gastroesophageal reflux disease (GERD). Weight
loss, through caloric restriction and behavioral modification, may
improve reflux inobese patient with GERD(14). Bariatric surgery and
Roux-en-Y gastric bypass (RYGB) has been consistently associated with
improvement in the symptoms of GERD(14).
6. Esophageal mucosa
Erosive changes in the esophageal mucosof of the lower esophagogastric junctionwere strongly associated with GERD(15).
7. Medication
The use of medication such as NSAIDs product can increase the risk of Gastroesophageal reflux disease (GERD)(16).
8. Chronic diseases
Chronic
diseases, including cough(17)(18)(19)pulmonary fibrosis(21), earache
and asthma(20) are also associated with the higher risk of develop
Gastroesophageal reflux disease (GERD).
9. Infection
Infection
caused by H. pylori can increase the risk of Gastroesophageal reflux
disease (GERD)(22) through the bacteria pylori suppression of
gastric acid secretion (Gastroenterology 1997 Jul;113(1):15-24).
10. Etc.
III. Complications In some severe cases as a result of frequent acid reflux.
1. Ulcers
Damage of the esophagus can lead to result of ulcers as a result of inflammation forming of scar(23).
2. Esophageal strictures
Prolonged
period and frequent acid reflux, if keft untreated can lead to
inflammation cause of narrowing of the esophagus(24)(25).
3. Barrett’s esophagus
Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE)(26). The highest yield for Barrett’s is in older (age 50 or more) Caucasian males with longstanding heartburn(27).
4. Esophageal adenocarcinoma
In
GICS 2009: EGF Genetic Variant Increases Risk for GERD-Associated
Esophageal Adenocarcinoma ” by Roxanne Nelson posted by Medscape Newa
Today, the author wrote that January 16, 2009 (San Francisco,
California)
5. Etc.
IV. Diagnosis and tests
If
you are experience some of the above symptoms, after recording your
family history and physical exam, the following test may be recommended
by your doctor.
1. Esophagogastroduodenoscopy (EGD)
Esophagogastroduodenoscopy
(EGD) also known as upper gastrointestinal endoscopy is a diagnosis
procedure allowed your doctor to check for any abnormality in the lining
of the esophagus, stomach, and upper duodenum after a flexible
endoscope inserted down the throat.
If any abnormality is found, your doctor order further examinations.
2. Barium swallow
Barium
swallow is a medical imaging procedure allowed your doctor to examine
the upper GI (gastrointestinal) tract, to exam the lining of the
esophagus and the stomach, after you have drunk a suspension of barium
sulfate.
3. Chest X-rays
A chest x-ray is
an x-ray of the chest that allows your doctor to examine the lining of
the esophagus, stomach, and upper duodenum.
4. Biopsy
A
biopsy is a test of removal sample of cells or tissues for examination
and determination of the grade and type of the tumors examined under a
microscope by a pathologist or chemically, if the location of the tumor
allows the test to be done without major risk to the patient.
4. Esophageal manometry
Esophageal
manometry is a test with the use of a pressure-sensitive tube-like
thin instrument passed through your mouth or nose and into your stomach
to allow your doctor to examine the motor function of the Upper
Esophageal Sphincter (UES), Esophageal body and Lower Esophageal
Sphincter (LES).
5. Etc.
V. The GERD Diet
According
to the GERD Diet (Gastroesophageal Reflux Disease) in McKinley Health
Center of The university of Illinois at Urbana-Champaign
Dietary
modifications are recommended to lessen the likelihood of reflux and to
avoid irritation of sensitive or inflamed esophageal tissue. Listed
below of several recommendations may help to manage GERD:
1. Decrease total fat intake – High fat meals and fried foods tend to decrease LES pressure and delay
2. Avoid large meals – Large meals increase the likelihood of increased gastric (stomach) pressure and reflux.
3. Decrease total caloric intake if weight loss is desired – Since obesity may promote reflux, weight loss
may
be suggested by your healthcare provider to control reflux. Reducing
both total fat and caloric intake will aid in weight loss.
4.
Avoid chocolate – Chocolate contains methylxanthine, which has been
shown to reduce LES pressure by causing relaxation of smooth muscle.
5.
Avoid coffee depending on individual tolerance – Coffee, with or
without caffeine, may promote gastroesophageal reflux. Coffee may be
consumed if it is well tolerated.
6. Avoid other known irritants –
Alcohol, mint, carbonated beverages, citrus juices, and tomato
products all may aggravate GERD. These products may be consumed
depending on individual tolerance.
B. Other modifications for treating GERD
7. Maintain upright posture during and after eating.
8. Stop smoking.
9. Avoid clothing that is tight in the abdominal area.
10. Avoid eating within 3 hours before bedtime.
11. Lose weight if you are overweight.
12. Sleep on your left side.
13. Chew non-mint gum which will increase saliva production and decrease acid in the esophagus.
14. Elevate the head of your bed 4-6 inches by placing bricks under the headboard. (Source)
VI. Treatments
A. Conventional medicine
A.1. Medication
1. Proton-pump inhibitors
Proton-pump
inhibitors including omeprazole, esomeprazole, pantoprazole, are used
to reduce the production of gastric acid in the stomach(28)(29).
2. H2 receptor blocker(30)
H2
receptor blockers include ranitidine, famotidine, cimetidine, etc.,
Over-the-counter medications are effective in treating symptomatic
gastro-oesophageal reflux disease, with 41% with histamine-2 receptor
antagonists, 60% with alginate/antacid combinations, and 11% with
antacids(31).
3. 5HT4 agonist
Mosapride 40 mg q.d.s. is effective in decreasing acid reflux in the oesophagus in patients with GERD(32).
4. GABA-B Receptor Agonists
Baclofen,
a GABA-B agonist, showed effectively in the treatment of patients with
GERD, through inhibition pf 34% to 60% of Transient Lower Esophageal
Sphincter Relaxation (TLESR) and improvement of basal lower esophageal
sphincter pressure(33).
5. Antacids
Antacids are oral medicine used to relieve symptom of heartburn of gastroesophageal reflux disease (GERB)(34)(35).
4. Pro motility Agents
Promotility
Agents are used to improve GERD symptoms for patients with slow
gastric emptying by stimulating the muscles of the gastrointestinal
tract to reduce acid reflux into the esophagus(36).
5. Etc.
A.2. Surgery: Fundoplication Surgery
The
aim of the surgery is to reduce heartburn caused by acid reflux, in
severe case of inflammation, such as hiatal hernia, damage of
esophagus, etc.. Fundoplication surgery(37)(38) is the procedure to
treat Gastroesophageal Reflux Disease (GERD) by strengthening the valve
between the esophagus and stomach as the upper curve of the stomach
wrapped and satured around the lower end of the esophagus to prevent
acid from backing up into the esophagus with a laparoscopic with a
small tunnel made from the stomach muscle to allow foods of the lower
part of the esophagus to pass through. The surgery is also by times for
the esophagus to heal.
Laparoscopic fundoplication is effective
in controlling symptoms in the majority of patients with Barrett's
esophagus(BE) to orevent the possibility of developing esophageal
adenocarcinoma(39)
B. Herbs
1. Deglycyrrhizinated licorice
Deglycyrrhizinated
licorice used by people with gastric and peptic ulcers for nearly a
hundred years. its three antiulcer agents FM 100, plaunotol, and
teprenon showed to increase the content of endogenous prostaglandins in
the gastric mucosa, through its endogenous secretin released and
antiulcer effect(40).
2. Aloe Vera
According
to the article of “Effect Of Orally Consumed Aloe Vera Juice On
Gastrointestinal Function In Normal Humans, excerpts By Jeffrey Bland,
Ph.D. (Linus Pauling Institute of Science & Medicine) involved ten
healthy subjects – five men (median age: 42; standard deviation: 14
years), and five women (median age: 32; standard deviation: 5 years) –
engaged Aloe vera juice oral supplementation in in a
semicontrolled study, promotes proper gastrointestinal function, such
as gastrointestinal motility, increasing stool specific gravity etc.
through its regulate gastrointestinal pH effect(41),
3. Mastic gum
Mastic
gum. a resin obtained from the mastic tree (Pistacia lentiscus), showed
to consist an ability to support the health of patients with ulcers,
GERD and acid reflux, according to the article of Strategies to Protect
Against Potential Bone-Destroying Effects”By Chris D. Meletis, ND,
4. Ginger
Ginger
has been used for thousands of years to enhance the function of
digestive system and treated stomach distress including nausea,
vomiting, diarrhea and in digestion, acid reflux, motion sickness,
dyspepsia, etc. due to its anti-inflammatory, antimicrobial and
analgesic properties.
The methanol extract of ginger rhizome
showed to inhibite the growth of all 19 strains of bacteria in vitro
with a minimum inhibitory concentration range of 6.25-50
micrograms/ml(42)
5. Peppermint
In
vitro, peppermint exhibited significant antimicrobial and antiviral
activities, strong antioxidant and antitumor actions, and some
antiallergenic potential. Animal model studies demonstrate a relaxation
effect on gastrointestinal (GI) tissue, analgesic and anesthetic
effects in the central and peripheral nervous system etc.,… Caution are
necessary for using peppermint oil therapy in patients with GI reflux,
hiatal hernia(43).
6. Etc.
C. Traditional Chinese medicine
a. Ban Xia Xie Xin Wan, also known as "Pinellia Drain Epigastrium Pills"
was recorded in classic texts around 210 C.E. used in TCM to treat
various gastrointestinal disorders such as gastritis, enteritis,
gastric ulcer, gastralgia exhibits its anti-ulcer action (probably
based on its ability to protect the gastric mucosa), through
improvement of gastric emptying and an anti-emetic action,
according to the study of the effects of hange-shashin-to on gastric function in comparison with sho-saiko-to" by , , , ,
b. Ingredients
b.1. Ban Xia (Pinellia Tuber)
Main use: Dries Dampness, Transforms Phlegm, Stops vomiting, Resolves masses, Disperses nodules....
b.2. Huang Qin (Skullcap Root)
Main use: Clears Heat, Dries Dampness, Expels toxins, Stops bleeding...
b.3. Dang Shen (Codonopsis Root)
Main use: Tonifies the Middle Burner, Strengthens Qi, Promotes generation of Body Fluids, Nourishes Blood....
b.4. Gan Cao ( Licorice Root)
Main use: Tonifies the Spleen, Benefits the Qi, Moistens the Lungs, Calms cough...
b.5. Huang Lian (Coptis Rhizome)
Main use: Clears Heat, Dries Dampness, Expels toxins...
b.6. Bai Shao
Main use: Nourishes Blood, Preserves the Yin, Nourishes the Liver, Calms pain....
b.7. Chen Pi
Main use: Regulates the Qi, Regulates the Middle, Dries Dampness, Transforms Phlegm...
References
(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157
(3) http://www.ncbi.nlm.nih.gov/pubmed/25232262
(4) http://www.ncbi.nlm.nih.gov/pubmed/25212408
(5) http://www.ncbi.nlm.nih.gov/pubmed/24347282
(6) http://www.ncbi.nlm.nih.gov/pubmed/25148757
(6a) http://www.ncbi.nlm.nih.gov/pubmed/2237280
(7) http://www.ncbi.nlm.nih.gov/pubmed/17682001
(8) http://www.ncbi.nlm.nih.gov/pubmed/16377311
(9) http://www.ncbi.nlm.nih.gov/pubmed/?term=Cardia+and+burning+sensation
(10) http://www.ncbi.nlm.nih.gov/pubmed/24330081
(11) http://www.ncbi.nlm.nih.gov/pubmed/8608873
(12) http://www.ncbi.nlm.nih.gov/pubmed/?term=Administration+of+a+Standardized+Meal.+Does+Timing+Matter
(13) http://www.ncbi.nlm.nih.gov/pubmed/17633874
(14) http://www.ncbi.nlm.nih.gov/pubmed/?term=weight+loss%2C+through+caloric+restriction+and+behavioral+modification+in+obese+with+GERD
(15) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2956342/
(16) http://www.ncbi.nlm.nih.gov/pubmed/23265146
(17) http://www.ncbi.nlm.nih.gov/pubmed/18046990
(18) http://www.ncbi.nlm.nih.gov/pubmed/25374758
(19) http://www.ncbi.nlm.nih.gov/pubmed/25327320
(20) http://www.ncbi.nlm.nih.gov/pubmed/16430100
(21) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3115688/
(22) http://www.ncbi.nlm.nih.gov/pubmed/10378360
(23) http://www.ncbi.nlm.nih.gov/pubmed/14986731
(24) http://www.ncbi.nlm.nih.gov/pubmed/24564071
(25) http://www.ncbi.nlm.nih.gov/pubmed/24482901
(26) http://www.ncbi.nlm.nih.gov/pubmed/23567358
(27) http://www.ncbi.nlm.nih.gov/pubmed/18341497
(28) http://www.ncbi.nlm.nih.gov/pubmed/21235462
(29) http://www.ncbi.nlm.nih.gov/pubmed/20124466
(30) http://www.ncbi.nlm.nih.gov/pubmed/11552905
(31) http://www.ncbi.nlm.nih.gov/pubmed/17229239
(32) http://www.ncbi.nlm.nih.gov/pubmed/9692698
(33) http://www.medscape.org/viewarticle/434528
(34) http://www.ncbi.nlm.nih.gov/pubmed/10886047
(35) http://www.ncbi.nlm.nih.gov/pubmed/15540548
(36) http://www.ncbi.nlm.nih.gov/pubmed/1349550
(37) http://www.ncbi.nlm.nih.gov/pubmed/25386679
(38) http://www.ncbi.nlm.nih.gov/pubmed/23943388
(39) http://www.ncbi.nlm.nih.gov/pubmed/14759403
(40) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1156688/
(41) http://www.desertharvest.com/physicians/documents/DH127.pdf
(42) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761965/
(43) http://onlinelibrary.wiley.com/doi/10.1002/ptr.1936/abstract
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