Acid reflux

Acid reflux

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Overview

The digestive tract is a series of organs joined in a twisting and long tube from the mouth to the anus. The solid organs of the GI tract are the liver, gallbladder, and pancreas. The hollow organs are the mouth, esophagus, stomach, small and large intestine, and anus. 

What is GERD?

Gastroesophageal reflux disease (GERD) is one of the common and chronic digestive diseases. It causes stomach acid and sometimes stomach acid to travel back up to the throat. This is known as acid reflux. Over time, acid reflux can damage the esophageal lining. Heartburn is also one of the common symptoms in patients suffering from GERD. The most common symptoms experienced by the people are heartburn and acid reflux from time to time, especially after having a heavy or spicy or heavy meal. GERD is usually diagnosed when the symptoms occur at least 2 times a week or are severe enough that it interferes with your activities of daily living (ADL).

What are the symptoms of GERD?

  • Heartburn
  • Acid reflux
  • Sore throat
  • Sour taste in the mouth
  • Problem in swallowing
  • Dry cough
  • Chest pain
  • Hoarseness of voice
  • Feeling a lump in your throat

How GERD affect your life?

Due to problems with the muscles which join the stomach and esophagus, acid reflux backs up into the throat. These muscles are usually tight and relax when the food is swallowed. This creates an opening which allows liquids and food to enter the stomach, and then these muscles tighten and again closes until the next time you swallow. Acid reflux occurs when these muscles weaken or relax abnormally.

How is GERD diagnosed?

Your doctor will take your history, and after doing a physical exam, he will suggest some tests to confirm the diagnosis:

  • Endoscopy: This procedure uses an instrument with a camera attached to a tube that goes down the throat and allows your doctor to view the lining of your esophagus to look for abnormalities and irritation. Sometimes, a sample tissue is also collected to test for complications like Barrett’s esophagus.
  • Barium swallow: It is an x-ray imaging test that allows the doctor to view the lining of your esophagus. In this test, barium is swallowed while the images are being obtained.
  • Ambulatory acid (pH) probe test: In this procedure, a monitor is placed in your esophagus to look at when and for how long stomach acid regurgitates there. The monitor is connected to a small computer. The monitor might be a flexible and thin tube (catheter) threaded through your nose into your esophagus or a clip placed in the esophagus during endoscopy and gets passed into the stool after about 2 days.
  • Esophageal manometry: This test helps in measuring the rhythmic muscle contractions in the esophagus when you swallow. This test also measures the force exerted by the esophagus muscles and its coordination.

How is GERD treated?

Common treatment options available are antacids and various other medications, lifestyle modifications, and surgery. Another option includes the stretta procedure.

What is the stretta procedure?

Stretta procedure is a minimally invasive, non-surgical procedure that only takes approximately an hour to perform. Most patients after the procedure return to their daily activities within a day. Most patients with GERD have damaged muscle that connects the throat to the stomach. The Stretta procedure helps to strengthen these muscles and results in better muscle control and lesser episodes of acid reflux.

Why is the stretta procedure done?

Doctors may advise the Stretta procedure to patients whose medication or surgery hasn’t helped or aren’t good candidates for medicine or surgery. As this procedure involves placing a tube down the throat, it’s only considered for patients without any throat obstructions.

How do you prepare for the stretta procedure?

Your doctor will guide you on how you should prepare for the surgery. Preparation for most patients includes:

  • Avoid eating anything after 12 pm the day before your procedure.
  • Ensure to only drink liquids like water, tea, black coffee, or apple juice on the day of the procedure.
  • Take your regular medications during the morning of the procedure, except for insulin or any diuretics.
  • Bring your regular medicines with you to your procedure.
  • Stop taking any blood thinner medications 3-5 days before the procedure.
  • Prefer wearing loose-fitted clothes to your procedure.
  • Bring someone who can take care and take you back to your home after the procedure.

What happens during the surgery?

During this procedure, your doctor will sedate you with anesthesia. Your doctor will insert a tube down your throat to the muscles that connect the throat to the stomach. This tube sends mild radiofrequency waves to the tissue where the esophagus and stomach meet. At the same time, water is released by the tube to help prevent any heat injury inside of the body. Once the radio waves are applied, the tube is removed.

What are the risks and complications associated with the stretta procedure?

Complications due to the Stretta procedure are rare. However, some of the possible risks include:

  • Food remaining in the stomach too long (Gastroparesis)
  • Throat irritation from the Stretta tube (Erosive esophagitis)
  • Throat injury from the Stretta tube (Esophageal perforation)
  • Adverse reaction to anesthesia
  • Gas and bloating

What are the benefits of the stretta procedure?

  • No general anesthesia
  • Fast recovery
  • Low risk of complications
  • No medications
  • No hospitalization

Tips for lifestyle modifications

Below are some lifestyle modifications that may help in reducing the frequency of acid reflux.

  • Maintain a healthy weight: Being obese or overweight put pressure on your abdomen and causes acid to reflux into the esophagus.
  • Quit smoking: Smoking reduces the ability of the lower esophageal sphincter to function properly.
  • Elevate the head of your bed: If you frequently experience heartburn while trying to sleep, cement brick or wood under the feet of your bed so that the head end is raised by 6-9 inches. You can also insert a wedge between the mattress and box spring to elevate your body from the waist up. Raising your head with some pillows is not effective.
  • Don't lie down after a meal: Keep a gap of approximately 3 hours after eating before lying down or going to bed.
  • Eat food slowly and chew thoroughly: Eating slowly will help in the digestion process. Keep the fork down after every bite and pick it up again once you have chewed and swallowed the food properly.
  • Avoid foods and drinks that trigger reflux: Some of the common triggers include fried or fatty foods, alcohol, mint, tomato sauce, chocolate, garlic, caffeine, and onion.
  • Avoid tight-fitting clothing: Wear clothes with loose fitting around your waist. Tight fitted clothes around the waist put pressure on your abdomen and the lower esophageal sphincter.

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