Tips for Calming Nighttime Acid Reflux
Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances, including arousal from sleep, increased wakefulness and overall poor sleep quality.
Here are several tips to help reduce nighttime acid reflux so you can sleep better:
1. Sleep with your head and shoulders elevated
2. Wear loose-fitting clothes
3. Wait 2 to 3 hours after eating to go to sleep
4. Avoid foods that trigger heartburn
source: http://www.acg.gi.org/
Sunday, March 23, 2008
Thursday, March 20, 2008
night time acid reflux
According to results of a survey presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, nighttime acid reflux, along with some of the less typical manifestations or symptoms of gastroesophageal reflux disease (GERD), is associated with significant sleep impairment.
In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.
Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.
"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.
source: http://www.acg.gi.org/
In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.
Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.
"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.
source: http://www.acg.gi.org/
incisionless operations for acid reflux
Surgeons at the Ohio State University Medical Center have performed the first incisionless operations in the United States using a device recently approved by the Food and Drug Administration to stop gastroesophageal reflux disease.
Ohio State's Medical Center is one of the nation's leaders in incisionless surgery, a new procedure that leaves no outside scarring; results in minimal, if any, post-operative pain; reduces patients' recovery time significantly; and is expected to be one of the next major medical advancements.
Surgeons at Ohio State have treated the first two patients, using the device known as EsophyX. The mechanism, new in the United States, has been proven safe and effective in patients treated throughout Europe for gastroesophageal reflux disease (GERD), also known as heartburn.
"The medical device offers a treatment for patients who suffer from an advanced degree of GERD and, until now, would have been candidates for surgery," said Dr. Scott Melvin, division director, general and gastrointestinal surgery, and director, Center for Minimally Invasive Surgery at the OSU Medical Center.
Heartburn is a condition in which acid refluxes from the stomach into the esophagus. The burning sensation felt in the chest can last for countless hours, resulting from inflammation, bleeding or ulcers in the esophagus. GERD is known to be associated with an increased risk of cancer of the esophagus.
Almost 30 million Americans are diagnosed with chronic reflux disease that requires medication for relief of symptoms. It is estimated that millions of dollars are spent on over-the-counter and prescription medications for treatment of the condition.
The incisionless surgery allows reconstruction of the one-way valve at the top of the stomach, when the valve is defective. The new tubular device is introduced to the body totally through the mouth, and is then advanced down the esophagus into the stomach. During the procedure, the operation is viewed through a small fiberoptic camera located within the tubular surgical tools. Patients are normally in the hospital overnight and, after the procedure, are symptom free.
"Throughout medical history, we have gone from a very painful surgery, to a better tolerated surgery and, now, to a potentially pain-free incisionless procedure. In addition, the new procedure allows a treatment option for many patients when reflux is not severe enough to require surgery," noted Melvin.
"We are far from incisionless technology's adoption for widespread use with other diseases, but there is a lot of discussion among surgeons about these new techniques," said Melvin. "Our use of this type of technology will continue to allow us to treat many diseases with minimal pain from surgery."
source: http://medicalcenter.osu.edu/
Ohio State's Medical Center is one of the nation's leaders in incisionless surgery, a new procedure that leaves no outside scarring; results in minimal, if any, post-operative pain; reduces patients' recovery time significantly; and is expected to be one of the next major medical advancements.
Surgeons at Ohio State have treated the first two patients, using the device known as EsophyX. The mechanism, new in the United States, has been proven safe and effective in patients treated throughout Europe for gastroesophageal reflux disease (GERD), also known as heartburn.
"The medical device offers a treatment for patients who suffer from an advanced degree of GERD and, until now, would have been candidates for surgery," said Dr. Scott Melvin, division director, general and gastrointestinal surgery, and director, Center for Minimally Invasive Surgery at the OSU Medical Center.
Heartburn is a condition in which acid refluxes from the stomach into the esophagus. The burning sensation felt in the chest can last for countless hours, resulting from inflammation, bleeding or ulcers in the esophagus. GERD is known to be associated with an increased risk of cancer of the esophagus.
Almost 30 million Americans are diagnosed with chronic reflux disease that requires medication for relief of symptoms. It is estimated that millions of dollars are spent on over-the-counter and prescription medications for treatment of the condition.
The incisionless surgery allows reconstruction of the one-way valve at the top of the stomach, when the valve is defective. The new tubular device is introduced to the body totally through the mouth, and is then advanced down the esophagus into the stomach. During the procedure, the operation is viewed through a small fiberoptic camera located within the tubular surgical tools. Patients are normally in the hospital overnight and, after the procedure, are symptom free.
"Throughout medical history, we have gone from a very painful surgery, to a better tolerated surgery and, now, to a potentially pain-free incisionless procedure. In addition, the new procedure allows a treatment option for many patients when reflux is not severe enough to require surgery," noted Melvin.
"We are far from incisionless technology's adoption for widespread use with other diseases, but there is a lot of discussion among surgeons about these new techniques," said Melvin. "Our use of this type of technology will continue to allow us to treat many diseases with minimal pain from surgery."
source: http://medicalcenter.osu.edu/
Monday, March 17, 2008
heartburn drugs and pregnancy
The Do's and Don'ts of Using Heartburn Drugs during Pregnancy
Pregnant women with mild reflux usually do well with simple lifestyle changes. If lifestyle and dietary changes are not enough, you should consult your doctor before taking any medication to relieve heartburn symptoms.
Pregnant women with mild reflux usually do well with simple lifestyle changes. If lifestyle and dietary changes are not enough, you should consult your doctor before taking any medication to relieve heartburn symptoms.
According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn medications to treat acid reflux during pregnancy should be balanced to alleviate the mother's symptoms of heartburn, while protecting the developing fetus."
Based on a review of published scientific clinical studies (in animals and humans) on the safety of heartburn medications during pregnancy, researchers conclude there are certain drugs that are considered safe for use in pregnancy and those which should be avoided.
Antacids are one of the most common over-the-counter medications to treat heartburn. As with any drug, antacids should be used cautiously during pregnancy.
Antacids
Antacids containing aluminum, calcium, or magnesium are considered safe and effective in treating the heartburn of pregnancy.
Magnesium-containing antacids should be avoided during the last trimester of pregnancy because it could interfere with uterine contractions during labor.
Avoid antacids containing sodium bicarbonate. Sodium bicarbonate could cause metabolic alkalosis and increase the potential of fluid overload in both the fetus and mother.
Histamine-type II (H-2) Receptor Antagonists
While limited data exists in humans on the safety of histamine-type II (H-2) receptor antagonists, ranitidine (Zantac?) is the only H-2 antagonist, which has been studied specifically during pregnancy.
In a double-blind, placebo controlled, triple crossover study, ranitidine (Zantac?) taken once or twice daily in pregnant heartburn patients not responding to antacids and lifestyle modification, was found to be more effective than placebo in reducing the symptoms of heartburn and acid regurgitation. No adverse effects on the fetus were reported. (Larson JD, et al., "Double-blind placebo-controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997; 90:83-7.)
A study on the safety of cimetidine (Tagamet?) and ranitidine (Zantac?) suggests that pregnant women taking these drugs from the first trimester through their entire pregnancy have delivered normal babies. (Richter JE., "Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin N Am 2003; 32:235-61.)
Proton Pump Inhibitors
Proton pump inhibitors should be reserved for pregnant patients with more severe heartburn symptoms and those not responding to antacids and lifestyle and dietary changes. Lansoprazole (Prevacid?) is the preferred PPI because of case reports of safety in pregnant women. Limited data exists about human safety during pregnancy with the newer PPIs.
Friday, March 14, 2008
heartburn and pregnancy
Heartburn symptoms are one of the most commonly reported complaints among pregnant women.
Heartburn usually starts during the first trimester and tends to worsen during the second and third trimesters.
Heartburn usually starts during the first trimester and tends to worsen during the second and third trimesters.
Studies have shown elevated levels of the hormone progesterone accompanied by increased intra-abdominal pressures from the enlarging uterus, may lower esophageal sphincter (LES) pressure in pregnant women contributing to heartburn symptoms, according to research highlighted in the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by the American College of Gastroenterology (ACG).
From the monograph, physician experts from ACG have compiled important health tips on managing heartburn symptoms, and importantly, identifying which heartburn medications are safe for use in pregnant women and those, which should be avoided.
Strategies to Ease Heartburn Symptoms during Pregnancy
According to the ACG, pregnant women can treat and relieve their heartburn symptoms through lifestyle and dietary changes. The following tips can help reduce heartburn discomfort:
Avoid eating late at night or before retiring to bed. Common heartburn triggers include greasy or spicy food, chocolate, peppermint, tomato sauces, caffeine, carbonated drinks, and citrus fruits.
Wear loose-fitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
Eat smaller meals. Overfilling the stomach can result in acid reflux and heartburn.
Don't lie down after eating. Wait at least 3 hours after eating before going to bed. When you lie down, it's easier for stomach contents (including acid) to back up into the esophagus, particularly when you go to bed with a full stomach.
Raise the head of the bed 4 to 6 inches. This can help reduce acid reflux by decreasing the amount of gastric contents that reach the lower esophagus.
Avoid tobacco and alcohol. Abstinence from alcohol and smoking can help reduce reflux symptoms and avoid fetal exposure to potentially harmful substances.
Tuesday, March 11, 2008
what to do when a baby has GERD
If you feed your baby with a bottle, add up to 1 tablespoon of rice cereal to 2 ounces of infant milk. You can add cereal to expressed milk if you are breastfeeding. If the mixture is too thick for your baby you can change the nipple size or cut a little “x†in the nipple.
Burp your baby after he’s consumed 1 or 2 ounces of formula. For breast-fed infants, burp after feeding on each side.
Do not overfeed. Talk with your infant’s doctor or nurse about the amount of formula or breast milk that your baby is consuming.
When possible, hold your infant upright in your arms for 30 minutes after feedings.
Infants with GER should usually sleep on their backs, as is suggested for all infants. Rarely, a physician may suggest alternative sleep positions.
Friday, March 7, 2008
Symptoms in Babies
GERD is common in healthy infants. More than half of all babies experience reflux in the first 3 months of life, but most stop spitting up between the ages of 12 to 24 months. Only a small number of infants have severe symptoms. An infant with GER may experience
spitting up
vomiting
coughing
irritability
poor feeding
blood in the stools
In a small number of babies, GER results in symptoms that cause concern. These symptoms include
poor growth due to an inability to hold down enough food
irritability or refusing to feed due to pain
blood loss from acid burning the esophagus
breathing problems
These problems can be caused by disorders other than GERD. Your health care provider will need to determine whether GERD is the cause of your child’s symptoms.
source: digestive.niddk.nih.gov
Tuesday, March 4, 2008
GERD
GERD is a chronic condition. Once it begins, it usually is lifeâ€"long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun, therefore, it usually will need to be continued indefinitely although it is argued that in some patients with intermittent symptoms and no esophagitis, treatment can be intermittent and done only during symptomatic periods.
In fact, the reflux of the stomach's liquid contents into the esophagus occurs in most normal individuals. One study found that reflux occurs as frequently in normal individuals as in patients with GERD. In patients with GERD, however, the refluxed liquid contains acid more often, and the acid remains in the esophagus longer. It has also been found that liquid refluxes to a higher level in the esophagus in patients with GERD than normal individuals.
As is often the case, the body has ways (mechanisms) to protect itself from the harmful effects of reflux and acid. For example, most reflux occurs during the day when individuals are upright. In the upright position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. In addition, while individuals are awake, they repeatedly swallow, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, the salivary glands in the mouth produce saliva, which contains bicarbonate. With each swallow, bicarbonateâ€"containing saliva travels down the esophagus. The bicarbonate neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.
Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when individuals are in the upright position. At night during sleep, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus.
Certain conditions make a person susceptible to GERD. For example, GERD can be a serious problem during pregnancy. The elevated hormone levels of pregnancy probably cause reflux by lowering the pressure in the lower esophageal sphincter (see below). At the same time, the growing fetus increases the pressure in the abdomen. Both of these effects would be expected to increase reflux. Also, patients with diseases that weaken the esophageal muscles (see below), such as scleroderma or mixed connective tissue diseases, are more prone to develop GERD.
source: www.medicinenet.com
Saturday, March 1, 2008
acid reflux defined
from www.wikipedia.com
acid reflux is also known as GERD or Gastroesophageal reflux disease. it is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus.
This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the cardia, transient cardia relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia.
from www.medicinenet.com
Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (cause, cause esophagitis) of the esophagus although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed–up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.
acid reflux is also known as GERD or Gastroesophageal reflux disease. it is defined as chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus.
This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the cardia, transient cardia relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatus hernia.
from www.medicinenet.com
Gastroesophageal reflux disease, commonly referred to as GERD or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up or refluxes) into the esophagus. The liquid can inflame and damage the lining (cause, cause esophagitis) of the esophagus although visible signs of inflammation occur in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed–up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage is not as clear as the role of acid.
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