Time for some science again!
If you haven't already, you may read Episode 1 of the ACIDITY Series!
Today we'll learn why we experience symptoms of Gastro-oesophageal Reflux Disease (GERD/GORD), or more commonly know to the mass population as Heartburn.
This is one of the most common, if not the commonest, complains of people. I mean seriously, who hasn't experienced heartburn at least once in their life!
Based on different locations you may know this as different names, heartburn, gastric problem, pain of gastric, etc. etc. They all refer to GERD.
It's not a pleasant sensation at all and we all have wondered or googled what we can do to prevent recurrences of the symptoms, haven't we!
Well, today we're going to learn all the non-medical personnel need to know about GERD, with a bit of medical insight into it!
Let's get started then!
So what exactly causes GERD?
As you already know from my previous post, the stomach produces acid. Now, normally, this acid is limited to stay in the stomach and not allowed to go backwards into our esophagus. The esophagus is a tube like structure through which food from the mouth travels into the stomach.
At the junction of the esophagus and the stomach, there is a specialized collection of smooth muscles, known as the lower esophageal sphincter. This muscle is tonically contracted and closes off the junction whenever food is not travelling down the esophagus to the stomach. This prevents the acid from the stomach to reflux backwards into the esophagus.
What happens in GERD is, for some reason (will discuss the most common ones in a bit) acid is being allowed to reflux back into the esophagus. This is the reason we experience the symptoms of GERD.
We've all played around with hydrochloric acid in our chemistry labs and many of us have spilled some onto our hands didn't we! (I hope not, but we did lol)! How did it feel? It burnt, right? And even if you were lucky to never have spilled a bit of acid on you skin, use your imagination! How do you think spilling acid onto your skin is gonna make you feel!!
Well that's exactly how it feels in GERD too! The acid refluxing back into the esophagus irritates the esophagus and creates a burning feeling in our chest (The esophagus lies in the chest). And since the general population know the heart to be residing in the chest, the say they are having heart burn, but in fact, this has got nothing to do with your heart! Trust me, I'm a doctor!
Can we have other symptoms besides the typical burning sensation in our chest?
A lot of patients may have a longstanding cough, usually worse at night when we might be woken up from our sleep due to the cough. This is termed as Nocturnal Cough. There are other causes of nocturnal cough as well, but that's for another day!
Now, why do we have cough with acid reflux, and why specially when we're asleep?
First let's answer why do we have cough in acid reflux. Sometimes the refluxed acid may go up so much that it may reach up to the Larynx. The larynx is the gateway into our breathing system and any sort of irritation in the respiratory tract is usually responded by with a cough, in attempt of our breathing system to get rid of the irritant. I mean, we all wanna get rid of irritants in our lives, don't we!
Now the second question, why during sleep? This is because we're not horses and we sleep lying down! Imagine trying to force water vertically straight up a pipe, and when the pipe is lying horizontally on the ground. Which is easier? Of course when the pipe is on the ground. So similarly, when we're lying down it's easier for the acid to travel further along the esophagus than when we're sitting up straight. This is why you've been told not to lie down straight after you've had a meal, sssh!
Among other symptoms, patients may experience chest pain, excessive salivation as well.
Now some important causes of GERD.
Well, what if someone has a dysfunctional sphincter, the muscles which were preventing the acid from refluxing. Yeah, exactly. The acid is gonna reflux back into the esophagus.
There are certain dietary factor which may exacerbate these symptoms you may have noticed! To name the common culprits, fatty food, chocolate, alcohol, tea and coffee. These have the ability to relax the sphincter muscles and thus allowing the gateway between the stomach and esophagus to open up. This is why you may have been asked to limit amounts of these foods. Almost everything has science behind it!
Increased pressure within your abdominal cavity. Say everything with the sphincter is fine, but the pressure is massively increased inside your abdomen. This pressure is going to try and force the contents of the stomach, including acid backwards and when this pressure is strong enough to overcome the strength of the sphincter muscles, acid is going to reflux back. Obesity is one of the factors that raise intra abdominal pressure and this is why you've heard, losing weight helps improve the symptoms in obese people.
Pregnancy also causes the pressure inside the abdomen to be raised, which is why a lot of pregnant women experience symptoms of heartburn.
Managing Your GERD
Most of us are guilty of going straight for anti-ulcerant medications like omeprazole, esomeprazole, lansoprazole, famotidine, etc whenever we have heartburn. And a lot of us are taking these medication as a dalily routine, for years and years (We really shouldn't be doing this. More on this in episode 3).
We have already learned the first line managements of our GERD. Can you recall them?
Don't lie down straight after a meal.
Avoid/reduce intake of foods that provoke symptoms like tea, coffee, fatty foods, etc.
Lose weight if you're overweight.
Add to these, avoiding heavy meals, and late dinners.
When symptoms fail to improve despite these lifestyle changes, only then we resort to medications to control the symptoms.
Episode 3 will be all about how the anti-ulcerant medications work and what's the rational way to take these medications We'll also learn in that episode, why we shouldn't be taking these medications continuously, for very prolonged periods of time.
Until Then, stay Healthy!
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Davidson's Principles and Practice of Medicine, 23rd edition
Clinical Guidelines for Gastro-Oesophageal Reflux Disease by National Institute for Health and Care Excellence (NICE)