Stomach Issues

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GASTRITIS / DYSPEPSIA

‘Gastritis’ is a term often used by general public to describe indigestion and refers to symptoms of chronic or recurrent pain or discomfort centered in the upper part of the abdomen. The medical term for these symptoms is dyspepsia. The medical definition of gastritis however refers more specifically to inflammation of the lining of the stomach.

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REFLUX

Reflux is an irritation of the swallowing tube, called the esophagus by acid that comes up from the stomach which causes troublesome symptoms and/or complications. It happens because the junction between the gullet and the stomach does not function normally, resulting in reflux.

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REFLUX

Reflux is an irritation of the swallowing tube, called the esophagus by acid that comes up from the stomach which causes troublesome symptoms and/or complications. It happens because the junction between the gullet and the stomach does not function normally, resulting in reflux.

What Causes Reflux?

During swallowing, food passes down the throat and through the swallowing tube into the stomach. Normally, a muscle valve at the end of the swallowing tube (lower esophageal sphincter) opens to allow food into the stomach; then it closes again.

When this muscle opens too often or does not close tight enough, stomach acid can reflux, or wash back into the swallowing tube, causing damage to its lining.

What Are the Symptoms?

Some people have heartburn pain when reflux happens.  Some people feel nothing. Other symptoms include burping, belching, bitter taste in your mouth, coughing at night, dry throat, sore throat, hoarseness in the morning, or worsening asthma.

What Are the Complications of Reflux?

Long standing reflux can cause:

Esophagitis is an inflammation of the esophagus; it may be associated with ulcers of the esophagus.

Stricture is the narrowing of the swallowing tube as a result of long standing inflammation.

Barrett’s Esophagus may occur in long standing inflammation which may lead to changes of the cells of the lower esophagus. Patients with Barrett’s esophagus have higher risk of esophageal cancer compared to general population.

How Is Reflux Detected?

In the simplest case, when symptoms are typical and the patient responds to medication, no diagnostic tests are requisite.
If the symptoms do not improve with medication, further investigation is mandatory.

Diagnostic Tests Include:

1. Gastroscopy (please refer to section on “Procedures Provided: Gastroscopy”) – allows the detection of inflammation at the lower esophagus and biopsy which will provide further testing for cell changes to rule out Barrett’s esophagus
2. 24-hour pH monitoring – to test the acidity of the swallowing tube (esophagus)
3. Manometry – to test the motility (contraction) of the swallowing tube and the pressure at the muscle valve (lower esophageal pressure)

Treatment of Reflux

The first treatments usually recommend for reflux are lifestyle and dietary changes. The purpose of these changes is to reduce the amount of reflux or reduce the potential for damage to the esophageal lining from refluxed substances. Inappropriate diet and certain habits can cause or worsen reflux by relaxing the lower esophageal sphincter and allowing it to open, increasing the amount of acid in the stomach, increasing stomach pressure, or by making the esophagus more sensitive to acids.

Dietary Habits That Improve Reflux

• These foods can relax the lower esophageal sphincter (muscle valve at the end of the swallowing tube), allowing stomach contents to reflux into the esophagus

• chocolate, sweet deserts, high-fat or spicy foods, curry, citrus fruits, garlic, onion and tomatoes or tomato-based products

• certain beverages, including citrus juices, alcohol, coffee, black tea

• Eating regular meals and small portions at each time
• Avoid eating or drinking for 2-3 hours before going to bed

Lifestyle Habits That Improve GERD

• Lose weight (if you are overweight)
• Stop smoking
• Avoid wearing tight-fitting clothing or belts
• Avoid lying down or prolonged bending over, especially after eating
• Avoid straining and constipation
• Elevate the head of your bed 6 to 8 inches
• Avoid Stress

What Medications Are Used to Treat reflux?

• Medication targeting acid secretion: proton pump inhibitors, H2 blockers
• Medication neutralizing gastric acid: antacids
• Medication improving peristalsis and stomach emptying: prokinetics

Is There Any Role for Surgery?

Most patients with reflux do not need surgery.