Barrett’s Esophagus - Causes, Symptoms, Diagnosis , and Treatment

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When GERD is left untreated it can create other problems. One possible health consequence of GERD is a condition called Barrett’s Esophagus (BE).

Barrett's esophagus is found in 5-15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, GERD)

Barrett's esophagus Causes

Barrett's esophagus is caused by gastro-oesophageal reflux disease, GORD(USA: GERD), which allows the stomach's contents to damage the cells lining the lower esophagus. Researchers are unable to predict which heartburn sufferers will develop Barrett's esophagus. While there is no relationship between the severity of heartburn and the development of Barrett's esophagus, there is a relationship between chronic heartburn and the development of Barrett's esophagus. Sometimes people with Barrett's esophagus will have no heartburn symptoms at all. In rare cases, damage to the esophagus may be caused by swallowing a corrosive substance such as lye.

The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.

Barrett's esophagus Sign and Symptoms

Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:

* frequent and longstanding heartburn
* trouble swallowing (dysphagia)
* vomiting blood
* pain under the breastbone where the esophagus meets the stomach
* unintentional weight loss because eating is painful

Diagnosis of Barrett’s Esophagus

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Diagnosis of Barrett's esophagus requires an examination called upper endoscopy or EGD (esophagogastroduodenoscopy). A barium x-ray is not accurate for detecting Barrett's esophagus. An EGD is done with the patient under sedation. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible endoscope.

Your doctor determines whether you have Barrett's esophagus using a procedure called upper endoscopy to:

* Examine your esophagus. Your doctor will pass a lighted tube (endoscope) down your throat. The tube carries a tiny camera that allows your doctor to examine your esophagus. Your doctor looks for signs that the esophageal tissue is changing. A person with Barrett's esophagus has tissue that appears different from normal esophageal tissue.

* Remove tissue samples. Your doctor may pass special tools through the endoscope to remove several small tissue samples. The samples are tested in a laboratory to determine what types of changes are taking place and how advanced the changes are.

Determining the degree of tissue changes

A doctor who specializes in examining body tissue in a laboratory (pathologist) will examine your esophageal tissue samples under a microscope. The pathologist determines the degree of changes (dysplasia) in your cells. Grades of dysplasia include:

* No dysplasia. If no changes are found in the cells, the pathologist determines there is no dysplasia.



* Low-grade dysplasia. Cells with low-grade dysplasia may show small signs of changes.



* High-grade dysplasia. Cells with high-grade dysplasia show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.



The type of dysplasia detected in your esophageal tissue determines your treatment options.

Treatments and drugs for Barrett’s Esophagus Patients
By Mayo Clinic staff

Your treatment options for Barrett's esophagus depend on the grade of changes in the cells of your esophagus, your overall health and your own preferences.

Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:

* Periodic endoscopy exams to monitor the cells in your esophagus. How often you undergo endoscopy exams will depend on your situation. Typically, if your biopsies show no dysplasia, you'll have a follow-up endoscopy one year later. If your doctor again detects no dysplasia, you may have endoscopy exams every three years. If low-grade dysplasia is detected, your doctor may recommend GERD treatments and another endoscopy in six months. If you're determined to have high-grade dysplasia, then your doctor may offer other treatment options.

Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.

* Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. This procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.

Treatment for people with high-grade dysplasia.

High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:

* Esophagectomy. Surgery to remove the esophagus. During an esophagectomy, the surgeon removes most of your esophagus and attaches your stomach to the remaining portion. Surgery carries a risk of significant complications, such as bleeding, infection and leaking from the area where the esophagus and stomach are joined. When esophagectomy is performed by an experienced surgeon, there's a reduced risk of complications. Still, because of the potential complications of this major operation, other treatments are usually preferred over surgery. One advantage to surgery is that it reduces the need for periodic endoscopy exams in the future.

* Removing damaged cells with an endoscope. Endoscopic mucosal resection is used to remove areas of damaged cells using an endoscope. Your doctor guides the endoscope down your throat and into your esophagus. Special surgical tools are passed through the tube. The tools allow your doctor to cut away the superficial layers of the esophagus and remove damaged cells. Endoscopic mucosal resection carries a risk of complications, such as bleeding, tearing of the esophagus and narrowing of the esophagus.

* Using heat to remove abnormal esophageal tissue. Radiofrequency ablation involves inserting a balloon filled with electrodes in the esophagus. The balloon emits a short burst of energy that burns the damaged esophageal tissue.

* Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain, difficulty swallowing and vomiting.

If you undergo treatment other than surgery to remove your esophagus, there's a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.

Medication and Drugs for Barrett’s Esophagus

The doctor may also prescribe medications to help. Those medications may include:

* Antacids to neutralize stomach acid.
* H2 blockers that lessen the release of stomach acid.
* Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines.
* Proton pump inhibitors that reduce the production of stomach acid.


Lifestyle and home remedies for Barrett’s Esophagus Patients
By Mayo Clinic staff

Most people diagnosed with Barrett's esophagus experience frequent heartburn and acid reflux. Medications can control these signs and symptoms, but changes to your daily life also may help. Consider trying to:

* Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you're overweight or obese, ask your doctor about healthy ways to lose weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

* Eat smaller, more frequent meals. Three meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.

* Avoid tightfitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.

* Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.

* Avoid stooping or bending. Tying your shoes is OK. Bending over for a long time to weed your garden may not be, especially soon after eating.

* Don't lie down after eating. Wait at least three hours after eating to lie down or go to bed.

* Raise the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of six to eight inches. Raising your head by using only pillows isn't a good alternative.

* Don't smoke. Smoking may increase stomach acid. If you smoke, ask your doctor about strategies for stopping.

Source: mayoclinic

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Laryngopharyngeal Reflux ( LPR )- Definition, Symptoms, Diagnosis, and Treatment

Definition of Laryngopharyngeal Reflux (LPR).

There are two sphincter muscles located in the esophagus: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). When the lower esophageal sphincter is not functioning properly, there is a back flow of stomach acid into the esophagus. If this happens two or more times a week, it can be a sign of gastroesophageal reflux disease, or GERD.

But what happens when the upper esophageal sphincter doesn't function correctly either?

As with the lower esophageal sphincter, if the upper esophageal sphincter doesn't function properly, acid that has back flowed into the esophagus is allowed into the throat and voice box. When this happens, it's called Laryngopharyngeal Reflux, or LPR.

It usually occurs without heartburn, less than 15% of people with this problem have heartburn. The larynx, trachea, bronchi and lungs are much more susceptible to damage from the stomach juices than the esophagus.

The esophagus is better able to handle the acid than the larynx and pharynx because it has built in protective mechanisms. It also means that it takes even smaller amounts of stomach juices to do the damage.

Digestive juices can get into the upper throat at night as with regular acid reflux or GERD, but more people with LPR have damage occur during the day than at night.

How is LPR different from GERD?

Are the symptoms the same for both diseases? Can people suffer from Laryngopharyngeal Reflux (LPR) without having any symptoms of Acid Reflux (GERD)? Can LPR occur without any heartburn at all? This is totally possible. Some of the people who suffer from LPR do not suffer from heartburn at all! How is this possible? Heartburn occurs when the acids stays in the esophagus and burns the surface. But in LPR, these stomach acids are not staying in the esophagus long enough to cause heartburn. In this case, acid goes past the esophagus and rests in the person’s throat or voice box. As the throat is more sensitive than esophagus, this will result in Laryngopharyngeal Reflux symptoms and not heartburn associated with GERD.

Symptoms of Laryngopharyngeal Reflux are:

* Hoarseness
* Chronic throat-clearing, excessive mucous
* Chronic cough
* Stridor (noisy breathing)
* Difficulty swallowing
* “Lump in the throat “(globus)
* Reactive airway disease (wheezing)
* Chronic bronchitis
* Chronic airway obstruction
* Wheezing
* Apnea
* Aspiration pneumonia
* Nasal obstruction
* Ear pain
* Chronic nasal congestion
* Sore throat
* Gagging

These symptoms are also related to many conditions thought to be aggravated or caused by LPR. These conditons include:

* Otitis media (ear infections)
* Sinusitis
* Chronic nasal congestion
* Vocal cord nodules
* Chronic laryngitis
* Laryngomalacia
* Apnea
* Subglottic stenosis
* Arytenoid fixation
* Laryngospasm
* Recurrent pharyngitis
* Chronic cough
* Exacerbation of asthma or reactive airway disease

Diagnosis of Laryngopharyngeal Reflux

Most often, your doctor can diagnose LPR by examining your throat and vocal cords with a rigid or flexible telescope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.

At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases.

Your doctor may do one of the following tests to determine if you have LPR:

* Laryngoscopy
This procedure is used to see changes of the throat and voice box.

* 24-hour pH testing
This procedure is used to see if too much stomach acid is moving into the upper esophagus or throat. Two pH sensors are used. One is located at the bottom of the esophagus and one at the top. This will let the doctor see if acid that enters the bottom of the esophagus moves to the top of the esophagus.

* Upper GI Endoscopy
This procedure is almost always done if a patient complains of difficulty with swallowing. It is done to see if there are any scars or abnormal growths in the esophagus, and to biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid.

Treatment of Laryngopharyngeal Reflux

Treatment for LPR is generally the same as that for GERD. Laryngopharyngeal reflux can be managed effectively with proper treatment.

Lifestyle modifications that may be prescribed include:

* Elevation of the head of the bed four to six inches
* Avoiding alcohol, chocolate and caffeine
* Avoiding overeating
* Eating or drinking nothing two to three hours before bed
* Avoiding greasy, fatty foods
* Losing weight

Medical treatments may include one or a combination of the following:

* Antacids to neutralize excess stomach acid
* Anti-secretory medications that decrease acid production by the stomach
* Surgery to tighten the junction between the stomach and esophagus. The most commonly performed surgery is called the Nissen Fundoplication. It is done by wrapping the top part of the stomach around the junction between the stomach and esophagus and sewing it in place.

Sources:
Charles N. Ford, MD, "Evaluation and Management of Laryngopharyngeal Reflux." JAMA. 2005;294:1534-1540.. The Journal of the American Medical Association. 11 Sep 2007 http://heartburn.about.com/od/gastrictractdisorders/a/whatis_LPR.htm

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Acid Reflux & Oesophagitis

Understanding the Oesophagus and Stomach

When we eat, food passes down the oesophagus (gullet) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.

There is a circular band of muscle (a 'sphincter') at the junction between the oesophagus and stomach. This relaxes to allow food down, but then normally tightens up and stops food and acid leaking back up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.

What are Reflux and Oesophagitis?

* Acid reflux is when some acid leaks up (refluxes) into the oesophagus.
* Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.

The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms with only a small amount of reflux. However, some people have a lot of reflux without developing oesophagitis or symptoms.

Gastro-oesophageal reflux disease (GORD)

This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.

What are The Symptoms of Acid Reflux and Oesophagitis?

* Heartburn is the main symptom. This is a burning feeling which rises from the upper abdomen or lower chest up towards the neck. (It is confusing as it has nothing to do with the heart!)

* Other common symptoms include: pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go, and tend to be worse after a meal.

* Some uncommon symptoms may occur. If any of these symptoms occur it can make the diagnosis difficult as these symptoms can mimic other conditions. For example:

• A persistent cough, particularly at night sometimes occurs. This is due to the refluxed acid irritating the trachea (windpipe). Asthma symptoms of cough and wheeze can sometimes be due to acid reflux.
• Other mouth and throat symptoms sometimes occur such as gum problems, bad breath, sore throat, hoarseness, and a feeling of a lump in the throat.
• Severe chest pain develops in some cases (and may be mistaken for a heart attack).
  

What Causes Acid Reflux and Who Does It Affect?

The sphincter at the bottom of the oesophagus normally prevents acid reflux. Problems occur if the sphincter does not work very well. This is common, but in most cases it is not known why it does not work so well. In some cases the pressure in the stomach rises higher than the sphincter can withstand. For example, during pregnancy, after a large meal, or when bending forward. If you have a hiatus hernia (when part of the stomach protrudes into the chest through the diaphragm), you have an increased chance of developing reflux. (See separate leaflet called 'Hiatus Hernia'.)

Most people have heartburn at some time, perhaps after a large meal. However, about 1 in 3 adults have some heartburn every few days, and nearly 1 in 10 adults have heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, the overweight, and those aged between 35 and 64.

What Tests Might Be Done?

Tests are not usually necessary if you have typical symptoms. Many people are diagnosed with 'presumed acid reflux' when they have typical symptoms, and the symptoms are eased by treatment. Tests may be advised if symptoms: are severe, or do not improve with treatment, or are not typical of GORD.

* Endoscopy is the common test. This is where a thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. With oesophagitis, the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid, and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:

• Oesophagitis. This term is used when the oesophagus can be seen to be inflamed.
• Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal.

* A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.

* Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

What Can I Do to Help with Symptoms?

The following are commonly advised. However, there has been little research to prove how well these 'lifestyle' changes help to ease reflux.

* Smoking. The chemicals from cigarettes relax the sphincter muscle and make acid reflux more likely. Symptoms may ease if you are a smoker and stop smoking.

* Some foods and drinks may make reflux worse in some people. It is thought that some foods may relax the sphincter and allow more acid to reflux. It is difficult to be certain how much foods contribute. Let common sense be your guide. If it seems that a food is causing symptoms, then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include: peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee, and alcoholic drinks. Also, avoiding large volume meals may help.

* Some drugs may make symptoms worse. They may irritate the oesophagus, or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include: diazepam, theophylline, nitrates, and calcium channel blockers such as nifedipine. But this is not an exhaustive list. Tell a doctor if you suspect that a drug is causing the symptoms, or making symptoms worse.

* Weight. If you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms.

* Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach which may make any reflux worse.

* Bedtime. If symptoms recur most nights, the following may help:

• Go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime, and don't drink in the last two hours before bedtime.
• If you are able, try raising the head of the bed by 10-20 cms (for example, with books or bricks under the bed's legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this do not use additional pillows, because this may increase abdominal pressure.
  

What are the Treatments for Acid Reflux and Oesophagitis?

Antacids

These are alkali liquids or tablets that neutralise the acid. A dose usually gives quick relief. There are many brands which you can buy. You can also get some on prescription. You can use antacids 'as required' for mild or infrequent bouts of heartburn.

Acid-suppressing drugs

If you get symptoms frequently then see a doctor. An acid-suppressing drug will usually be advised. Two groups of acid-suppressing drugs are available - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. Proton pump inhibitors include: omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers include: cimetidine, famotidine, nizatidine, and ranitidine.

In general, a proton pump inhibitor is used first as these drugs tend to work better than H2 blockers. A common initial plan is to take a full dose course of a proton pump inhibitor for a month or so. This often settles symptoms down and allows any inflammation in the oesophagus to clear. After this, all that you may need is to go back to antacids 'as required' or to take a short course of an acid suppressing drug 'as required'.

However, some people need long-term daily acid suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment with an acid-suppressing drug is thought to be safe, and side-effects are uncommon. The aim is to take a full dose course for a month or so to settle symptoms. After this, it is common to 'step-down' the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed by some people.

Prokinetic drugs

These are drugs that speed up the passage of food through the stomach. They include domperidone and metoclopramide. They are not commonly used but help in some cases, particularly if you have marked bloating or belching symptoms.

Surgery

An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery. In general, the success of surgery is no better than acid-suppressing medication. However, surgery may be an option for some people whose quality of life remains significantly affected by their condition and where drug treatment is not working well or not wanted long-term.

Are There Any Complications from Oesophagitis?

* Stricture. If you have severe and long-standing inflammation it can cause scarring and narrowing (a stricture) of the lower oesophagus. This is uncommon.

* Barrett's oesophagus. In this condition the cells that line the lower oesophagus become changed. The changed cells are more prone than usual to become cancerous. (About 1 or 2 people in 100 with Barrett's oesophagus develop cancer of the oesophagus.)

* Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.

It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty (food 'sticking') when you swallow which may be the first symptom of a complication.

References

• Dyspepsia - proven gastro-oesophageal reflux disease, Clinical Knowledge Summaries (June 2008)
• The management of dyspepsia in primary care, MeReC Briefing, No 32, 2006.
• Dyspepsia: Managing dyspepsia in adults in primary care, NICE Clinical Guideline (2004)

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20 Tips Home Remedies for Acid Reflux Disease or GERD

The Best Home Remedy to keep Acid Reflux at bay is eating a healthy diet that minimizes the production of stomach acid.

However, if you treat GERD with natural remedies, you get a more permanent solution because they heal the damage caused by refluxed stomach acid and also help restore the esophageal tissues to health. By treating these underlying causes, natural remedies will not only relieve the pain, they will also assure that the condition does not return.

1. Drink a glass of Fat Free Milk.

Drinking small amounts of chilled skim milk every one to two hours will ease the burning sensation associated with acid reflux.

2. Drink water.

Drink plenty of water throughout the day, especially after eating a meal or snack. Water will help the lower esophageal sphincter form a tight seal over the stomach by washing any food particles away.

3. Chew almonds.

A few almonds, taken in the morning and/or after meals, chewed very well, have been hailed as the new miracle treatment for acid reflux by some people.

4. Chamomille or fennel tea.

The soothing effects of chamomile or fennel tea are also known to provide acid reflux relief. The tea should best be sipped, not gulped, and should be of a moderate temperature, not too hot or cold.

5. Eat an apple.

Eating an apple after a meal has also been found to alleviate acid reflux. Choose organic apples and chew well.

6. Candied ginger.

Chew a piece when you're feeling the acid reflux kick in. You can also put a piece of candied ginger in your tea and let it sit for a bit before drinking it if you don't like eating candied ginger.

7. Apple cider vinegar.

Swallow two to three table spoons undiluted for an acute attack, or dissolve the same amount in warm water to drink to prevent acid reflux from recurring.

Look for organic apple cider vinegar with the "mother" in it. It looks like stringy globs of stuff floating around. This sounds disgusting, but the mother contains enzymes that can help with healing. Bragg's Apple Cider Vinegar, available at natural food stores, is usually recommended.

Shake up the apple cider vinegar to distribute the mother throughout the vinegar, and take one tablespoon before every meal. It can work in as little as three days, but usually it takes three to nine months to completely get rid of heartburn symptoms.

8. Papaya enzyme.

Available in the form of papaya enzyme pills, this enzyme has helped end acid reflux symptoms for some people.

9. Aloe.

Despite its consistency which takes some getting used to, aloe juice also is some acid reflux patients favorite remedy.

Aloe vera juice has been used in Europe for many years as a natural remedy for acid reflux. A quarter cup taken about 20 minutes before eating will help to soothe an irritated, inflamed esophagus.

Don't try to squeeze the gel out of the leaves if you have an aloe vera plant, as it contains aloe latex, which is a powerful laxative. Buy only aloe vera juice or gel that specifically says it's for internal use. It can be found at natural food stores.

10. Chew gum.

After your meals, chew sugarless gum for 30 minutes. This stimulates saliva production which in turn like water that you drink dilutes the contents of your stomach and helps wash down anything from your esophagus into your stomach.

11. Licorice

Deglycyrrhizinated licorice, or DGL, helps to stop heartburn by stimulating the production of the protective mucus that lines the digestive tract. This helps to protect the esophagus from stomach acid. It also boosts the immune system and is a very strong anti-inflammatory.

Take two 250-milligram capsules before each meal. Instead of taking DGL with water, it's best to suck on the capsules and let them slowly dissolve in the mouth. This helps the DGL to cover the inflamed tissues in your throat and esophagus.

It can take about four weeks to work, so don't give up too soon.

12. Ginger

Ginger is a very effective herb for digestive problems. It works by relaxing the smooth muscles on the esophagus walls, which helps to prevent acid reflux. You can use powdered ginger or fresh ginger root. Both are readily available at the supermarket.

If you're using ginger capsules, take two capsules twenty minutes before eating. Or you can make tea from the ginger root or the powder. Candied or pickled ginger is very effective, too.

Ginger can be too strong for people with sensitive stomachs. In this case, try ginger tincture. Dissolve 15 drops in a half-cup of water and drink it. If it's not strong enough, you can increase the dose up to 60 drops, but it's always better to start with a smaller dose first.

13. Glutamine

The last on the list of natural remedies for acid reflux is glutamine. This amino acid is an anti-inflammatory that reduces the irritation that goes along with heartburn. It works by encouraging the production of new cells in the gastrointestinal tract, while helping to dispose of damaged cells. Faster healing of irritated tissue in the digestive tract is the result.

14. Drink herbal tea made.

Drink herbal tea made with fennel seeds, lavender, and aniseed. To prepare the herbal tea, boil these ingredients in water, strain it into a glass, and add some honey to it.

Herbal tea is taken at night before going to sleep or at any time of the day to reduce acid reflux heartburn.

15. Honey

Swallow a few teaspoons of honey, especially before going to bed. Honey has been used as a healing agent for centuries. It coats the esophageal lining, protecting the damaged tissues from infection and soothing the pain.

16. Pineapples

Pineapple is an effective natural remedy for acid reflux (Sklar and Cohen, 2003). Pineapples contain an enzyme called bromelain among other proteases that are able to breakdown proteins, thus improving digestion and speeding up the natural healing process for acid reflux. Bromelain is only present in raw pineapple or in freshly made pineapple juice. Canned or bottled pineapple juice has bromelain that has been inactivated by heat, so it does not work. Actually, canned or bottle pineapple juice can make acid reflux worse.

17. Chicory Root Tea

Users of chicory root tea recognize it as an herbal remedy for acid reflux. Johnson (2001) mentions chicory as one of the effective herbal remedies against digestive problems such as dyspepsia. Half cup of chicory root should be boiled for 5 to 10 minutes. After cooling the tea is ingested to relieve acid reflux symptoms.

18. Grapefruit

Another natural remedy for acid reflux is grapefruit skin. Evidence of grapefruit skin as an herbal remedy is completely anecdotal so please use your judgment or ask your doctor. Grapefruit skin is dried and then chewed to alleviate acid reflux symptoms. Maybe the effect of this herbal remedy is due to the stimulation of the digestive system because of the chewing action. Organically grown grapefruits is preferable.

19. Lemon Balm

This herb has the homeopathic power to relax and sedate a nervous stomach when used as an infusion or tincture.

20. Peppermint

A nervous stomach and nausea can be treated when you add 15 grams of dried peppermint to 2 cups of water to create an effective infusion recipe. New mothers should refrain from this approach when breastfeeding because this remedy has been known to reduce milk flow.


When looking for ways to treat GERD permanently, the most important thing you can do is learn. You need to learn what is happening to your body and how your digestive tract works. By learning these things, you will have a much better chance of successfully treating this disease.

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Acid Reflux During Pregnancy

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Gastroesophageal reflux disease occurs in up to 50% of pregnant women. Many women experience heartburn for the first time during pregnancy — and though it's common and generally harmless, it can be quite uncomfortable.

Heartburn (also called acid indigestion or acid reflux) is a burning sensation that often extends from the bottom of the breastbone to the lower throat. It's caused by some of the hormonal and physical changes in your body.

During pregnancy, the placenta produces the hormone progesterone, which relaxes the smooth muscles of the uterus. This hormone also relaxes the valve that separates the esophagus from the stomach, allowing gastric acids to seep back up, which causes that unpleasant burning sensation. Additionally, the growing fetus causes an increase in intra-abdominal pressure, resulting in an increase in the development of reflux.

Progesterone also slows down the wavelike contractions of your esophagus and intestines, making digestion sluggish. Later in pregnancy, your growing baby crowds your abdominal cavity, pushing the stomach acids back up into the esophagus.

Many women start experiencing heartburn and other gastrointestinal discomforts in the second half of pregnancy. Unfortunately, it usually comes and goes until your baby is born.

It can be tough when you get pregnant. Acid reflux during pregnancy can be one problem that you will have to take care of. The discomforts are common when you are pregnant and some time you may even get pain. You can not use medicine since you are now pregnant. Most of medicines are not tested to the pregnant ladies to prove their safety. They can not do that. You have to bear in mind that using medicines is not safe.

What Causes Acid Reflux During Pregnancy?

Acid reflux during pregnancy can make it difficult for you to get the nutrition you need for yourself and your growing baby. The causes of acid reflux during pregnancy include changes in your hormone levels, the position of your internal organs and your dietary habits. What causes acid reflux during pregnancy.

1. Prenatal Vitamins. Taking prenatal vitamins may irritate your throat and stomach and cause you to have acid reflux.
2. Hormones. Heartburn during pregnancy occurs for a number of reasons. Increased levels of hormones in your body while pregnant can soften the ligaments that normally keep the lower esophageal sphincter (LES) tightly closed. If the LES relaxes at inappropriate times, food and stomach acids can reflux back up into your esophagus and throat. Also more pressure is put on your stomach as your body changes and your baby grows. This, in turn, can force stomach contents through the LES and into your esophagus.
3. Foods. Your food cravings during pregnancy may cause acid reflux, especially if you eat greasy, fatty or spicy foods.
4. Caffeine. Although you may not be drinking coffee while pregnant, the caffeine in chocolate, hot cocoa and black tea may cause you to have acid reflux.
5. Eating Too Much. During pregnancy, the capacity of your stomach is smaller and acid reflux may result from eating too much at once.
6. Fetal Position. The position of your baby may trigger your acid reflux, especially once your baby turns head down and the feet push into your ribs.
7. Uterine Growth. As your uterus gets larger in the last few months of pregnancy, it pushes your other internal organs into a smaller amount of space, resulting in acid reflux.
   

source : Mayo Clinic

How to prevent or Treat Acid Reflux during Pregnancy?

What can be done to prevent or treat gastroesophageal reflux disease in pregnancy? Lifestyle modifications can prevent increases in intra-abdominal pressure and decreases in lower esophageal sphincter pressure that promote reflux. Here's a list of both ways to prevent and treat gastroesophageal reflux in pregnancy. Though you may not be able to eliminate heartburn completely, you can take some steps to minimize your discomfort.

1. Don't eat foods that are known heartburn triggers. These include chocolate, citrus fruits and juices, tomatoes and tomato-based products, mustard, vinegar, mint products, and spicy, highly seasoned, fried, and fatty foods. For a complete list of foods to avoid, check out this chart. For foods that have a low risk of causing heartburn, check out this chart.
2. Avoiding caffeine (coffee, tea, cola), chocolate and peppermints. These food groups all lead to a decrease in lower esophageal sphincter pressure.
3. Avoid alcohol. Alcohol relaxes the LES. Read the article on alcohol and heartburn for more information.
4. Chewing gum. This increases saliva production and swallowing frequency, which can help clear away acid that has refluxed from the stomach into the esophagus. A clear reduction in acidic esophageal reflux has been documented in patients who chewed sugar-free gum for 30 minutes after a meal.
5. Avoid drinking large quantities of fluids during meals — you don't want to distend your stomach. (It's important to drink eight to ten glasses of water daily during pregnancy, but sip it between meals.)
6. Eating frequent, small meals. Eating smaller meals empties the stomach more rapidly. Eating more frequently increases stomach contractions. If the stomach is contracting and empty this will decrease the incidence of reflux. After meals, pregnant women are not supposed to lie down.
7. Don't eat close to bedtime. Give yourself two to three hours to digest before you lie down.
8. Don't rush through your meals. Take your time eating, and chew thoroughly.
9. Wait at least three hours after your last meal before going to bed.
10. It's important to drink plenty of water during pregnancy (8-10 glasses daily) along with other fluids, but don't drink these only at mealtimes. Large quantities of fluids can distend your stomach, putting more pressure on the LES and forcing it to open inappropriately. Drink some of your fluids in between meals.
11. You need to make your head higher than your body. Use the wedge pillow or elevate the head of your bed 6-8 inches higher. This means the two feet of your upper part must be elevated while sleeping. This will allow gravity to work for you and it will help keep your stomach acids where they should be--in your stomach and not in your esophagus. Acid reflux during pregnacy can be greatly reduced by the right sleeping position in the pregnant women. Studies have documented that, as compared with patients who sleep flat on their backs, patients who elevate the head of the bed have significantly fewer reflux episodes, and when they do, the episodes that do occur are shorter and produce generally milder symptoms.
12. Occasionally, reclining chair may be needed if you want a day nap.
13. Wear loose, comfortable clothing. You need to avoid any tightness around your waist and stomach.
14. Bend at the knees instead of at the waist. Bending at the waist puts more pressure on your stomach.
15. Lying on one's left side at night. Sleeping on the left side as opposed to the right side may reduce the frequency and duration of reflux episodes in patients prone to symptoms during the night. It is felt that there are more frequent episodes of decreases in lower esophageal sphincter pressure when patients lie on the left side as opposed to the right side.
16. Gain a sensible amount of weight and stay within the guidelines your doctor suggests. Too much of a weight, and obesity, puts more pressure on your stomach, and can force stomach contents through the LES and into your esophagus.
17. Don't smoke. While your doctor may urge you break the habit because you're pregnant, smoking can also increase your odds of experiencing heartburn. Read about smoking and heartburn to find out the reasons smoking increases heartburn.
18. You should always check with your doctor before taking any over-the-counter remedies while pregnant, but there are a few choices you have that can help eliminate heartburn.
19. You can try Rolaids, Maalox or Tums. However, anything that contains sodium bicarbonate can cause fluid retention and should only be used under the supervision of a physician. During the third trimester, any antacid that contains magnesium should be avoided because they have been known to interfere with contractions.
20. Antacids such as Mylanta and Maalox are effective and very safe as they are not absorbed into the bloodstream.
21. H2 blockers Zantac, Pepcid and Tagamet are effective. These medicines include Pepcid AC and Zantac. While they are absorbed into the bloodstream, studies have not revealed any adverse effects on the developing fetus. H2 receptors work by shutting off the production of acid in the stomach and are effective in cases of mild reflux. H2 receptors: They are relatively inexpensive and provide longer-lasting relief than antacids. Women take them a half-hour before meals or at bedtime.
22. Proton pump inhibitors Nexium, Aciphex and Prevacid should be used only in severe cases that are not responsive to H2 blockers. While they are felt to be safe, there are no long-term studies available confirming this.
    

In most cases, acid reflux is easily treated, even in pregnancy. If there are however, more refractory symptoms that result in complications such as gastrointestinal bleeding, difficulty swallowing or weight loss, your obstetrician may refer you to a gastroenterologist. Other conditions such as gallbladder disease, pancreatitis or even cancers of the esophagus and stomach can mimic gastroesophageal reflux disease.

Beware of:

* Tomatoes and Related Sauces (Pizza, Spaghetti, etc.)

* Ketchup

* Mustard

* Horseradish

* Salad Dressings

* Vinegar

* Fried Foods

* Caffeine

* Coffee and Tea (Even decaffeinated products can instigate acid production).

* Chocolate

* Citrus Juices/Foods

* Caffeine

* Products flavored with peppermint (candy, cocoa, etc.)

* Processed Meats

* Cream Sauces (Alfredo)

* Alcohol and Tobacco (Of Course)

Pregnancy is something to be celebrated but it can also be an overwhelming state. If you arm yourself with these remedies for acid reflux during pregnancy you’ll be prepared regardless of what Mother Nature throws your way.

Remember that an increased incidence of GERD episodes during pregnancy is quite common and there are many preventative measures that you can take to avoid those annoying and painful occurrences. The changes may seem small but, collectively, they will make a big difference.

Reflux Medications Taken During Pregnancy Linked to Asthma in Children
By : Jan Gambino

A new study indicates that moms who took reflux medications during pregnancy may increase the risk of having a child with asthma symptoms. The study, presented at the American Academy of Allergy, Asthma and Immunology this week examined the health records of 30,000 children. It was found that mothers who took prescription reflux medications such as H2 blockers (Zantac, Axid, Pepcid, and Tagament) and Proton Pump Inhibitors (PPI's) such as Nexium, Prevacid, Prilosec, and Aciphex were significantly more likely (51%) to have a child with asthma symptoms such as wheezing. The study did not look at the effect of taking over the counter antacid medications.

It is estimated that approximately half of all pregnant mothers experience reflux symptoms during pregnancy. However, my own survey of moms indicates that the statistic is closer to 100%! My small frame combined with over sized babies gave me my first real experience with what heartburn and reflux felt like. I remember eating like a bird and propping up my pillows at night so I could sleep. Along with stretch marks and hormone swings, I accepted heartburn as part of the package deal.


Sources:

- "Healthy Pregnancy - Pregnancy - Pregnancy Basics." U.S. Department of Health & Human Services. 21 Jan 2007

- "Heartburn, Hiatal Hernia, and Gastroesophageal Reflux Disease (GERD)." NIH Publication No. 03­0882 June 2003. NIH Publication No. 03­0882 June 2003. National Digestive Diseases Information Clearinghouse (NDDIC). 21 Jan 2007

- remedyforheartburn.
- healthcentral
- foxnews
- babycenter
- acid-reflux-tips

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Infant Acid Reflux Alternative Treatments

GInfants are being diagnosed and treated for reflux at an alarming rate these days. Prior to, or in addition to medicating your baby you may want to try some alternative treatments for infant reflux.



Positioning as an alternative treatment for infant reflux

Positioning is one alternative treatment that even Western Medicine recognizes. When feeding, the baby should be as upright as possible with a straight spine. Ideally the baby should be in this position for 30-60 minutes after feeding and while sleeping. Find out about reflux wedges that make this an easy task. We especially love the feeding and sleeping wedge combination. During the middle of the night feed the baby upright on a feeding wedge and then put him on a sleeping wedge. You go right back to sleep rather than holding him upright for 60 minutes!

Infant massage as an alternative treatment for infant reflux

In addition to general relaxation, it is believed that massage stimulates the vagus nerve. The vagus nerve increases peristalsis which assists in digestion. Seek a certified Infant Massage Instructor. When practicing massage, be sure to start slowly and listen to your baby. Never attempt to massage a baby without first referring to a book on infant massage. This is also a great way to calm a baby with infant reflux.

Craniosacral or Chiropractor visits as an alternative treatment for infant reflux

It is believed that the process of being carried in the womb or the process of birth (namely C-section or very quick vaginal delivery) can cause imbalances in the central nervous system. Craniosacral treatments are very light fingertip adjustments that correct restrictions in the membranes surrounding the brain and spinal cords. Chiropractor adjustments on infants are also very gentle adjustments on certain parts of the spine typically using a single fingertip or small tool to correct the vertebras positioning and allow the nerve pathways to function efficiently. I have heard of these treatments working with great success for some and with limited to no success for others. We saw moderate improvement in my son's infant reflux.

Slippery Elm as an alternative treatment for infant reflux

Slippery Elm has been used in traditional Chinese medicine as a treatment for gastrointestinal symptoms. It works by coating and soothing the gastrointestinal tract and throat. The theory is that this helps prevent burning that stomach acid can cause. The powder can be brewed into a tea and the capsules can be mixed in with applesauce once your baby begins to eat solids. See www.ajc.com for dosing guidelines and more background information. Because it is so mucilaginous it should not be offered at the same time as other medications. I used this with my son and believe it to be helpful. Please note this will not affect the frequency or amount your baby spits up but it helps to make him more comfortable when it does happen, much like an antacid or an H2RA.

Other alternative treatment mentions

I have heard of the following alternative treatments for infant reflux, although I have no experience with them:

• Mastica
• Aloe Vera juice
• Licorice
• Kinesiology
• Accupuncture
  

Resource:
- Pollywog

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Infant Acid Reflux Disease

Infant acid reflux occurs when acids and other materials in the stomach flow back into the esophagus. The esophagus is a muscular tube that connects the throat with the stomach. Normally, the esophagus contracts to move food from the throat into the stomach. A tough rim of muscle, called the esophageal sphincter, opens to allow food out of the esophagus, and then contracts tightly to prevent it from re-entering the esophagus. In infant acid reflux, the esophageal sphincter does not work properly, and the acid flows backwards into the esophagus, causing the infant discomfort. Acid reflux is not at all uncommon in infants--up to have of all babies may experience it occasionally.

Most of these babies are healthy and require no special medical intervention. Symptoms of occasional infant acid reflux may include spitting or vomiting, coughing, occasional fussiness or crying after eating (acid reflux can cause an unpleasant burning sensation in the chest and throat), and reluctance to feed due to discomfort.

What Are the Symptoms of Acid Reflux in Infants and Children?

The most common symptoms are:

• Frequent or recurrent vomiting
• Heartburn, gas, abdominal pain, or colicky behavior (frequent crying and fussiness)
• Regurgitation and re-swallowing
• Spitting up or gulping with a painful look on the face, as if heartburn
• Irritability during or after feedings
• Projectile vomit, sometimes out the nose
• Sour breath
• Persistent hiccups or cough
• Excessive fussiness, crying or colic
• Sudden bursts of painful crying
• Poor day and/or nighttime sleep habits
• Constantly wants to nurse or refuses to nurse
• Poor feeding habits - arches back, pulls up legs, stiffens or screams while feeding or refuses to eat while still hungry
• Prefers upright or inclined positions
• Always wants to be held

In young infants and children, some problems may be associated with GERD and include:

• Colic (frequent crying and fussiness)
• Feeding problems
• Recurrent choking or gagging
• Poor growth
• Breathing problems
• Recurrent wheezing
• Recurrent pneumonia
  

When to see a doctor?

Normal infant acid reflux doesn't interfere with a baby's growth or well-being. Contact your baby's doctor if your baby:

• Isn't gaining weight
• Spits up forcefully, causing stomach contents to shoot out of his or her mouth
• Spits up more than a tablespoon or two at a time
• Spits up green or brown fluid
• Resists feedings
• Is irritable after feedings but improves when held upright
• Has fewer wet diapers than normal or appears lethargic
• Has other signs of illness, such as fever, diarrhea or difficulty breathing
  

Some of these signs may indicate more serious conditions, such as gastroesophageal reflux disease (GERD) or pyloric stenosis. GERD is a severe version of reflux that can cause pain, vomiting and poor weight gain. Pyloric stenosis is a rare condition in which a narrowed valve between the stomach and the small intestine prevents stomach contents from emptying into the small intestine.

What causes Acid Reflux in infants ?

Reflux in infants is due to a poorly coordinated gastrointestinal tract. Many infants with the condition are otherwise healthy; however, some infants can have problems affecting their nerves, brain or muscles.

Normally, the ring of muscle between the esophagus and the stomach (lower esophageal sphincter) relaxes and opens only when you swallow. Otherwise, it's tightly closed — keeping stomach contents where they belong. Until this muscle matures, stomach contents may occasionally flow up the esophagus and out of your baby's mouth. Sometimes air bubbles in the esophagus may push liquid out of your baby's mouth. In other cases, your baby may simply drink too much, too fast.

Tests and Diagnosis

Diagnosis of infant acid reflux is typically based on your baby's symptoms and a physical exam. If your baby is healthy, content and growing well, tests and treatment aren't usually needed.

If your baby's doctor suspects a more serious condition, such as GERD, diagnostic tests may include:

1. Lab tests. Your baby's doctor may do various blood and urine tests to identify or rule out possible causes of recurring vomiting and poor weight gain.
2. Esophageal pH monitoring. To determine if irritability, sleep disturbances or other symptoms are associated with reflux, it may be helpful to measure the acidity in your baby's esophagus. The doctor will insert a thin tube through your baby's nose or mouth into the esophagus. The tube is attached to a device that monitors acidity. Your baby may need to remain in the hospital for the monitoring, which often lasts 24 hours.
3. Barium swallow or Upper GI series. If the doctor suspects a gastrointestinal obstruction, he or she may recommend a series of X-rays known as an upper gastrointestinal (GI) series. Before the X-rays, your baby may drink a white, chalky liquid (barium). The barium coats the stomach, which helps any abnormalities show up more clearly on the X-rays.
4. Upper GI Endoscopy. Your baby's doctor may use this procedure to identify or rule out problems in the esophagus, such as narrowing (stricture) or inflammation (esophagitis). The doctor will insert a special tube equipped with a camera lens and light through your baby's mouth into the esophagus, stomach and first part of the small intestine. Samples of any suspicious areas may be taken for analysis. For infants and children, endoscopy is usually done under general anesthesia.
   
5. Gastric emptying study. During this test, the child drinks milk or eats food mixed with a safe radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.
   

Treatments and drugs for Infant Acid Reflux

Most cases of infant acid reflux clear up on their own. Treatment is typically limited to simple changes in feeding technique — such as smaller, more frequent feedings, interrupting feedings to burp or holding your baby upright during feedings. If you're breast-feeding, your baby's doctor may suggest that you avoid cow's milk or certain other foods. If you feed your baby formula, sometimes switching brands helps.

For babies who have severe infant acid reflux or GERD, more aggressive treatment may be recommended.

1. Medication. If your baby is uncomfortable, the doctor may prescribe infant doses of medications commonly used to treat heartburn in adults. The two major pharmacotherapies are H2-blockers and proton pump inhibitors (PPIs), both of which are effective in decreasing acid secretion and have been used safely in children. H2-blockers include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid). PPIs include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix) or rabeprazole (Aciphex). Another group of drugs, prokinetics, can be prescribed to increase motility. These are usually given with medications that inhibit the acid. Examples are metaclopramide (Reglan) and cisapride (Propulsid). Antacids may be tried first in children with mild symptoms.
2. Alternative feeding methods. If your baby isn't growing well, higher calorie feedings or a feeding tube may be recommended.
3. Surgery. Rarely, the muscle that relaxes to let food into the stomach (the lower esophageal sphincter) must be surgically tightened so that less acid is likely to flow back into the esophagus. The procedure, known as fundoplication, is usually reserved for the few babies who have reflux severe enough to interfere with breathing or prevent growth. Although surgery can reduce GERD symptoms, the complications are potentially serious — including persistent gagging during feedings.
   

Resource:
- By Mayo Clinic staff
- Medicinenet.

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