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Stop AcidRefluxNow!

Revised October 2007

Stop Acid Reflux Now!

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Table of Contents

Introduction ________________________________________________________4

What are Acid Reflux, GERD and Heartburn? _______________________________ 4

What’s the Difference Between GER and GERD?____________________________ 7

Causes ________________________________________________________________ 7Being Overweight ____________________________________________________________8Pregnancy __________________________________________________________________9Hiatal Hernia ________________________________________________________________9Lower Esophageal Sphincter______________________________________________ 9Esophageal Contractions________________________________________________ 10Emptying of the Stomach_____________________________________________________10Genetics_____________________________________________________________ 10

Symptoms_____________________________________________________________ 10

The Impact of Acid Reflux, GERD and Heartburn _____________________13The Stressed _______________________________________________________________13Pregnant Women ___________________________________________________________13Over 50s ___________________________________________________________________14The Overweight _____________________________________________________________15Infants and Children _________________________________________________________15Symptoms indicative of Reflux Disease or GERD: _____________________________17

Medication Takers___________________________________________________________19Medications Used to Treat Asthma and Breathing Difficulties____________________20Medications Used to Treat Heart and Blood Pressure __________________________20Medications Used to Treat Arthritis and Inflammation __________________________20Medications Used to Treat Osteoporosis _____________________________________20Medications Used to Treat Anxiety, Insomnia, Depression, and Pain _____________21Medications Used to Treat Parkinson's Disease and Muscle Spasms ____________21Medications Used to Treat Cancer __________________________________________21Hormones _______________________________________________________________21

Complications _______________________________________________ 22

Anemia _______________________________________________________________ 22

Apnea ________________________________________________________________ 22

Asthma _______________________________________________________________ 22

Barrett's Esophagus ____________________________________________________ 23

Bleeding and Ulcers ____________________________________________________ 23

Coughing and Hoarseness ______________________________________________ 24

Eroded Dental Enamel __________________________________________________ 24

Esophageal Cancer_____________________________________________________ 24

Failure to Thrive________________________________________________________ 25

Fluid in the Sinuses and Middle Ears______________________________________ 25

Gagging and Choking___________________________________________________ 26

Inflammation and infection of the Lungs ___________________________________ 26

Inflammation of the Throat and Larynx ____________________________________ 26

Painful and Difficult Swallowing __________________________________________ 26

Sleep _________________________________________________________________ 27


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Diagnosing Acid Reflux, GERD and Heartburn _______________________28

Examination of the throat and larynx ______________________________________ 29

Endoscopy ___________________________________________________________ 259

Biopsy ________________________________________________________________ 29

Esophageal pH Probe___________________________________________________ 30

X-Rays________________________________________________________________ 30

Esophageal Acid Testing ________________________________________________ 30

Acid Perfusion Test_____________________________________________________ 32

Esophageal Motility Testing______________________________________________ 32

Gastric Emptying Studies________________________________________________ 32

Medications ___________________________________________________________ 34Antacids ___________________________________________________________________34Foaming Agents ____________________________________________________________35H2 Blockers_________________________________________________________________33Proton pump Inhibitors _______________________________________________________36Prokinetics _________________________________________________________________37

Surgery _______________________________________________________________ 37Fundoplication ______________________________________________________________36Potential Complications of Fundoplication ____________________________________39

Endoscopy _________________________________________________________________40

Lifestyle Changes ______________________________________________________ 41Eating Habits _______________________________________________________________41Smoking ___________________________________________________________________41Weight loss_________________________________________________________________41Alcohol ____________________________________________________________________42Relaxation__________________________________________________________________42Exercise ___________________________________________________________________42Dressing Sensibly ___________________________________________________________42Sleep ______________________________________________________________________43

Dealing With Stress_____________________________________________________ 43

Herbal Treatments______________________________________________________ 45

Digestive Enzymes _____________________________________________________ 49

Diet___________________________________________________________________ 50Food Table _________________________________________________________________53Recipes____________________________________________________________________55Breakfast ________________________________________________________________56Lunch ___________________________________________________________________57Main Courses ____________________________________________________________59Desserts_________________________________________________________________63

Pregnancy_____________________________________________________________ 67

Infancy________________________________________________________________ 69

Common Myths __________________________________________________ 71

GERD at a Glance ________________________________________________ 74

For More Information _____________________________________________ 77

Glossary __________________________________________________________79


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Introduction

What are Acid Reflux, GERD and Heartburn?

GERD, or gastro-esophageal reflux disease, is an alternative name for what

many people call acid reflux. It is a condition that occurs when your lower

esophageal sphincter doesn’t close properly and your stomach contents leak

back, or reflux, into your esophagus.

The lower esophageal sphincter, or LES, is a ring of muscle, which is at the

bottom of your esophagus - or gullet - that acts like a valve between your

esophagus and stomach. Your esophagus carries the food you eat from your

mouth to your stomach.

When refluxed stomach acid contacts the lining of your esophagus, it can

cause a burning feeling in your chest or throat known as heartburn. When this

fluid is tasted in the back of your mouth this is called acid indigestion. This

may inflame and damage the lining of your esophagus.

The regurgitated liquid usually contains acid and pepsin, an enzyme produced

in the stomach that begins the digestion of proteins. The refluxed liquid may

additionally contain bile that has backed-up into your stomach from your

duodenum, which is the first part of the small intestine that attaches to your

stomach. The acid is believed to be the most damaging part of the refluxed

liquid.

Heartburn usually feels like a burning pain in your chest, beginning behind

your breastbone and moving upward to your neck and throat. It can feel like

food is coming back into your mouth leaving an acidic or bitter taste. The

burning, pressure can last up to two hours, or longer and is often worse after

eating. Heartburn can also be caused by lying down or bending. The most

common remedy is to take an antacid that can help neutralize acid in the

stomach.


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Heartburn pain is sometimes mistaken for a heart attack, but there are a

number of differences. For example, a heart attack typically feels like your

chest is being squeezed or crushed with the pain extending up into the jaw

and back and can be accompanied by cold sweats. Exercise makes the chest

pain worse, whereas with heartburn the pain often gets worse with rest,

especially when lying down.

However, if you suspect a heart attack it’s important to seek medical attention

immediately.

Occasional heartburn is common, but this doesn’t necessarily mean that you

have GERD. If your heartburn occurs more than twice a week, a doctor will

often diagnose GERD, which can possibly lead to more serious health

problems.

Although heartburn is the most common symptom of GERD, you can have

GERD without having heartburn. Symptoms can include excessive clearing of

your throat; problems swallowing; the feeling that food is stuck in your throat;

a burning feeling in your mouth; or chest pain.

GERD may cause coughing, and other respiratory problems as well as

repeated vomiting in infants and children. Most infants grow out of GERD by

the time of their first birthday.

If you’ve been using antacids for over two weeks, you need to see your

medical practitioner. You may also need to visit a specialist - a

gastroenterologist— who treats diseases of the stomach and intestines.

Changes in your lifestyle and diet changes can help to relieve heartburn.

Some people who suffer from GERD also need medication, and surgery may

be a last resort solution.

No-one knows why some people who suffer from heartburn develop GERD.

Several factors are likely to be involved. GERD is a chronic condition, and

once it begins, it tends to last your whole life unless life style changes are

made. After medical treatment, the condition returns in most patients within a


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few months. Therefore, once treatment for GERD is started it usually needs to

be continued indefinitely unless it is managed through life style changes.

Reflux actually occurs in most individuals. The difference with GERD sufferers

is that reflux is experienced more frequently and as a result damage is often

caused to the esophagus.

During the day acid reflux can often be counteracted by the body’s natural

position and process. The refluxed liquid is more likely to flow back down into

your stomach. Also, while you are awake, you repeatedly swallow, whether or

not you have reflux. Each time you swallow refluxed liquid is carried back into

the stomach. The saliva glands in your mouth produce saliva, which contains

bicarbonate. This means that the bicarbonate-containing saliva that travels

down the esophagus neutralizes the small amount of acid that remains in your

esophagus. Because you swallow less when sleeping your saliva is reduced,

and reflux that occurs at night is more likely to cause acid to remain in the

esophagus longer, potentially causing damage.

Some people are more susceptible than others to GERD. For example, it can

be a serious problem during pregnancy. Higher hormone levels and the

growing fetus increasing pressure in the abdomen contribute towards this.

About twenty-five million adults suffer from heartburn daily. Twenty-five per

cent of pregnant women experience daily heartburn and more than half per

cent have occasional problems. Over sixty million Americans experience

heartburn at least once a month. Recent studies show that GERD in babies

and children is more common than was previously recognized and may

produce a variety of problems. In the following sections, we’ll look at GERD in

more detail, and the various options for managing this condition.


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What is the Difference Between GER and GERD?

The term reflux is an alternative way of referring to GER (Gastro Esophageal

Reflux). When someone is referred to as having GER, it means that they have

a benign condition in which they have frequent reflux episodes. This may also

be called "functional GER" and it doesn’t cause complications, lead to long

term problems, affect growth or development in babies or always require

medical attention. GER can range from reflux material in the esophagus to

spitting up and sometimes frequent projectile vomiting in babies. Projectile

vomiting alone is not a complication. GER is referred to as GERD when

complications arise. However, the terms are often used interchangeably. In

secondary GER, there is an underlying cause of the reflux episodes.

Examples of secondary GER are food allergies, metabolic disorders and

infections.

Silent GER refers to GER or GERD without any obvious or typical symptoms.

It means that someone isn't vomiting or appearing uncomfortable but is having

episodes of reflux. Some children swallow refluxed material back down

instead of throwing it up. This can be much more difficult to diagnose as the

most common symptoms aren’t present. Additionally, it can be more

damaging. Whether or not a child’s silent reflux needs to be treated depends

on the complications that arise from it.

Causes

No one knows why some people suffer with GERD and others don’t. However,

some factors that may contribute to GERD include:

� Drinking alcohol

� Being overweight

� Being pregnant

� Smoking


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Also, certain foods are associated with reflux occurrences including:

� Citrus fruits

� Chocolate

� Drinks with caffeine

� Fatty and fried foods

� Garlic and onions

� Mint flavorings

� Spicy foods

� Tomato-based foods

For a more comprehensive list please refer to the food table on page 50.

There are multiple causes, and different causes can be apparent in different

people or in the same individual at different times. A few people with GERD

produce abnormally large amounts of acid, however, this is not common.

Some factors that contribute towards GERD are hiatal hernias, lower

esophageal sphincter abnormalities, esophageal contractions, and slow

emptying of the stomach. Alcohol and smoking relax the LES, and therefore

can contribute to GERD as this allows the stomach contents to escape more

easily.

Being Overweight

People who are obese - in other words those who have a body mass index

greater than thirty - have been found to be almost three times more likely to

develop esophageal cancer than those with healthy body weight. (BMI is a

measure of a weight in relation to height.) Esophageal cancer can be a

complication of GERD.

Exactly how excess body weight increases the likelihood of GERD is unclear.

A possibility is that excessive weight in your abdomen compresses your


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stomach and raises the pressure inside, leading to reflux. In addition, obesity

can contribute towards the release of inflammatory substances that can raise

the risk of GERD. Diet plays a large role in the development of GERD and

fatty foods are high risk foods that commonly trigger acid reflux.

Pregnancy

Higher hormone levels in pregnancy cause reflux by lowering the pressure in

the LES as well as the growing fetus increases pressure in the abdomen. The

combination of these factors often increases reflux. Women with diseases that

weaken the esophageal muscles become more prone to develop GERD. It

usually begins in the first or second trimester of pregnancy and continues until

delivery. For many women, the heartburn is mild and intermittent; with others

it may be severe. The symptoms often disappear after delivery.

Hiatal Hernia

A hiatal hernia occurs when the upper part of the stomach bulges above your

diaphragm, the muscle wall that separates your stomach from your chest

cavity. The diaphragm helps the LES prevent acid from coming up into your

esophagus. With a hiatal hernia, it’s easier for acid to reflux. A hiatal hernia

can occur in people of any age, however it is more common in people over the

age of fifty. Sudden physical exertion, straining, coughing, or vomiting can

cause increased pressure in your abdomen resulting in hiatal hernia. Obesity

and pregnancy are also contributory factors. Hiatal hernias don’t always need

treatment.

Lower Esophageal Sphincter

Studies have shown that many GERD suffers have various abnormalities of

the LES. Common problems include an abnormally weak contraction of the

LES that reduces its ability to prevent reflux. Another is abnormal relaxations

of your LES, called transient LES relaxations. They don’t tend accompany

swallows, and can last for up to several minutes. These allow reflux to occur

more easily. They occur most commonly after meals when your stomach is


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distended with food and allow trapped air to escape in the form of burping. A

further problem is laxity of the LES. This allows easier opening of the LES and

a greater backward flow of acid.

Esophageal Contractions

Swallowing causes a wave of contraction of the esophageal muscles,

narrowing the inner cavity of the esophagus. This contraction begins in the

upper part of the esophagus and travels to the lower esophagus. It pushes

food and saliva down the esophagus into your stomach. When this contraction

is defective, refluxed acid is not pushed back into your stomach, therefore

staying in the esophagus for longer and increasing the risk of damage.

Emptying of the Stomach

Most reflux during the day occurs after meals. This reflux probably is due to

transient LES relaxations caused by your stomach being distended with food.

Some GERD sufferers have stomachs that empty abnormally slowly after a

meal. This prolongs the distension of their stomach with food after meals. The

slower emptying prolongs the time during which reflux is more likely to occur.

Genetics

It’s unclear whether GERD is inherited. The fact that members of the same

family often experience symptoms could be due to inherited genes, or it could

be due to their shared environment. Recent studies have shown that inherited

genes are likely to be an important cause of GERD, but non-genetic factors

are responsible for most cases.

GERD/Acid Reflux Symptoms

The main symptoms are recurring heartburn and the regurgitation of acid.

Some people suffer from GERD without heartburn. Instead, they feel chest

pain or hoarseness in the morning, or have trouble swallowing. It can feel like


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food is stuck in your throat, as if you are choking, or your throat is tight. GERD

may also cause bad breath and a dry cough. Some people also suffer from

nausea. In infants and children, it may cause episodes of vomiting, coughing,

and respiratory problems. Most babies grow out of GERD by their first

birthday.

Heartburn

Heartburn, also known as acid indigestion, is the most commonly experienced

symptom of GERD and often feels like a burning chest pain beginning behind

your breastbone and moving upwards to your neck and throat. Many sufferers

say it feels like food is coming back into their mouth leaving an acid or bitter

taste. Some people suffer a sharp or pressure-like pain rather than burning. It

can also extend to the back.

The pain of heartburn can last for two hours or more and is often more severe

after eating. It also tends to be worse at night or when lying down or bending

over. As acid reflux is more common after meals, heartburn is more likely to

occur after meals. Heartburn commonly strikes when you lie down because

acid that escapes into the esophagus returns to your stomach more slowly

without the aid of gravity. Relief can be obtained by standing up, propping

yourself up with pillows or by taking an antacid.

Episodes of heartburn tend to happen periodically. The episodes can be

frequent or severe for a several weeks or months, and then ease or disappear

for several weeks or months. However, heartburn tends to be a life-long

problem, and usually returns.

Regurgitation

Regurgitation is when refluxed liquid returns to the mouth. However, often

only small quantities of liquid reach your esophagus, with the majority of the

liquid remaining in your lower esophagus.

http://www.naturally-stop-acid-reflux.com/freshbreath.html


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Occasionally, larger quantities of liquid, sometimes containing food reach your

upper esophagus. When small amounts of refluxed liquid enter your throat,

your may experience an acid taste in your mouth. With larger quantities, you

may suddenly find your mouth filled with the liquid. Frequent or prolonged

regurgitation can lead to dental damage.

Nausea

Nausea is a less common symptom. However, some people suffer from

frequent or severe nausea, sometimes resulting in vomiting. In cases of

unexplained vomiting or nausea, GERD is usually one of the first conditions

suspected.

GERD can potentially lead to complications and cause conditions as serious

as cancer – more about these later on. If symptoms have persisted after two

weeks of using antacids, or you have unexplained nausea or vomiting, you

should see your doctor.


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The Impact of Acid Reflux, GERD and Heartburn

Who can Suffer From Acid Reflux?

The Stressed

About fifty-eight per cent of those who suffer frequent heartburn say that their

hectic lifestyle is a factor in their flare-ups. Over half of all heartburn sufferers

say that work-related stress increases their heartburn. Although stress hasn't

been directly linked to heartburn, it can lead to behavior that can triggers

heartburn.

During stressful times, people may not follow normal routines when it comes

to meals, exercise, and medication. By alleviating stress, you can make

stress-related heartburn less likely. Regular exercise helps to lower stress and

helps with digestion. Sleeping seven to eight hours each night will help to

keep your stress level lower as studies show that sleep-deprived people have

higher stress levels. Stress can also affect digestion by slowing it down. If

food lingers in the body too long it can enhance the effects of reflux.

Pregnant Women

Heartburn occurs in a quarter to half of all pregnant women. It tends to begin

in the first or second trimester and continues throughout the pregnancy. For

most women, the heartburn is usually mild and intermittent, but in some it can

be severe.

Complications of GERD in pregnant women are uncommon, however the

usual medications may not be safe in pregnancy, so alternative solutions may

need to be found.

The reason why acid reflux is common in expectant mothers is because the

LES can weaken during pregnancy. This is an effect of the change in levels of


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hormones (estrogen and progesterone) that forms part of pregnancy. This

weakness usually resolves itself after delivery.

It’s unknown if the contraction of the esophagus above the sphincter is

impaired in pregnancy by the baby and whether this is responsible for

delaying acid clearance from the esophagus back into the stomach. The

distortion of the organs in the abdomen along with increased abdominal

pressure caused by the growing fetus also acts to promote the reflux of acid.

Management of GERD during pregnancy involves many of the same

principles as treatment for non-pregnant individuals. Lifestyle changes are

particularly important. The head of the bed should be raised or six to eight

inches with wedge-shaped foam rubber pads used to elevate the upper body.

The wedges should extend all the way to the waist so that the entire chest is

elevated. Lying on the left side at night may also decrease acid reflux as this

promotes the clearance of acid from the stomach. Any specific foods that

aggravate heartburn should be avoided.

Over 50s

Up to twenty per cent of adults aged fifty-five to seventy-four suffer from

GERD. Reflux is more common in this age range because of the physiological

changes that time brings. The wave-like motions of the esophagus — that

push down food — may not be as powerful as they used to be. Aging can also

weaken the LES. Mature sufferers are also almost twice as likely to develop a

hiatal hernia, which can lead to acid reflux symptoms.

Other factors that can impair the LES include medications prescribed to

mature patients for other conditions, such as nitroglycerine (for angina),

calcium channel-blockers (for high blood pressure) and beta-agonists (for

asthma).

Erosive esophagitis (where the esophagus becomes inflamed, damaged and

bleeds) and other GERD complications occur more frequently in the over 50’s

age range. They frequently have impaired motility of the esophageal muscles,

http://www.naturally-stop-acid-reflux.com/mattress-adjuster.html


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decreased saliva volume, hiatal hernias, take medications that may reduce

the strength of the sphincter, and are more likely to do less physical exercise.

The Overweight

People who are overweight (defined by a body mass index of 25 to 30) are

almost one and a half times as likely to develop GERD symptoms, while

people who are obese (a body mass index of 30+) are nearly twice as likely to

develop symptoms in comparison with those with a healthy body weight. Also,

obese people are almost three times more likely to develop esophageal

cancer than those with a healthy body weight. The risks increase with

increasing weight.

Popular opinion has associated heartburn with being overweight for a long

time, and most medical practitioners find this to be valid. Heartburn is often

caused by eating the wrong types of foods and can occur because of

overeating. Even small weight changes can increase the risk of heartburn.

Losing weight is a factor in managing heartburn, and as little as ten per cent

decrease in weight has been shown to improve heartburn symptoms.

However, weight loss does not guarantee symptoms will subside. Some

studies have shown that heartburn sufferers continue to experience symptoms

even after major weight loss. Therefore, weight loss alone may not be enough

to resolve symptoms for everyone.

Infants and Children

Reflux can occur when babies cough, cry, or strain. The majority of infants

with GERD are happy and healthy even if they spit up or vomit. More than half

of all babies experience reflux during their first three months of life.

An infant with reflux may experience:

� Constant or sudden crying or colic like symptoms

� Spitting


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� Vomiting

� Irritability

� Coughing

� Poor feeding

� Blood in their stools

� Irritability and pain

� Arching their necks and back during or after eating

� Poor sleep habits typically with frequent waking

� Spitting-up

� Wet burp or frequent hiccups

� Frequent ear infections or sinus congestion

An infant doesn’t need to exhibit all of these symptoms, in fact, only displaying

one of the above could mean they have reflux. This does not necessarily

mean that they need treatment. If your infant shows one or more symptoms,

but otherwise is happy and healthy, then some lifestyle modifications will help

until they outgrow it.

GERD is common and can be overlooked in children. It can cause vomiting as

well as coughing, and other respiratory problems. Children's immature

digestive systems are usually the cause, and most infants grow out of GERD.

Only a minority of infants suffers severe symptoms and most infants stop

spitting up between the ages of twelve to eighteen months.

Occasionally, babies have other symptoms that can cause concern including:

� Poor growth because of not holding down enough food

� Irritability


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� Refusing to feed due to pain

� Blood loss from acid burning the esophagus

� Breathing problems

The above problems can be caused by a number of disorders. Your doctor

needs to determine what is causing your child's symptoms. If the child is

healthy, happy, and growing well, tests or treatment may be unnecessary. Any

treatment depends on the infant's symptoms and age, and can include

changes in eating and sleeping habits. Medication may sometimes be an

option or even surgery in severe cases.

Symptoms indicative of Reflux Disease or GERD:

� Refusing food

� Accepting only a few bites of food despite being hungry

� Requiring constant small meals or liquid

� Food or oral aversions

� Anemia

� Excessive drooling

� Running nose

� Sinus infections

� Swallowing problems

� Gagging

� Choking

� A chronic, hoarse voice

� Frequent red and sore throat without an infection being present

� Apnea


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� Chronic ear infections

� Respiratory problems such as pneumonia, bronchitis, wheezing,

asthma, night-time cough, aspiration

� Gagging themselves with their fingers or fist (sign of esophagitis)

� Poor weight gain

� Weight loss

� Failure to thrive

� Dental enamel erosion

� Neck arching (Sandifer's syndrome)

� Bad breath

Because infant reflux is so common, reflux is often diagnosed simply by

child’s symptoms alone. Some doctors prefer to have tests done before

prescribing medication.

Some babies appear to have been outgrowing their reflux when their

symptoms return. Teething can irritate reflux as can colds, ‘flu, and other

common illnesses. At other times, reflux can get worse for a day or more with

no apparent reason.

Every baby is different, and it's difficult to pinpoint a single specific formula

that is the best to use when they have reflux. If your baby has a milk allergy

or sensitivity then giving a soy based or hypoallergenic formula may help their

reflux improve.

Hypoallergenic formulas are pre-digested (partially or completely) and they

tend to move through the stomach faster than standard formulas. Breast milk

is often the best option for reflux. Its proteins are more hypoallergenic than

those of formula and it's more easily digested.


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Babies with reflux are notorious for being poor sleepers. Propping them up

can be helpful, as can small frequent meals and not feeding them too close to

bedtime.

The treatment chosen depends on the infant's symptoms and age. Some

babies may not need treatment, because the condition often resolves by itself.

Healthy and happy babies may only need their food thickened with cereal and

to be kept upright after being fed. Overfeeding can worsen reflux, so your

doctor may suggest different ways of handling feeding. For example, smaller

quantities and more frequent feeding can help to decrease the chances of

regurgitation. If a food allergy is suspected, you may need to change your

baby's formula, or to modify your diet if you are breastfeeding. If a child isn’t

growing well, food with a higher calorie content or tube feeding may be

recommended.

Medication Takers

Heartburn can be brought on or worsened by many different medications. Let

your doctor know if you suffer from heartburn or if your heartburn worsens

when you begin a new medication.

It’s a good idea to keep a record of when you began to experience your

symptoms as well as when you started taking any new medication. This

applies whether it’s a prescription or non-prescription medication. If the

offending medication can’t be stopped, alternatives could be available. You

may be able to switch to another medication less likely to contribute towards

heartburn.

People who suffer from reflux should be aware of another pill-related problem.

If a pill became lodged in the esophagus, it could cause injury to its lining.

This can lead to ulcers and narrowing of the esophagus. Drugs most likely to

do this are certain antibiotics (particularly tetracycline); potassium

supplements; quinidine and alendronate. Anti-inflammatory agents can also

have this effect. It’s worth being careful with any pain medication. Always take


20

a full glass of water to wash pills down and don’t lie down for half an hour to

an hour after taking them.

Medications Used to Treat Asthma and Breathing Difficulties

Theophylline, and other medication used for asthma and breathing difficulties,

can lead to a weakening of the LES, which makes it easier for stomach acid to

reflux into your esophagus. Some people taking these medications -

especially theophylline – suffer from heartburn. Using an inhaler may be less

problematic.

Medications Used to Treat Heart Conditions and Blood Pressure

Medications commonly used to treat heart conditions and high blood pressure,

for example, calcium channel blockers (diltiazem, nifedipine); beta-blockers

(propranolol, atenolol); alpha-blockers (prazosin); and nitrates (isosorbide

dinitrate, nitroglycerin) can also relax the LES increasing your risk of reflux.

Medications Used to Treat Arthritis and Inflammation

All non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen,

and those available without a prescription, may cause or worsen heartburn.

Cyclooxygenase-II inhibitors (celecoxib) are also associated with heartburn.

Low dosages of aspirin or NSAID aren’t likely to produce this side effect.

Medications Used to Treat Osteoporosis

Bisphosphonates, for example, alendronate (Fosamax) and risedronate

(Actonel), along with other medications used to treat osteoporosis, may injure

the lining of your esophagus and lead to heartburn. If you take these

medications, be sure to take them with a full glass of water and don’t lie down

for half an hour to an hour after swallowing them. Taking precautions reduces

the chance of these medications causing any injury to your esophagus.


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Medications Used to Treat Anxiety, Insomnia, Depression, and Pain

Some medications that act on the nervous system may contribute to

heartburn. Anti anxiety medications and agents used to treat insomnia, for

example, diazepam or lorazepam, antidepressants including the tricyclic

antidepressants such as amitriptyline, and narcotics such as morphine and

merpidine used to treat pain, may all cause or worsen your heartburn by

relaxing the LES.

Medications Used to Treat Parkinson's Disease and Muscle Spasms

Some anti-Parkinson medications containing levodopa and anti-spasmodics,

such as dicyclomine or glycopyrrolate, may increase reflux and heartburn by

causing your LES to relax when it needs to be closed.

Medications Used to Treat Cancer

Some drugs used to treat cancer may cause heartburn, indigestion, and

nausea. Those receiving cancer chemotherapy may require additional

medication to relieve heartburn and indigestion as well as medication to treat

nausea.

Hormones

Certain hormones, such as progesterone, a hormone contained in some birth

control pills, may contribute to heartburn symptoms by decreasing LES

pressure.


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Possible Complications

Anemia

Anemia can be caused by blood loss and is defined as a drop in hemoglobin

count. Reflux can lead to anemia by damaging your esophagus causing it to

bleed.

Apnea

Apnea refers to a pause of more than ten to twenty seconds during breathing.

People who have GERD are susceptible to apnea episodes. The exact cause

is not known however there are a number of theories. One theory is that sleep

apnea can change the pressure within the lungs and gastrointestinal systems,

possibly resulting in some of the stomach contents to be drawn up into the

esophagus. Another theory is that irritation of the esophagus due to reflux

could cause airway spasms that lead to sleep apnea.

Asthma

More than seventy-five per cent of people with asthma also have GERD or

reflux and asthma sufferers are twice as likely to have GERD as people

without asthma do.

When asthma is diagnosed, the possibility of reflux should be also be

investigated. Some sufferers don’t display any symptoms of reflux and are

referred to as having silent reflux. The only symptom may then become

asthma and the link between reflux and asthma may not be realized. This

means that their asthma can be difficult to control with normal medication.

One possibility as to why reflux makes asthma worse is that the acid refluxing

up your esophagus can enter the airways, especially when lying down. This

can cause your airways to narrow and create wheezing and shortness of


23

breath. Over time, your airways can become damaged from the refluxing acid,

worsening asthma symptoms. Also, acid present in the lower part of your

esophagus can stimulate nerve endings, causing the muscle in your airways

to contract, narrowing breathing tubes and promoting asthma symptoms.

Some indications that asthma may be caused by reflux are:

� Asthma symptoms get worse after eating, particularly after eating high

fat foods

� Asthma like symptoms appear with any other typical or atypical

symptoms of reflux

� A persistent cough, which is worse when you lie down

Barrett's Esophagus

Long-standing or acute GERD can cause changes in the cells that line your

esophagus. These cells become pre-cancerous, and, may develop into

cancerous cells. This condition is called Barrett's esophagus, which occurs in

about ten per cent of acid reflux sufferers.

Barrett's esophagus can be diagnosed through an endoscopy and confirmed

by a biopsy. If you have this condition, you are advised to have occassional

surveillance endoscopies, to detect any pre-cancerous changes so that

cancer-preventing treatment can be started. Early treatment and prevention of

GERD prevents the progression of Barrett's esophagus to cancer. Newer

experimental techniques that destroy the Barrett's cells may also prevent the

progression to cancer. Thankfully, only a minority of those with Barrett’s

esophagus go onto develop cancer. The standard treatment for early cancers

in this case is surgical removal of a portion of your esophagus.

Bleeding and Ulcers


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Liquid refluxing from your stomach into your esophagus can damage the cells

lining your esophagus. An ulcer occurs when the lining breaks down and

inflammation and bleeding starts. Ulcers, and the accompanying inflammation

they cause, may erode into your esophageal blood vessels and cause

bleeding in your esophagus. Sometimes the bleeding is severe and requires

blood transfusions and surgical treatment.

You should seek immediate medical attention if you start coughing up or

vomiting blood or your stools take on a black, tarry appearance.

Coughing and Hoarseness

GERD is a common cause of unexplained coughing. In the same way that

acid refluxed from the stomach can damage your esophagus and lungs, it can

also damage your throat and vocal cords. Sometimes, this might be the only

symptom of GERD, which makes it more difficult to diagnose.

There are a number of nerves in your lower esophagus. Some of these nerves

are stimulated by refluxed acid resulting in heartburn. Other nerves don’t lead

to heartburn, rather they stimulate yet more nerves that provoke coughing.

This means that refluxed liquid can cause coughing without ever reaching

your throat.

Eroded Dental Enamel

Some GERD / Acid Reflux sufferers experience regurgitation. This can be just

liquid or liquid and food. Occasionally this can reach the mouth and when

stomach acid that enters your mouth, it can erode your teeth, just as it does

your esophagus, throat and vocal cords.

Esophageal Cancer


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The type of cancer associated with Barrett's esophagus is increasing in

frequency. Twelve to eighteen thousand new cases of Esophageal cancer are

diagnosed per year in the US.

One type of esophageal cancer, adenocarcinoma, accounts one-third to one-

half of esophageal cancers and is mainly found in Caucasian men.

Adenocarcinoma has been increasing steadily in the US and Western Europe.

It has been estimated that Barrett’s esophagus might be responsible for half of

all adenocarcinomas. However, adenocarcinoma can occur without the

changes of Barrett's esophagus.

Failure to Thrive

Newborns and young babies are expected to grow at a steady and predictable

rate, more rapidly than when they get older. Sometimes babies don’t gain

weight at an acceptable or safe rate and fall below the acceptable low end of

the scale. These babies are diagnosed as having failure to thrive.

Failure to thrive can have many different causes. GERD can cause failure to

thrive in a few ways. Frequent or constant vomiting makes weight gain, or

maintaining current weight, difficult or impossible. Even without vomiting,

some babies begin to associate food with pain and unpleasantness and

develop a dislike of eating. Occasionally, some children are so fearful of food

that only tube feeding can provide them with nourishment.

Fluid in the Sinuses and Middle Ears

Refluxed liquid that enters your upper throat can inflame your adenoids

causing them to swell. Swollen adenoids can block the passages from your

sinuses and Eustachian tubes (middle ear). When your sinuses and middle

ears are closed off from your nasal passages by your adenoids swelling, fluid

accumulates in them. This accumulation can lead to discomfort in your

sinuses and ears. Because the adenoids are more prominent in young

children, this is usually seen in children and not adults.


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Gagging and Choking

Babies and children with GERD seem to have a stronger gag reflex than other

children and they may frequently gag and choke on their food. They may also

gag and choke for no apparent reason, probably from refluxed material

coming part of the way up.

Inflammation and infection of the Lungs

Refluxed liquid can enter your lungs, called aspiration, which often results in

coughing and choking. Aspiration, however, can occur without producing

these symptoms. It can lead to infection of your lungs resulting in pneumonia.

This sort of pneumonia is serious and requires immediate treatment.

When aspiration is unaccompanied by symptoms, it can result in a slow,

progressive scarring of your lungs, which may be observed on chest x-rays.

It’s more likely to occur at night, as that is when the bodily processes that

protect against reflux and the coughing reflex are not active.

Inflammation of the Throat and Larynx

If refluxed liquid gets past your upper esophageal sphincter it can enter your

throat and even your voice box. The resulting inflammation can lead to a sore

throat and hoarseness.

Painful and Difficult Swallowing

Scars from tissue damage can narrow your esophagus and make swallowing

difficult. This is called a stricture. The scar tissue is thicker than the normal

lining of the esophagus causing a narrowing of the esophagus that can

prevent food and even liquids from passing through. Strictures can be

surgically corrected.


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Sleep

Reflux commonly impacts on the quality of sleep with many sufferers

experiencing their worst symptoms when lying down. Some sufferers, who

have respiratory problems worsened by acid reflux, may not show heartburn

symptoms.


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Diagnosing Acid Reflux, GERD and Heartburn

The usual way that GERD is diagnosed is by its characteristic symptom -

heartburn. To confirm a diagnosis, doctors commonly treat patients with

medications to suppress the stomach’s acid production. If heartburn is

diminished to a large extent, the diagnosis is confirmed.

There are problems with this approach because it does not include diagnostic

tests. Patients who have conditions that can mimic GERD – for example,

duodenal or gastric ulcers - may also respond to this treatment. If the doctor

assumes that the problem is GERD, they won’t look for the cause of the ulcer

disease.

An infection called Helicobacter pylori, or non-steroidal anti-inflammatory

drugs (ibuprofen), can also cause ulcers. These conditions would be treated

differently from GERD. There is also a placebo effect, which means that some

patients will respond to any treatment. This means that those who whose

symptoms are caused by something other than GERD (or ulcers) can feel a

decrease in symptoms after receiving treatment for GERD. These patients

then will be treated for GERD, even though they don’t have GERD and the

true cause of their symptoms won’t be pursued any further.

Typically, the first test done to diagnose reflux is not always the most reliable.

Negative results are common with children who do have reflux. This is

because the child needs to actually reflux during the test to produce a positive

result. The test is more valuable for determining anatomic abnormalities within

the digestive system.

If your heartburn does not improve with changes in lifestyle or drug treatment,

you may need additional tests.


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Examination of the throat and larynx

Sufferers with symptoms of cough, hoarseness, or sore throat, often visit an

ear, nose, and throat (ENT) specialist. The specialist frequently finds signs of

throat or larynx inflammation. Although diseases of your throat or larynx are

usually the cause of the inflammation, sometimes it can be due to GERD.

Therefore, acid-suppressing treatments are generally tried to confirm the

diagnosis.

Endoscopy

After a spray to numb your throat, a small flexible tube with a tiny camera

(called an endoscope) is inserted through your mouth and then down into your

esophagus and stomach. This is used to examine the lining of your stomach,

esophagus, and part of your small intestine. Most patients with symptoms of

reflux have a normal looking esophagus, and therefore endoscopy won’t help

in the diagnosis of GERD. If the procedure reveals injury to your esophagus,

no other tests are usually needed. Endoscopy will identify several of GERD’s

complications, including, ulcers, strictures, and Barrett's esophagus. Other

problems that may be causing similar symptoms to GERD can also be

diagnosed.

Biopsy

Biopsies can be painlessly obtained during an endoscopy. A biopsy is a small

sample of tissue that is extracted and then examined with a microscope for

signs of inflammation and other problems. A biopsy can reveal acid reflux

damage and rule out other problems if no infecting organisms or abnormal

growths are present. Biopsies are the way to diagnose the cellular changes of

Barrett's esophagus.


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Esophageal pH Probe

This method is often used when diagnosing infants. A light, thin wire with an

acid sensor at its tip is inserted through your nose and into the lower part of

your esophagus. The probe is used to detect and record how much stomach

acid comes back up into your esophagus. It can also tell if acid is in the

esophagus when a child has symptoms such as crying, arching their back, or

coughing.

X-Rays

Before endoscopy was introduced, an x-ray of the esophagus was the only

means available of diagnosing GERD. Barium solution – a white, chalky liquid

- is swallowed and a series of fluoroscopic x-rays taken at intervals over about

fifteen to twenty minutes. The barium highlights, or outlines, your esophagus,

your throat and your upper intestines, allowing the doctor to view food as it

travels down your esophagus, into your stomach and into the first part of your

small intestines. A problem with this method is that it is an insensitive test. In

other words, it fails to find signs of GERD in many patients because they had

little or no damage to the lining of their esophagus. X-rays are only able to

show some complications of GERD, such as ulcers and strictures. They are

most useful when evaluating complications.

Esophageal Acid Testing

To show whether acid is present in the esophagus and for how long a twenty-

four hour esophageal ph test. (Ph is how the amount of acidity is expressed)

is carried out.

A small tube (catheter) is passed through your nose and positioned in your

esophagus. It has a sensor to sense acid on its tip. The other end of the

catheter exits from your nose, wraps back over your ear, and travels down to

your waist, where it is attached to a recorder. Whenever acid refluxes back


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into your esophagus from your stomach, it stimulates the sensor. The recorder

then records the episode of reflux. After twenty to twenty-four hours, the

catheter is removed and the record analyzed. While the testing is being done,

you record each time you experience symptoms. It can then be worked out

whether acid reflux occurred at the same time that the symptoms were

present.

There are problems with this method. It is not enough alone to confirm the

presence of GERD. Ph testing is useful in managing GERD. The test can help

determine why symptoms do not respond to treatment. If testing reveals

substantial reflux while medication continues, then the treatment is ineffective

and needs to be changed. If testing reveals good acid suppression with

minimal reflux of acid, a diagnosis of GERD may be incorrect and other

causes for the symptoms can be considered. If reflux occurs at the same time

as the symptoms, then it is likely to be the cause of those symptoms.

A relatively new method for prolonged measurement - over forty-eight hours -

of acid exposure in your esophagus uses a small, wireless capsule attached

to your esophagus just above your LES. The capsule is passed to your lower

esophagus by a tube inserted through either your mouth or nose. After the

capsule is attached to your esophagus, the tube is removed.

The capsule measures acid refluxing into your esophagus and transmits its

information to a receiver worn at your waist. The capsule falls off the

esophagus after three to five days and is passed in a stool. The advantage of

this is that there is no discomfort or unsightliness from a catheter passing

through your throat and nose. However, sometimes the capsule does not

attach, or falls off prematurely. There may be periods when the receiver

doesn’t receive signals, and some information may be lost. Sometimes, there

is pain swallowing after the capsule has been placed.


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Acid Perfusion Test

The acid perfusion – Bernstein - test is used to see if chest pain is caused by

acid reflux. A catheter is passed through one nostril, down the back of your

throat, and into the middle of your esophagus. A diluted acid solution and a

salt solution are alternately poured through the catheter into your esophagus.

If the acid provokes the pain and the salt solution produces no pain, it’s likely

that your pain is caused by acid reflux. This test is only used rarely.

Esophageal Motility Testing

This determines how well the muscles of your esophagus are working. A

catheter is passed through one of your nostrils, down the back of your throat,

and into your esophagus. The catheter has sensors that detect pressure.

When the muscle of your esophagus contract pressure is generated in your

esophagus and detected by the catheter. The end of the catheter is attached

to a recorder. During the test, the pressure at rest and the relaxation of your

lower esophageal sphincter are evaluated. Sips of water are swallowed to

evaluate the contractions of your esophagus. How well the LES is working can

determine whether it is contributing to your acid reflux symptoms.

Gastric Emptying Studies

Gastric emptying studies determine how well food empties from your stomach.

About twenty per cent of patients with GERD have a slow emptying stomach.

In this test, you eat a meal containing a radioactive substance. A sensor

similar to a Geiger counter is placed over your stomach and measures how

quickly the radioactive substance in the meal empties from your stomach. If

you continue to have symptoms despite treatment, your doctor might

prescribe medication that speeds up stomach emptying. Alternatively, they

might do a surgical procedure to promote a more rapid emptying of your

stomach.


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Treating Acid Reflux and GERD With Medication andSurgery

There are several ways to manage GERD with medication. The best approach

to take depends on the frequency and severity of your symptoms, your

response to treatment, and any complications present.

For infrequent heartburn, life-style changes and an occasional antacid may be

all that’s needed. If heartburn is frequent, daily non-prescription strength H2

antagonists may be necessary. Also, a foam barrier can be used with the

antacid or H2 antagonist.

If these don’t work, you may need to consider prescription drugs. Your doctor

can assess you for possible complications based on the presence of

symptoms like a cough, asthma, hoarseness, sore throat, difficulty swallowing,

unexplained lung infections, or anemia. Your doctor will also look for diseases

with similar symptoms to GERD, such as gastric or duodenal ulcers.

If there are no symptoms or signs of complications and no likelihood of other

diseases, a trial of acid suppression using H2 antagonists often is a possibility.

If these aren’t effective, a second trial, with the more potent PPIs is often

offered. However, dependent upon severity, sometimes treatment begins with

a PPI and skips the H2 antagonist. If treatment offers complete relief, no

further evaluation is needed and the effective drug is often continued.

If there are symptoms or signs suggesting complicated GERD, or a different

condition is diagnosed, or if the medications don’t work, an endoscopy will

usually be carried out for further evaluation.

There are several possible results of endoscopy, each requiring different

treatment. If your esophagus is normal there are no traces of other diseases,

the focus is on relieving your symptoms. Therefore, prescription strength H2

antagonists or PPIs are given. If the esophagus is damaged, then the

treatment’s goal is to heal the damage. In this case, PPIs are preferred to H2

antagonists because they allow for better healing.


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If complications are found, treatment with PPIs also is appropriate. However,

the adequacy of treatment often needs to be evaluated with a ph study during

treatment with the PPI. Strictures may need to be treated by widening your

esophageal narrowing.

With Barrett's esophagus, endoscopic examinations are necessary to identify

pre-malignant changes. Also if symptoms don’t respond to the maximum

doses of PPI, there are two options.

The first is to perform ph testing to find out whether the PPI is ineffective or if

another condition is present. A higher dose of PPI may be tried. An alternative

is to add another drug that works in a different way, for example, a pro-motility

drug or a foam barrier. All three types of drugs can be used.

Medications

There are a number of antacids, which you can buy over the counter, or

medications that neutralize or inhibit acid production, or help muscles to

empty your stomach.

Antacids

Antacids are usually the first drugs recommended to relieve heartburn

symptoms and other GERD symptoms as they work to neutralize stomach

acid. The problem with antacids is that they empty from your stomach quickly

and acid can then re-accumulate.

The best time to take antacids is about an hour after your meals, or just before

your reflux symptoms begin. An antacid taken after a meal stays in your

stomach for longer. A second dose of antacids, about two hours after a meal,

replenishes the acid-neutralizing capacity within the stomach – although be

careful with the dosages as neutralizing acid can lead to reduced digestive

effectiveness.


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Many brands use different combinations of three basic salts -magnesium,

calcium, and aluminum - with hydroxide or bicarbonate ions to neutralize the

acid in your stomach.

There are some downsides to taking antacids.

Calcium-based antacids stimulate the release of gastrin, the hormone mainly

responsible for the stimulation of acid secretion. So, after the neutralizing

effect of the calcium carbonate is exhausted, the level of acid secretion in the

stomach increases (or rebounds) due to gastrin release, resulting in an

overproduction of acid.

The main benefits of Calcium antacids are that they are cheap and add

calcium to your diet. Taking these occasionally is ok, however long term use is

not recommended.

Magnesium based antacids can lead to diarrhea, and aluminum based ones

often cause constipation. Aluminum and magnesium salts can be combined in

a single product to balance their effects.

Common antacids include: aluminum hydroxide and magnesium hydroxide

(Maalox, Mylanta Maalox), aluminum hydroxide and magnesium carbonate

(Alka-Seltzer, Pepto-Bismol, Rolaids, and Riopan), calcium carbonate

antacids, (Tums, Titralac, and Alka-2), magnesium hydroxide (Milk of

Magnesium.)

Foaming Agents

Foaming agents work by covering your stomach contents with foam to prevent

reflux. They are best taken after meals and when you’re lying down, as this is

commonly when acid reflux strikes. Foam barriers aren’t often used as the first

or sole treatment for GERD, tend to be taken alongside other drugs to

improve overall symptoms. Foaming agents are helpful for people who do not

have damage to their esophagus. A common foam barrier, which is a

combination of aluminum hydroxide gel, magnesium trisilicate, and alginate is

Gaviscon.


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H2 Blockers

H2 blockers, or histamine antagonists, impede acid production. Histamine

attaches to receptors on your stomach's acid-producing cells and stimulates

cells to produce acid. H2 blockers work by blocking the receptor for histamine

and so preventing histamine from stimulating acid-producing cells. Therefore

reducing the amount of acid in the stomach, which reduces the risk of acid

reflux. They are referred to as H2 blockers because the specific receptor they

block is the histamine type two receptor.

H2 antagonists are best taken thirty minutes before meals. This is so the H2

antagonists will be at peak levels in your body after your meal when your

stomach actively produces acid. They can also be taken at bedtime to

suppress night-time acid production.

H2 antagonists are good at relieving symptoms of GERD but not very good for

healing inflammation that may accompany GERD. They are mainly used for

treating heartburn in GERD that is not associated with complications, and are

available in prescription strength and over the counter in non-prescription

strength.

H2 blockers provide short-term relief however, they are not designed to be

used for long term treatment. H2 blockers are effective for about half of those

with GERD symptoms. Four different antagonists are available by

prescription, including cimetidine (Tagamet), ranitidine (Zantac), nizatidine

(Axid), and famotidine, (Pepcid). All of these are also available over-the-

counter, without any need for a prescription. The dosages are lower in over-

the counter drugs than in those available by prescription.

Proton Pump Inhibitors

Proton pump inhibitors are available by prescription. PPIs work in a similar

way to H2 blockers, but are more effective and relieve symptoms in almost

everyone who suffers from GERD. PPIs block the secretion of acid into your


37

stomach by the acid-secreting cells. PPIs are also good for protecting your

esophagus from acid so that inflammation can heal. They are used when H2

antagonists aern’t sufficient to relieve symptoms adequately or when there are

complications. They are best taken an hour before meals. Many people

benefit from taking H2 blockers at bedtime combined with a proton pump

inhibitor. Five different PPIs are approved for treating GERD, including

omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex),

pantoprazole (Protonix), and esomprazole (Nexium.)

Prokinetics

Prokinetics, or pro-motility drugs, help to strengthen your LES and encourage

your stomach to empty more quickly. They also improve muscle action in your

digestive tract. These drugs have side effects that limit their usefulness. Pro-

motility drugs are at their most effective when taken thirty minutes before

meals and again at bedtime. They are usually given to critically ill patients and

are not routinely prescribed for treating the symptoms or complications of

GERD.

As different drugs work in different ways, varying combinations of drugs may

help to control symptoms. People who get heartburn after meals may take

both antacids and H2 blockers. Antacids neutralize the acid in the stomach,

while H2 blockers act on acid production.

Surgery

Surgery is an option when drugs don’t work and lifestyle changes aren’t made.

GERD sufferers could consider surgery if regurgitation can’t be controlled with

drugs. This is particularly important if regurgitation results in infections in the

lungs, or occurs at night when aspiration into their lungs is more likely.

Surgery should also be considered if you need large doses of PPI or multiple

drugs to control your reflux. Some physicians recommend that all patients with

Barrett's esophagus should have surgery. This is based on a belief that


38

surgery is more effective than drug treatment in preventing both reflux and

cancerous changes in your esophagus.

Surgery can help with the following:

� Esophageal stricture

� Barrett’s esophagus

� Life-threatening apnea

� Large hiatal hernia

� Failure of medical therapy to reduce severe symptoms

� Severe esophageal inflammation

� Recurrent pneumonia, chronic lung disease

� Failure to gain weight

Fundoplication

Fundoplication (usually Nissen fundoplication) is the standard surgical

treatment for GERD. Because of possible complications, it is usually done as

a last resort. Different types of fundos are performed: Nissen fundoplication

refers to wrapping the fundus, the top part of the stomach, all the way around

the LES.

A 180° wrap is called a Thal or Toupet fundo and a 90° wrap is known as an

anterior partial wrap. The upper part of your stomach is wrapped around your

LES to strengthen the sphincter thus preventing acid reflux.

Fundoplication surgery can be performed as open surgery or as a

laparoscopic procedure. Laparoscopic fundoplication means that the surgeon

uses a number of small incisions, and a special instrument that holds a tiny

camera is placed inside the body and its findings viewed with the aid of a

videoscope and TV monitors.


39

Laparoscopic fundoplication has been used effectively in people of all ages,

even babies. Patients leave the hospital in one to three days and return to

work within a couple of weeks.

Not all fundoplications can be done in this way because of adhesions from

previous operations. In this case an open surgery fundoplication is needed.

The fundoplication works by keeping your lower esophageal sphincter closed

enough to prevent acid reflux while still allowing food to pass through your

esophagus and into your stomach.

Potential Complications of Fundoplication

Every surgery comes with risks. Fundoplication can have the additional

complications listed below.

� An inability to burp or vomit

� Gas bloat syndrome

� The heartburn returns

� Difficulty eating

� Dumping syndrome (the stomach empties too quickly and causes

nausea, abdominal cramping, retching, pale skin, hypoglycemia, and

sweating.)

� Disruption of the wrap (stitches come undone)

� Dysphasia (swallowing problems)

� Hiatus hernia

Surgery can be effective at relieving symptoms and treating GERD

complications for between 50 – 90% of cases. However, patients often


40

continue having to take medication, although symptoms are usually improved.

The long term success of the surgery is not clear with one study showing that

16% of people had to have a second operation within10 –12 years to deal

with complications caused by the initial surgery.

Endoscopy

A number of endoscopic techniques for the treatment of GERD have been

developed. One type involves suturing the area of your lower esophageal

sphincter to tighten the sphincter, which stops acid escaping from the

stomach.

A second endoscopic procedure involves applying radio-frequency waves to

the bottom of your esophagus just above the sphincter. The waves damage

the tissue underneath the esophageal lining and a scar forms. The scar

shrinks and pulls on surrounding tissue, tightening the sphincter and the area

just above it.

A third type of endoscopic treatment involves injecting material into your

esophageal wall in the area of your LES to increase pressure in your LES and

prevent reflux. This is not actually surgery and has the advantage that

hospitalization isn’t necessary.


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Treating Acid Reflux, GERD and Heartburn Naturally

Lifestyle Changes

Eating Habits

The first step is to eat smaller, more frequent meals. Large meals expand your

stomach and increase upward pressure against your esophageal sphincter.

Avoid lying down for at least two hours after you eat. Staying upright allows

gravity to help keep your stomach acid from entering the esophagus and

helps the flow of food and digestive juices from your stomach to your

intestines.

Smoking

If you’re a smoker now is the time to give up. Apart from being generally bad

for your health, smoking relaxes your esophageal sphincter allowing acid to

escape more easily. Smoking also stimulates the production of stomach acid

and can hinder saliva production, a natural acid neutralizer. For help with

stopping smoking visit Stop Smoking Once And For All. Follow the 4-step

plan and say goodbye to cigarettes forever.

Weight Loss

Being overweight is one of the biggest risk factors for developing acid reflux

and GERD. It is though that being overweight increases abdominal pressure,

which can then push your stomach contents upwards, placing pressure on the

LES. According to some statistics, approximately thirty-five per cent of

overweight people experience heartburn. For many people, as little as a ten

per cent decrease in weight improves heartburn symptoms.

So, if you’re overweight losing the excess pounds can make big difference to

acid reflux and GERD symptoms.

http://www.stop-smoking-for-life.com/


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Alcohol

Alcohol is another common cause of acid reflux. It irritates and erodes the

mucous lining of your stomach and increases the amount of stomach acid

produced. Alcohol also has a general relaxant effect on muscles, including the

LES.

Relaxation

While stress hasn't been linked directly to heartburn, it is known that it can

lead to patterns of behavior that can trigger heartburn like overeating, eating

the wrong sort of foods, drinking alcohol excessively and smoking. Relaxation

techniques can alleviate stress making stress-related heartburn less likely.

Stress is any factor that causes tension.

Exercise

While the wrong sort of vigorous exercise can aggravate acid reflux, moderate

exercise can be helpful in fighting acid reflux as it aids digestion. Sometimes

chest pain following exertion is described as heartburn when in fact it can be

angina. Anyone with chest pain during or after exercise should be evaluated

for heart problems. In general however, regular exercise is known to help

lower stress and increase your endorphins (natural feel good chemicals.) Try

walking or cycling. Exercise that involves running, jumping or puts strain on

your LES like weightlifting can bring on acid reflux, so these forms of exercise

are best avoided.

Dressing Sensibly

What you wear can also have an impact on your acid reflux / GERD

symptoms. Avoid belts or clothes that fit tightly around your waist. Clothes that

fit tightly around your abdomen squeeze your stomach, forcing food up

against your LES, and can lead to reflux. Types of clothing that may cause

problems include tight-fitting belts and slenderizing undergarments.


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Sleep

For many sufferers reflux is worse at night. This is partly due to the loss of

gravity helping to keep food and acid in your stomach as it does when you’re

upright. This allows refluxed liquid to travel further up your esophagus and

remain in your esophagus for longer.

To counter symptoms at night elevate your head and chest while you sleep,

as lying flat presses your stomach's contents against your LES. With your

head higher than your stomach, gravity helps to reduce the pressure. You can

place bricks or blocks securely under the legs at the head of your bed. You

can also use an additional pillow, or a wedge-shaped pillow, to lift your head.

It is important that your upper body and not just your head is elevated.

Elevating your head alone does not raise your esophagus and so fails to

restore the effects of gravity. Reflux also occurs less frequently when you lie

on your left rather than on your right side as this helps with stomach emptying.

Summary of Quick & Easy Lifestyle Tips

� Stop smoking

� Avoid alcohol

� Lose weight if necessary

� Eat smaller meals more often

� Wear loose-fitting clothes

� Avoid lying down directly after a meal

� Raise the head of your bed by using blocks of wood or elevate your

head and chest with a wedge pillow

Dealing With Stress

Stress comes in many forms and affects all types of people. There is no way

of predicting stress levels in individuals. The degree of stress in your life

depends on a number of factors such as your health, your relationships, and

http://www.naturally-stop-acid-reflux.com/wedge-pillow.html



44

your responsibilities. If you are poorly nourished, get inadequate sleep or have

inadequate social support networks, you are likely to experience higher stress

levels.

The symptoms of stress can be highly varied. It can induce headaches, cause

feelings of anger, anxiety, or tension. High levels of stress negatively affect

your immune system and other medical conditions. Stress can also encourage

behaviors that can worsen acid reflux and GERD.

There are many simple and inexpensive ways of reducing stress in your life.

Eating a well-balanced diet, avoiding caffeine and taking regular exercise

have all been proven to reduce stress levels. Going outdoors and enjoying the

sunshine can also be helpful.

Aromatherapy can help to reduce stress. Five to six drops of lavender oil in a

warm bath or a few drops on a cloth to inhale during the day has a strong

relaxing effect.

The first steps to relaxation involve making time for yourself. Once your own

needs are met, it’s easier to find more time for others. Deep breathing

exercises, massage, guided imagery and a healthy sex life help to reduce

feelings of stress.

A good way to dealing with stress is to learn how to relax. Choose somewhere

comfortable to lie down, remove your shoes and loosen any tight clothing.

Stretch out with your arms by your side, feet slightly apart and eyes closed.

Allow yourself to become calm and quiet. Close your eyes and feel your

body’s weight. Inhale slowly and allow your mind to go blank. As you exhale,

sink deeper into your support. Inhale through your nose, hold the breath, and

then exhale as if you were blowing air through a straw. Empty your lungs and

inhale deeply. You now need to go through your body, from top to bottom,

letting go of tension. Begin by thinking of your scalp. Think about releasing

tension and feel it relax. Then think of your forehead. Imagine those muscles

feeling relaxed and comfortable. Do the same with your eyes, mouth, and jaw.


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Feel your whole head relax and move onto your neck and throat. Continue

down your body, imagining each part of it letting go of tension and the

muscles in that area of your body relaxing. When you have reached your toes,

let the energies flow through your body. Remain in this relaxed state for five or

ten minutes. Blank your mind and enter a state of light sleep. When you’re

ready to awaken, tell yourself that you are deeply relaxed and ready to wake

feeling refreshed. Open your eyes and stretch your arms. Sit up and stretch

again.

To maximize results, practice this technique at least once a day for two

weeks. After this, regular relaxation sessions – for example, four times a week

– will maintain your relaxation response. Finding time for relaxation should be

a high priority.

Herbal Treatments

One important thing to remember about natural medicines as opposed to

prescription drugs is that it can often take longer before results are seen. Each

person's system is different, so it’s important to give the treatment an

opportunity to have the desired effect before deciding whether to discontinue

use. Also, you may find that one specific herbal treatment is not right for you,

however, trying a different herbal approach may bring results. It pays to keep

trying until you find the right combination or herbal treatment.

Herbal treatments need not replace your current medication, but can be used

to supplement it. When you first decide to use a new herbal treatment check

for interactions with any medication first. You should note any reaction you

have to it and if there are adverse effects, stop use immediately. Start with a

low dose and build up gradually. The efficiency of herbal medicine is partly

dependent on it being in your system continually so don’t expect results after

just one ‘dose’.

Herbs That Decrease Stomach Acid

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Meadowsweet, slippery elm, flax, liquorice, calendula, wild yam

Meadowsweet works by reducing acid production in the stomach as it has

antacid properties. It also helps to soothe and heal the esophagus.

Slippery elm is easy to digest and can be made into gruel. Slippery Elm has

traditionally been used to treat sore throats. It is believed that it helps reduce

acid reflux as the inner bark of the plant contains mucilage (a gel-like

substance) that swells when added to water. When swallowed this coats the

esophagus and can alleviate irritation caused by reflux.

Licorice extract – DGL – can be used to treat heartburn and stomach and

esophagus ulcers. Ordinary Licorice shouldn’t be used by patients with high

blood pressure or heart disease.

Herbs That Relieve Indigestion and Intestinal Irritation (carminative)

Chamomile, ginger, peppermint.

Chamomile is widely recognized for its calming properties and is thought to

help relieve irritation in the esophagus and aid proper digestion. It can help to

lower stomach acid due to its high calcium content. Drinking chamomile tea

after meals can relieve esophageal irritation. It also acts as an anti-

inflammatory. Chamomile oil is a potent uterine stimulant that should be

avoided during pregnancy, but the dried or fresh herb is safe in moderation.

Ginger assists proper digestion by promoting intestinal movement. Also,

ginger has anti-inflammatory and anti-nausea properties. It has been found to

help in dealing with morning sickness during pregnancy and is commonly

taken for motion sickness.

Peppermint is also believed to be useful against indigestion, and also calms

the gastrointestinal tract. One study of peppermint in combination with

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http://www.naturally-stop-acid-reflux.com/DGL.html


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caraway fruit found it eased the symptoms of heartburn. A drop put on the

tongue or added to a glass of water can help with heartburn. As it’s a uterine

stimulant you should avoid the oil entirely if pregnant, although low doses of

the dried herb can be used.

Warning: peppermint may induce acid reflux and GERD symptoms in some

sufferers so use with caution.

Bitter Digestive Stimulant

Blessed thistle

Blessed thistle promotes digestive enzyme production and helps alleviate

heartburn. Traditionally, it’s used to ease gas, prevent constipation, and ease

general stomach pains. Its bitterness stimulates digestive activity and

improves digestion.

Soothing Agents

Aloe vera, slippery elm, marshmallow, papaya.

Aloe vera juice can be drunk to heal the intestinal tract, but it shouldn’t be

taken if you’re pregnant. Chewable papaya tablets can be purchased and they

are helpful reducing heartburn. Alternatively, you can drink papaya tea.

Marshmallow root helps reduce irritation of the esophagus and relieve

heartburn.

Others

Fennel

Fennel has been used for centuries to aid digestion. You can eat fennel seeds

or make a tea from them. If eaten, consume between five and seven grams

daily. To make a fennel tea boil 250 ml of water, add two to four grams of


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crushed seeds, and steep for ten to fifteen minutes. Keep the pot covered so

the oils in the fennel seeds don't evaporate. Allow to cool, strain, and drink

three cups a day. Or you can take two to four ml of fennel tincture three times

a day. Fennel is a uterine stimulant in high doses and should be used in

moderation during pregnancy.

Turmeric

Turmeric has a long history in Chinese and Ayurvedic medicine as being an

effective digestive. You can buy extract of turmeric as a tincture, or as tablets

or capsules. Half to one and a half ml of the tincture can be used up to three

times a day. In tablet or capsule form take four hundred to six hundred mg of

curcumin (the active ingredient of turmeric) three times a day.

Aniseed

Aniseed - or anise – is a powerful herb that helps to ease digestive conditions.

Use the ash-colored anise (green anise), European anise or sweet anise. The

other types of anise, star anise and caraway do not have the same beneficial

effects. Anise is a uterine stimulant in high doses, but safe as a culinary herb.

Use it in moderation during pregnancy, and avoid using the oil entirely.

Lavender

Lavender has enormous healing powers for your body. It is an excellent

stomach aid and is useful in reducing acid in the stomach. As lavender is a

uterine stimulant in high doses it should only be used in moderation during

pregnancy. It’s safe in cooking a culinary herb or for moderate use.

Almonds

Almonds can relieve heartburn. Eat almonds when heartburn symptoms

persist.


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Herbal Tea for Heartburn

One recipe that has helped sufferers is the following:

Mix equal amounts of aniseed, peppermint and lavender. Make an infusion.

Boiling two and a half cups of distilled water pour it water over a teaspoon of

the herbal mixture. Let the tea sit for three to five minutes. Strain the tea and

sweeten with honey if desired. You can drink up to eight ounces each morning

and evening.

Alternatively, try swapping your usual tea or coffee for a cup of chamomile

tea.

Digestive Enzymes

Digestive enzymes break down food particles so they can be utilized for

energy. Deficiencies in digestive enzymes can cause a number of abdominal

complaints. Enzymes are necessary to break down food particles into the

components your cells can use. You need them to build and repair bone and

tissue; to enable iron molecules to link with red blood cells so that they can

carry oxygen; detoxify your blood and tissues; and for your immune systems

to function.

Your body’s supply of enzymes is limited. For each ten years of life, you lose

about thirteen per cent of your enzyme potential. So consuming enzymes

through your diet is important to replenish supplies. Half of all adults don’t

produce enough digestive enzymes.

Digestive enzymes exist naturally in foods you eat raw. When foods are

cooked, the enzymes are destroyed and more stress is placed on your body

to produce digestive enzymes to help digest the food. Supplements can be

purchased that contain enzymes you can take in capsule form. Also,

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50

increasing your intake of raw foods will help. While all raw foods contain

enzymes, sprouting foods contain the highest concentrations of digestive

enzymes. Try adding sprouted seeds, grains, and legumes to your diet.

Betain, Pepsin, and Papaya Digestive Enzymes

As you age, your body’s ability to produce the hydrochloric acid needed to

digest protein lessens. Undigested protein can lead to the aggravation of or

cause acid reflux or heartburn. Digestive enzymes that contain Betain, pepsin,

or HCl taken with each meal can help you digest protein more efficiently.

Papaya enzymes (which contain papain), are also good for protein digestion

and you can take them at each meal. Use 500 mg or more of papaya

enzymes per meal.

Pineapples

Pineapples are a great natural source packed full of enzymes and contain

bromelain, an enzyme that helps digest protein. Pineapples support digestion,

reduce inflammation, and support wound healing. Fresh pineapple juice has

high levels of enzymes that can help prevent acid reflux. You can also buy

bromelain in tablet form and take from 200 to 500mg at each meal.

Diet

Sufferers with acid reflux can reduce symptoms by following a special acid

reflux diet. You need to know which foods are safe and those that trigger your

heartburn. Certain foods are known to be more likely to cause reflux than

others do. Changing your eating habits can be highly beneficial as reflux is

generally worse after meals. Eating earlier and having smaller evening meals

may help reduce the symptoms of reflux. A smaller meal results in less

stomach distension and by bedtime, a smaller meal eaten earlier meal is more

likely to have emptied from your stomach than a larger one eaten late.

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Foods that are common acid reflux triggers are:

• Chocolate

• Peppermint

• Alcohol

• Caffeinated and carbonated drinks

• Fatty foods

Other foods may also aggravate your symptoms, for example, spicy or acid-

containing foods, citrus juices, carbonated beverages, and tomato juice. Sulfur

containing vegetables (garlic, onions, leeks, broccoli, cauliflower, cabbage,

asparagus, and Brussels sprouts) can produce gas and this can exacerbate

reflux.

Chewing gum can be helpful in relieving symptoms for many acid reflux

suffers as chewing gum stimulates the production of bicarbonate-containing

saliva and increases your swallowing rate. After you swallow your saliva it

helps neutralizes any acid in your esophagus. However, this remedy does not

work for everyone and can even bring on symptoms in some people. But the

majority does seem to find it helpful.

Some foods have been shown to be acid reflux neutral for many. However,

people do vary, so you may find you can eat the foods from the "danger"

group with no problem or have problems with foods listed as safe. It’s a good

idea is to keep a food diary. For about two weeks, write down everything you

eat, when you eat, and details of any symptoms you experience. This will give

you an idea of what your personal safe foods are.

Often acid reflux sufferers can enjoy some ‘trigger’ foods occasionally and in

small amounts. They may trigger heartburn if they are consumed frequently or

in large amounts. You may find that you can eat these foods with no

problems, or you may have to avoid certain foods on this list entirely. Again, a

food diary will help here.


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The most effective diets are those that are made up of whole foods from both

plant and animal kingdoms. Staying away from processed and packaged

foods as much as possible can make a big difference to your symptoms.

Summary of Quick Diet Tips

� Avoid eating two to three hours before bed.

� Eat smaller meals more often.

� Avoid alcohol.

� Avoid carbonated drinks, chocolate, caffeine, and foods that are high in

fat or contain a lot of acid, or spices.

� Limit acid containing foods.

� Avoid hard candy, which increases the amount of swallowed air.

� Don’t drink from a straw.


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Food Table

The table below lists the different foods that can signal danger, are usually

OK, or can be eaten in moderation. Your own personal experience may be

different, so you may eventually want to create your own list.

Danger Usually OK In Moderation

Alcohol

Barley (OK if purledbarley is cooked 10minutes)

Beans (gas producing)

Black Pepper (WhiteOK)

Broccoli

Brussels Sprouts

Buffalo wings

Cabbage

Caffeine

Carbonated Beverages

Cauliflower

Chicken nuggets

Chili Powder

Chocolate

Citrus fruits

Coffee (evendecaffeinated)

Corn

Cottage cheese, regular

Cranberry juice

Apple

Baked potato

Banana

Bread, multi grain orwhite

Cabbage

Carrots

Cereal, bran or oatmeal

Cheese, feta or goat

Chicken breast, skinless

Cookie, fat free

Corn bread

Cream cheese, fat free

Egg white

Fish

Graham crackers

Green beans

Ground beef, lean

Jelly beans

Mineral water

Peas

Potato chips, baked

Apple cider

Beer

Blueberries

Cheddar cheese

Chicken salad

Cola

Cookie, low-fat

Cottage cheese, low-fat

Cranberries, dried

Eggs, fried

Fish, fried

Frozen yogurt

Garlic bread

Granola cereal

Grapes

Ground beef, lean

Ham

Hot dog, beef or pork

Ketchup

Leeks

Mozarella cheese


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Creamy Foods/Gravies(High fat content)

Cucumber

Foods with "air" such asfluffy baked goods

French fries

Fatty and fried foods

Garlic

Grapefruit juice

Gooey Pastries (High fatcontent)

Green Peppers

Ground beef, chuck

Guargum (thickener)

High Energy Foods(digest slowly)

Honey

Ice cream

Kale

Lemonade

Macaroni and cheese

Marbled sirloin

MCT Oil (medium chaintriglycerides, digestslowly)

Mashed potatoes

Meat extracts

Meat with connectivetissue/gristle (takelonger to digest)

Milk (lactose intolerancecan provoke reflux insome people)

Pretzels

Red liquorice

Rice

Rice cakes

Salad dressing, low fat

Sour cream, fat free

Soy cheese, low fat

Steak

Muffin

Non-alcoholic beer

Onion, cooked

Orange juice, low-acid

Peach

Raspberries

Root beer

Sauerkraut

Scallions

Scrambled eggs, inbutter

Strawberries

Tuna salad

Yogurt


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Milk shakes

Molasses

Oats (rolled oats OK)

Onion

Pectin

Peppermint/Spearmint

Sour cream

Spaghetti with sauce

Turnips

Rhubarb

Rye Seeds

Simple Sugar Foods

Spicy foods

Tea

Tofu (avoid largequantities)

Tomato

Vinegar

Recipes

These recipes are ideal for anyone on an acid reflux diet. There are

suggestions for breakfast, lunch, dinner, dessert and snacks. You can amend

the recipes by substituting other foods if one of the ingredients is something

you are sensitive to. Although you may not normally take breakfast, eating a

number of small meals a day rather than having three larger meals has helped

many people relieve their symptoms.


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Breakfast Suggestions

One English muffin with one tablespoon of margarine.

Eight ounces of skim milk.

Half a cup of sliced peaches.

One cup of hot oatmeal cereal with eight ounces of skim milk

Half a cup of papaya slices.

Two slices of whole wheat bread

One tablespoon of margarine

Half a cup of puffed wheat cereal with eight ounces of skim milk.

Two slices of whole-wheat toast with one tablespoon of margarine.

One small banana

One cup of bran flake cereal with eight ounces of skim.

One English muffin with one tablespoon of margarine.

One cup of fresh or frozen strawberries.

One cup of hot oatmeal cereal with eight ounces of skim milk.

Two slices of whole-wheat toast with one tablespoon of margarine.

One cup of unsweetened apple sauce.

Eight ounces of skim milk

One bagel with one tablespoon of peanut butter or low-fat cream cheese.

One small banana


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Lunch Options

Stuffed Tuna Pocket

One whole grain pita bread

Four ounces of water-packed tuna

Two tablespoons of low fat mayonnaise

One-quarter cup of cucumber slices

Lettuce leaf

Soup and Sandwich

One and a half cups of cream of chicken soup

Two slices of whole-grain bread

Four ounces of deli-style sliced chicken

One tablespoon of low-fat mayonnaise

Lettuce leaf

Half a cup of raw carrot sticks

Turkey Sandwich and Chips

Two slices of whole-wheat bread

Four ounces of oven-roasted turkey luncheon meat

One ounce of low-fat mayonnaise

Two ounces of baked potato chips

One cup of cottage cheese

One cup of sliced peaches


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Soup and Sandwich

One and a half cups of chicken noodle soup

Two slices of whole grain bread


Four ounces of deli-style sliced chicken

One cup of unsweetened applesauce

Half a cup of celery sticks

Chicken Wrap

One fat-free flour tortilla

Four ounces of diced chicken breast

Two tablespoons of low-fat mayonnaise

Half a cup of shredded lettuce

One ounce of low-fat shredded mozarella cheese

One cup of sliced peaches

Soup and Sandwich

Two cups of cream of potato soup

Two slices of slices whole wheat bread

Four ounces of white turkey luncheon meat


Two lettuce leaves

Half a cup of raw carrot sticks


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Main Course Ideas

Baked Pork Chops with Oregano

Eight large pork chops or steaks, with bones

One teaspoon of salt

Half a cup of apple cider or juice

Two teaspoons of dried oregano

Three bay leaves

One cup of chicken broth

Fresh chopped parsley to garnish

Method

Place the pork chops into a dish and sprinkle with salt. Drizzle apple cider

over them. Sprinkle on oregano. Place bay leaves between two of the chops.

Cover the dish with plastic wrap and refrigerate for at least four hours. Preheat

oven to 325 degrees. Heat a nonstick skillet on a high heat. Remove the pork

chops from the marinade, brown lightly on both sides. Place in a dish with the

marinade. Pour in chicken broth, cover dish with foil, and bake for two hours

or until the meat is tender. Garnish with parsley and serve. Serves six.

Beef Loaf

One and a half pounds of very lean ground beef

Two eggs

One and a half cups of breadcrumbs

Two tablespoons chopped parsley

Half a teaspoon of pepper

Two teaspoons of salt

Method

Preheat the oven to 350 degrees. Combine ground beef, unbeaten eggs,

breadcrumbs, chopped parsley, pepper and salt. Blend the mixture


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thoroughly. Place in a bread pan. Bake for about two hours. Baste every

quarter of an hour with hot stock. Cut into thin slices. Serves four.

Broiled Lamb Chops with Mushrooms

One and a half tablespoons of vegetable oil

One quarter teaspoon of salt

Two teaspoons of ground ginger

Three cups of sliced mushrooms

Four 4 oz lamb chops, each one inch thick with visible fat trimmed

One and a half cups of long-grain brown rice, cooked without salt or fat

Method

Combine the vegetable oil, salt, and ginger. Place rack in a pan, and lamb

chops on the rack. Brush the top of the lamb chops with the oil mixture. Broil

for five minutes. Turn the lamb chops and place mushrooms around them.

Brush lamb chops with the remaining oil mixture. Broil for five more minutes.

Serve immediately with cooked rice. Serves four

No Tomato Sauce Lasagna

Twelve ounces of very lean ground beef

Half a cup of beef broth

Twelve ounces of wide lasagna noodles

Two cups of low-fat alfredo sauce

One and a half cups of grated mozzarella cheese

Method

Preheat the oven to 375 degrees. Cook the noodles in boiling water until just

tender and drain. While noodles are cooking, brown the ground beef. Add

browned beef and broth to noodles. Toss together. Spread one cup of the

alfredo sauce on the bottom of a pan. Add three strips of lasagna.

Spread half of the beef mixture on top. Lay three strips of lasagna noodles.


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Spread the remaining beef mixture on top. Add another three strips of lasagna

noodles. Spread the top with remaining white sauce and sprinkle with grated

mozzarella cheese. Bake for twenty-five to thirty-five minutes. Serves eight.

Pasta and Ham

Twelve ounces of uncooked pasta

Two tablespoons of olive oil

One 14.5 ounce can of reduced-sodium chicken broth

Three quarters of a teaspoon of dried basil, crumbled (or one tablespoon

fresh)

Four ounces of low-sodium boiled ham, thinly sliced and cut into half inch

strips

Grated Parmesan cheese

Method

Cook the pasta. Heat the oil in a medium saucepan over a medium heat. Pour

in the broth and stir in the basil. Cook for three minutes, or until it just starts to

boil. Drain pasta. Return the pasta to the pan and pour in the broth. Add the

ham to the pasta and toss well to combine. Cook for about two minutes over

medium-high heat, or until piping hot. Serves four.

Tuna Noodle Casserole

Eight ounces of elbow macaroni, uncooked

One six ounce can of water-packed tuna, drained

One cup of sliced celery

One can (10¾ oz) reduced-fat cream of celery soup, undiluted

Half a cup of skim milk

One cup of shredded, reduced-fat sharp cheddar cheese

Half a cup of low-fat mayonnaise

Method


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Cook macaroni and drain. Rinse with cold water. Drain again. Combine the

cooked macaroni, tuna, and celery. Mix well, and set aside. Combine soup

and milk In a small saucepan and heat over a medium heat until smooth. Add

the cheese and continue to heat until the cheese is melted. Remove the soup

from the heat. Add mayonnaise to soup and stir until well blended. Pour the

soup over the macaroni mixture. Mix well. Pour macaroni and soup mixture

into casserole dish. Bake at 350 degrees, uncovered, for thirty minutes.

Vegetable Beef Stew

One tablespoon of vegetable oil

One pound of beef stew meat

One can (14 oz) of beef broth

Two thirds of a cup of water

Three and a half cups of red potatoes, cubed

Two cups of sliced raw carrots

Half a cup of sliced celery

Half a cup of frozen peas

Method

Add vegetable oil and heat until oil is hot. Next, add the stew meat and cook

for three to four minutes, (until browned on all sides) Remove the beef and set

aside. Add beef broth and water to saucepan. Add the potato cubes, carrots,

and celery. Heat until boiling and then add the beef to the vegetables and

broth. Cover, reduce heat, and simmer for half an hour, or until the meat is

tender. Add frozen peas. Cook for an additional two minutes. Serves four.


63

Tempting Desserts

Angel cake

One cup of superfine sugar, divided into one three quarter cup and one

quarter cup portions

One cup sifted cake flour

Twelve large egg whites, at room temperature

One teaspoon cream of tartar

Half a teaspoon of salt

Two teaspoons of vanilla extract

Method

Preheat the oven to 375 degrees. Whisk together the three quarter cup of

sugar and the flour. Beat the egg whites until they’re thick and foamy. Add

cream of tartar, salt, and vanilla. Beat until soft peaks form. Sprinkle the

remaining sugar gradually over the top of the batter and continue to beat until

stiff and glossy. Fold the flour mixture into the egg white mixture, using a

rubber spatula or slotted spoon. Pour into an ungreased ten inch tube pan

with removable sides. Use a knife to cut through the batter to eliminate air

pockets. Bake for thirty to thirty five minutes. Invert the cake over a funnel, or

a narrow bottle to cool.

Apple Cinnamon Coffee Cake

Filling and topping

Two tablespoons of cinnamon

Five tablespoons of sugar

Six cups of chopped apples

Cake

Two cups of sugar

One cup of applesauce


64

Four teaspoons of vanilla

A pinch of salt

Four lightly beaten eggs

Three cups of flour

One tablespoon of baking powder

One teaspoon of nutmeg

Method

Preheat the oven to 350 degrees. Spray a nine inch baking dish with nonstick

cooking spray.

Filling and Topping

Combine the cinnamon and sugar in a bowl. Set aside one tablespoon of the

mixture. Add apples to the remainder of the mixture and toss until apples are

coated.

Cake

Whisk together the sugar, applesauce, vanilla, salt, and eggs. Combine flour,

baking powder, and nutmeg and fold into sugar mixture. Spoon one third of

the batter into the pan. Cover with half of apple mixture, then spoon in

remaining batter. Place apple slices on top. Sprinkle top lightly with the set

aside cinnamon and sugar. Bake for one hour.

Banana Cupcakes with Cream Cheese Frosting

Cup cakes

One cup of flour

Half a teaspoon of baking soda

One quarter of a teaspoon of salt

Half a teaspoon of ground cinnamon

Three quarters of a cup of granulated sugar

One quarter of a cup of butter

One teaspoon of vanilla extract


65

Half a cup of mashed ripe bananas

Four large egg whites

One quarter of a cup of fat-free sour cream

Frosting

One and a half cups of powdered sugar

Eight ounces of softened fat-free cream cheese


Method

Preheat oven to 350 degrees. Stir together flour, baking soda, salt, and

cinnamon until well blended. Set aside. Cream together sugar and butter. Add

the vanilla and mashed bananas to the creamed sugar and butter and beat

well. Add egg whites to the mixture and beat thoroughly. Stir in half the flour

mixture and the sour cream. Add the remaining flour mixture, and stir until

combined. Spoon into greased twelve muffin cups. Bake for twenty-five to

forty minutes, or until a toothpick inserted into the center comes out clean.

Cool for fifteen minutes before removing the cupcakes from the pan, and cool

cupcakes completely before frosting them. To make the frosting, beat all the

frosting ingredients together until creamy. Spread the frosting thinly over the

cupcakes using a knife or spatula.

Berry Cobbler

Two cups of all-purpose flour

One cup of white sugar

Two and a half teaspoons of baking powder

Half a teaspoon of salt

Three tablespoons of melted butter

Two thirds of a cup of milk


One beaten egg

Two cups of raspberries (other berries can be substituted)


66

Method

Preheat oven to 350 degrees. Blend together flour, sugar, baking, powder and

salt. Stir in butter, milk, vanilla and egg until the mixture is smooth. Fold in

berries.

Pour into prepared pan, and bake for thirty-five to forty minutes, or until top is

firm.


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Treating Reflux in Pregnancy and Infancy

Pregnancy

It may not be possible to eliminate heartburn completely during your

pregnancy, but you can take steps to minimize your discomfort. In addition to

avoiding the known triggers listed above:

� Don't eat big meals. Eat several small sized meals throughout the day

instead.

� Don't rush your meals as this can make digesting the food harder and

you are likely to swallow lots of air.

� Wait at least three hours after your last meal before going to bed.

It is important to drink water during pregnancy, along with other fluids, but

don't drink only at mealtimes. Large quantities of fluids can distend your

stomach, and put more pressure on your LES forcing it to open. Drink fluids

regularly throughout the day.

Sleep with your head and shoulders propped up with a pillow, or elevate the

head of your bed a few inches. This will allow gravity to work in your favor,

and help keep your stomach acids where they should be. A wedge pillow can

make this more comfortable.

Wear loose and comfortable clothing. Avoid tightness around your waist and

stomach. Remember to bend at your knees instead of at your waist. Bending

at your waist puts pressure on your stomach and can cause reflux. Sit upright

in a comfortable chair rather than slouching.

Try not to put on too much weight. Gaining too much additional weight puts

more pressure on your stomach, and can force your stomach contents

through your LES and into your esophagus.

If lifestyle changes aren’t enough treatments that are only minimally absorbed

into the body, and not a potential threat to the fetus, can be used. You should



68

check with your doctor before taking any remedies while pregnant, but there

are generally some you can take that will help to eliminate heartburn. Tums,

Maalox, Titralac, Mylanta, Riopan, or Gaviscon may prove helpful.

It’s best to start with antacids, an hour after meals and at bedtime. You may

need to alternate magnesium and aluminum-containing antacids to avoid

diarrhea or constipation. If antacids alone aren’t effective, then alginic

acid/antacid may be added. The antacids and alginic acid/antacid should be

taken after meals and at bedtime and more frequently if necessary.

If sucralfate is being used, it should be taken half an hour before or after

antacids or alginic acid/antacid. Sucralfate acts by coating and protecting the

lining of your esophagus and stomach and is more effective in an acidic

environment.

Some antacids contain aluminum, and small amounts of aluminum are

absorbed into your body. However, it doesn’t accumulate in your body unless

you have kidney impairment. Therefore, absorption of aluminum is unlikely to

cause a problem for the fetus unless you have kidney impairment.

In theory, magnesium containing antacids could slow your labor. This problem

would only apply if they were taken just prior to labor.

Antacids can inhibit iron absorption, and iron is important for the growing

baby. Pregnant women usually receive iron supplements and a slight

decrease in iron absorption should not result in a deficiency of iron, but check

with your doctor.

After antacids, the safest absorbed drugs that can be given are H2

antagonists. Animal studies haven’t shown any effects on the fetuses of

pregnant animals. Nitzadine shouldn’t be used because effects on animal

fetuses have been shown.

Proton pump inhibitors should be used only when H2 antagonists fail to control

heartburn. Omeprazole should be avoided as it has been shown to have

effects on the fetuses of animals at high doses.


69

Concern about the use of H2 antagonists and proton pump inhibitors are

greatest in the first three months of pregnancy, when there is more danger of

abnormality being caused in the fetus. It is less of a problem later in

pregnancy as the fetus has done most of the development by this stage.

It is important to consult your doctor before taking any medication for acid

reflux and heartburn.

Infancy

Many babies have problems with spitting up that don't require treatment. Their

symptoms usually disappear after six or eight months. For some infants their

symptoms are a sign of something more serious that may need medical

attention. A doctor should be consulted if you have any concerns. It’s also

important to take advice before making significant changes in feeding.

Reflux treatment depends on the infant’s symptoms and age. If your child is

uncomfortable, finds it hard to sleep or eat, or fails to thrive, your doctor may

suggest medications. If your child continues to have symptoms, tests may be

arranged to help find better treatments. Occasionally, if the problems are

severe, surgery may be the best option. It’s rare for children to need surgery

for GERD. Most infants don't need medication and outgrow reflux by one or

two years of age.

Thickened feeding can reduce the amount your baby will regurgitate. Cereal

adds weight to the food, which helps to keep the food from splashing around

in the baby's stomach and can help keep it down. Babies who are having

problems in gaining weight may also benefit from the added calories. Add up

to a tablespoon of rice cereal to two ounces of formula. If the mixture is too

thick, you can change the teat nipple size, or cross cut the nipple. Some

babies have reactions to rice that make their reflux worse. In these cases,

adding oatmeal instead may prove to work.

Burping your baby frequently during feeding can help minimize gastric

pressure and reflux. Waiting to burp your baby after they have a full stomach


70

can increase the chances of regurgitation. Burp your baby after one or two

ounces of formula are taken. Burp breastfed infants after feeding on each

side. Sucking on a pacifier increases saliva production, which can help to

neutralize some of the acid that may come up.

Feeding every two to three hours when your baby is awake will reduce reflux.

Overfeeding can increase abdominal pressure and lead to gastric reflux.

Avoid tight elastic around the waist, and keep diapers as loose as possible.

Keep your child upright during feeding and hold your infant upright in your

arms for half an hour after feeding. Formula fed babies may require longer

periods for feeding, since formula is digested more slowly than breast milk.

If you lay your baby down after feeding, place them on their stomach on an

incline of at least thirty degrees. This can reduce regurgitation. But only place

your baby in this position if they are awake. Lying a baby on the stomach is

not recommended during sleep, because of the link between this position and

sudden infant death syndrome. Putting a baby to sleep on their stomach is

only considered where the risks from GER complications outweigh the

potential increased risk of SIDS, but this should be discussed with a doctor

first.

Elevate the head of the crib by thirty degrees to allow gravity to help keep

stomach contents where they belong.

The way an infant is positioned in a car seat can cause an increase in

regurgitation. Slouching over causes abdominal compression, increasing the

risk of reflux. Using simple supports to keep them upright will prevent this. Use

a car seat that allows your baby to be reclined enough that they aren't

slouched.

If you breastfeed it can be helpful to avoid foods associated with reflux (see

the previous section on trigger foods). Breastfeeding is best for a reflux baby

because it is more hypoallergenic than formula and is more easily digested.


71

If eliminating foods from your diet seems to help, you can slowly introduce one

thing at a time back into your diet and watch your baby's reactions. This way

you will know exactly what was making the reflux worse. Some children have

milk or gluten allergies or sensitivities to milk or gluten products, which can be

mistaken for reflux or worsen existing reflux. It’s a good idea to experiment

with different formulas, or eliminate milk and gluten products from your diet if

breastfeeding.

Try carrying your baby around as much as possible in a baby carrier

throughout the day. Carried babies tend to cry less and crying can make reflux

worse, plus, it keeps baby upright.

Also, infant massage may help to improve digestion and also can help to relax

your baby.


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Common Myths About Reflux and GERD

Excess Acid is the Only Cause of Heartburn

The amount of acid in the stomach of a GERD sufferer is usually normal. The

problem is often not the amount of acid but where it ends up – the esophagus.

It’s true that medication is given to reduce stomach acid. This is because

drugs do not effectively treat the underlying factors.

Acid Reflux Only Causes Problems in My Esophagus

Other conditions may be caused or worsened by acid reflux, including asthma.

GERD sufferers may also experience hoarseness caused by acid irritation in

the throat or around the vocal cords, or a chronic cough and sore throat. Acid

can also aspirate into the lungs leading to damage and infections and in

severe cases GERD can lead to Barrett’s esophagus, which can increase the

risk of esophageal cancer.

Stress Causes Heartburn

Stress does not cause heartburn, however stress can worsen symptoms as it

encourages behavior that often triggers acid reflux.

Nothing Can be Done About Heartburn and Acid Reflux

A full range of treatment is available, including prescription medication, non

prescription remedies, lifestyle and diet changes.

It’s My Fault I Have Heartburn

Although certain lifestyle habits and your food and drink choices may

aggravate your symptoms, some people make significant lifestyle changes

and can still experience heartburn. It’s a medical condition with real biological

causes and it can take trial and error to find an effective treatment /

management approach.

It’s Just a Fact of Life I Can't Control

You don’t need to suffer in silence. Diet and lifestyle changes, as well as


73

medication, can provide relief for most sufferers. Surgery or non-surgical

techniques may be appropriate treatment options for some people.

Heartburn is Minor and Trivial

It’s common, but not trivial. Frequent heartburn can severely impact your

productivity, daily activities and quality of life. Persistent heartburn may be a

symptom of GERD, which if untreated, can cause or contribute towards a wide

range of problems including the development of Barrett’s esophagus, which

can be a precursor for esophageal cancer.

After Dinner Mints Offer a Soothing way to Drift off to Sleep

After dinner mints combine three common heartburn triggers—chocolate, mint

and lying down — making them likely to cause heartburn and are therefore

best avoided.

Antacids aren't Real Medicine

Because antacids are sold without a prescription some people believe they’re

not real medicine. They are medicine, and you need to be sure to follow

directions for taking them carefully as with any drug. If used in moderation and

occasionally, antacids are safe.

I Have to Live With my Heartburn

Lifestyle changes, dietary modifications and medication can effectively treat

and prevent heartburn as well as provide complete symptom relief

Smoking a Cigarette Helps Relieve Symptoms

Cigarette smoking makes acid reflux worse. Acid reflux occurs when the LES

relaxes, allowing the acidic contents of the stomach to back into the

esophagus. Smoking acts as a muscle relaxant allowing the LES to relax.

Give up smoking today.

You Need Surgery to Correct Chronic Heartburn

Many people who have surgery still take acid reflux medication regularly.

However, surgery maybe worth considering if medication fails to help.

http://www.stop-smoking-for-life.com/


74

Nighttime Heartburn Sufferers Must Sleep Sitting Up

Rolling onto your left side can be just as effective. Sleeping on your right side

can aggravate acid reflux. Sleeping on your back allows acid to slip back into

your esophagus more often, but the acid takes longer to clear out when you

sleep on your right side.

All Chronic Heartburn Symptoms are Alike

Not all GERD sufferers experience typical heartburn chest pains. The

absence of heartburn does not mean you don’t have acid reflux / GERD.

Drinking Milk Before Sleep Eases Symptoms

Drinking milk can be a quick solution to a reflux problem. Unfortunately, milk

has a rebound action and eventually encourages secretion of more stomach

acid, which causes reflux.


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GERD at a Glance

GERD is a condition in which the acidic liquid contents of the stomach back

up into the esophagus.

The causes of GERD include an abnormal lower esophageal sphincter, hiatal

hernia, abnormal esophageal contractions, and slow emptying of the stomach.

GERD may damage the lining of the esophagus and cause inflammation.

The most common symptoms of GERD are heartburn, regurgitation, and

nausea.

Complications of GERD include ulcers and strictures of the esophagus,

Barrett's esophagus, cough and asthma, throat and laryngeal inflammation,

inflammation and infection of the lungs, and collection of fluid in the sinuses

and middle ear.

Barrett's esophagus is a pre-cancerous condition that requires surveillance for

the development of cancer.

GERD may be diagnosed or evaluated by a trial of treatment, endoscopy,

biopsy, x-ray, examination of the throat and larynx, esophageal acid testing,

esophageal motility testing, emptying studies of the stomach, and esophageal

acid perfusion.

GERD is treated with life-style changes, antacids, histamine antagonists (H2

blockers), proton pump inhibitors, pro-motility drugs, foam barriers, surgery,

and endoscopy.


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Medical disclaimer

This book contains information on a medical topic; however, no warranty

whatsoever is made that the medical information is accurate. There is

absolutely no assurance by the author that any statement contained in a topic

touching on medical matters is true, correct or precise. This book may have

been written, in part or in whole, by non-medical personnel. Even if a

statement made about medicine is accurate, it may not apply to you or your

symptoms. The medical information provided is, at best, of a general nature

and cannot substitute for the advice of a medical professional (for instance, a

qualified doctor/physician, nurse, pharmacist/chemist, and so on).

None of the individual contributors, system operators, developers, sponsors of

this book nor anyone else connected to this book can take any responsibility

for the results or consequences of any attempt to use or adopt any of the

information presented in this book or on the affiliated web site. Nothing in this

book should be construed as an attempt to offer or render a medical opinion

or otherwise engage in the practice of medicine.


77

For More Information

American College of Gastroenterology (ACG)

4900-B South 31st Street, Arlington, VA 22206–1656

Phone: 703–820–7400

Fax: 703–931–4520

Internet: www.acg.gi.org

American Gastroenterological Association (AGA)

National Office, 4930 Del Ray Avenue, Bethesda, MD 20814

Phone: 301–654–2055

Fax: 301–652–3890

Email: [email protected]

Internet: www.gastro.org

International Foundation for Functional Gastrointestinal Disorders

(IFFGD) Inc.

PO Box 170864, Milwaukee, WI 53217–8076

Phone: 1–888–964–2001 or 414–964–1799

Fax: 414–964–7176


Internet: www.aboutgerd.org

North American Society for Pediatric Gastroenterology, Hepatology and

Nutrition (NASPGHAN)

PO Box 6, Flourtown, PA 19031

Phone: 215–233–0808

Fax: 215–233–3939


Internet: www.naspghan.org


78

Pediatric/Adolescent Gastroesophageal Reflux Association Incorporated

(PAGER)

P.O. Box 1153

Germantown, MD 20875–1153

Phone: 301–601–9541


Internet: www.reflux.org


79

Glossary

Acid perfusion test – a test used to determine if chest pain is caused by acid

reflux

Adenocarcinoma – a type of esophageal cancer

Anemia - a drop in hemoglobin count

Antacid – neutralizes acid

Apnea - a period of more than ten to twenty seconds of interrupted breathing

Barrett's esophagus - Long-standing or severe GERD causes changes in the

cells that line the esophagus. These cells then become pre-cancerous, and

finally cancerous.

Body mass index - a measure of a weight in relation to height

Diaphragm - the muscle wall that separates the stomach from the chest.

Digestive enzymes - complex proteins involved in digestion that stimulate

changes in certain substances.

Duodenum - the first part of the small intestine that attaches to the stomach.

Endoscopy - suturing the area of the lower esophageal sphincter, which

tightens the sphincter; applying radio-frequency waves to the lower part of the

esophagus just above the sphincteror injecting material into the esophageal

wall in the area of the LES to increase pressure in the LES and prevent reflux.

Esophageal acid testing – a test where a sensor is placed in the esophagus to

detect the level of acidity there

Esophageal motility testing – a test to determine how well the muscles of the

esophagus are working.

Esophageal pH probe – a probe used to detect and record the amount of

stomach acid coming back up into the esophagus

Esophagus - carries food from the mouth to the stomach. Also called the

gullet.

Failure to thrive - when babies will not gain weight at an acceptable or safe

rate

Foaming agent - works by covering your stomach contents with foam to

prevent reflux

Fundoplication - wrapping the fundus around the esophagus


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Gastroenterologist – a doctor who specializes in internal medicine.

GERD - stands for gastroesophageal reflux disease. It’s an alternative name

for what many people call acid reflux and occurs when the lower esophageal

sphincter doesn’t close properly and stomach contents leak back, or reflux,

into the esophagus.

H2 Blockers/histamine antagonists - histamine attaches to receptors on the

stomach's acid-producing cells and stimulates the cells to produce acid. H2

blockers work by blocking the receptor for histamine and so prevent histamine

from stimulating the acid-producing cells.

Heartburn – also called acid indigestion. A burning chest pain beginning

behind the breastbone and moving upwards to the neck and throat.

Hiatal hernia - when the upper part of the stomach is above the diaphragm

Lower esophageal sphincter (LES) - a ring of muscle at the bottom of the

esophagus that acts like a valve between the esophagus and stomach.

Pepsin - an enzyme that begins the digestion of proteins in the stomach that

are produced by the stomach.

Prokinetics/pro-motility drugs - help to strengthen the sphincter and makes the

stomach empty faster

Proton pump inhibitors - blocks the secretion of acid into the stomach by the

acid-secreting cells

Refluxed liquid – liquid returned from the stomach.

Regurgitation - when refluxed liquid returns to the mouth

Ulcer - a break in the lining of the esophagus that occurs in an area of

inflammation.

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