Dr Darren’s Thursday surgery
Q: I have been suffering from indigestion and heartburn for three months. When I go to sleep at night I often feel bloated and uncomfortable despite having an early dinner, and when I wake up in the morning I feel like my chest is on fire.
I often find myself drinking ice-cold milk for breakfast to alleviate the symptoms. My wife regularly suggests that I eat yoghurt and swears by it helping her. Do you think this is true ?
I am a fairly healthy person with a hectic travelling schedule, especially at this time of the year. My weight has been pretty stable for the past few years. However, I have picked up 8kg in six months.
My exercise routine is erratic. When I do exercise, I find that my chest seems tighter than usual and I struggle to finish my routine.
The only other ailment I have is a temperamental right knee which I had operated on for a cartilage tear about six years ago. The pain is persistent but improves with my chronic medication.
I have a history of colon cancer in my mother’s family, so should I be worried, doctor, and what can I do to stop these symptoms?
A: Thank you for sharing your story with us. I am concerned about a few issues. This is a common list of complaints that most people choose to ignore or self-treat until matters spiral out of control. You describe the typical features of gastro-oesophageal reflux disease or Gerd.
Your history reveals a few risk factors for the condition, including stress, lack of sleep, weight gain as well as the most common cause – medication overuse, especially the anti-inflammatories. You should understand that one of the common causes of reflux disease is a hiatus hernia, and as you gain weight, it can worsen the symptoms as the hernia then increases in size.
Your tight chest and possible wheezing during exercise also points to reflux disease. Asthma-like symptoms are often caused by silent reflux at night time.
What is Gerd?
Clinically it is a collection of typical symptoms associated with excessive acid production and reflux disease.
The syndrome includes burning abdominal pain, heartburn, persistent nausea as well as burping repeatedly after meals. Bloatedness after eating is also present in some cases.
Gerd is caused when the stomach valve or sphincter does not close properly during digestion. Acid pushes up into the oesophagus causing significant harm to the lining of the digestive tract. Inflammation then follows, leading to further symptoms of discomfort and eventually pain.
In addition to this, the excessive acid secretion by the stomach also plays a role in combination with a pathological organism which grows in the stomach and “drills” holes in the gastric mucosa leading to significant gastritis and ulcers.
Increased acid production is caused by chronic stress, poor sleep and then specific medical conditions which affect the autonomic nervous system and release of acid into the stomach. The proton pump and the Parietal cells are extremely important for this process.
The role of diet in causing reflux disease is well researched and continues to grow in stature.
But the way forward is to control the pH of the gut and the influence of digestive enzymes as well as the effect of cultures on the maintenance of the gastro-intestinal (GIT) tract are all part of the leading approach in dealing with this global medical condition.
Early detection and screening for GIT cancers are essential in combating the disease. For most people, the problem of reflux is recurrent unless diagnosed and treated effectively with a multi-faceted approach.
What is a gastroscopy?
Basically, swallowing a fibre-optic camera. This is done under controlled circumstances with conscious sedation in some cases – however this is not always necessary as many people have it done while awake. Make sure your specialist is experienced and cautious as this procedure should not have major complications. It is done for a detailed view and if necessary a biopsy of the gastric mucosa if any suspicious lesions are seen.
Dealing with Gerd
* Persistent symptoms deserve further investigation.
* A gastroscopy is bearable – do not fear.
* Eradication of harmful organisms in the gut is possible (Helicobacter pylori) – a course of two antibiotics is issued.
* Medical management with a Proton pump inhibitor decreases acid reflux.
* Dietary modifications are effective in treatment.
* Genetic predisposition to GIT cancers calls for vigilance.
* Weight management can assist Gerd – decrease symptomatic hiatus hernias.
Practical tips for dealing with reflux problems
* Place two bricks under the top end of your bed – the gradient helps to prevent reflux.
* Try to stop eating three hours before bedtime.
* Avoid alcohol at least two hours before going to bed.
* Include pH- controlling foodstuffs in your diet – go easy on tomatoes and fizzy drinks.
* Get probiotics into your routine. Regular bowel motion prevents delayed gastric emptying and constipation.
* If your symptoms persist despite these measures, and the use of over-the-counter antacids, get urgent help.