Labels: acid reflux, GERD

Labels: Ger, GERD

Stomach acid may only be part of the problem when it comes to esophagus injury related to gastroesophageal reflux disease (GERD). A new study suggests that an immune system response may be the real culprit behind reflux esophagitis.

Researchers say it's been assumed that reflux esophagitis develops when cells in the lining of the esophagus become burned and damaged by stomach acid backing up into the esophagus.

But in a rat model of GERD, researchers found that this acid reflux didn't directly damage the lining of the esophagus. Instead, the acid triggered the release of chemicals called cytokines that attract inflammatory immune cells to the area, which were responsible for the real damage.

If further studies in humans confirm these results, researchers say new GERD treatments that target this immune response may be needed to effectively manage the disease.

"Currently, we treat GERD by giving medications to prevent the stomach from making acid," says Rhonda Souza, MD, associate professor of internal medicine at the University of Texas Southwestern Medical Center, in a news release. She says "maybe we should create medications that would prevent these cytokines from attracting inflammatory cells to the esophagus and starting the injury in the first place."

In the study, published in Gastroenterology, researchers created GERD in rats by performing an operation to connect the duodenum (first section of the small intestine) to the esophagus, allowing stomach acid and bile to enter the esophagus.

The results showed damage to the lining of the esophagus did not occur immediately after exposure to the stomach acids. It happened weeks later.

"That doesn't make sense if GERD is really the result of an acid burn," says researcher Stuart Spechler, MD, professor of internal medicine at UT Southwestern, in the news release. "Chemical injuries develop immediately. If you spill battery acid on your hand, you don't have to wait a month to see the damage."

Within three days after the operation, researchers found no damage to the cells on the surface layer of the esophagus, but they found inflammatory cells in the deeper layers. Those inflammatory cells rose to the surface three weeks later after the initial stomach acid exposure.

WebMD

Labels: acid reflux, GERD

Indigestion

Indigestion is often a sign of an underlying problem, such as gastroesophageal reflux disease (GERD), ulcers, or gallbladder disease, rather than a condition of its own.

Also called dyspepsia, indigestion is a term used to describe a feeling of fullness or discomfort during or after a meal. It can be accompanied by burning or pain in the upper stomach.

What Are the Symptoms of Indigestion?

The symptoms of indigestion include:

• Bloating (full feeling)
• Belching and gas
• Nausea and vomiting
• Acidic taste
• Growling stomach
• Burning in the stomach or upper abdomen
• Abdominal pain

These symptoms may increase in times of stress.

People often have heartburn (a burning sensation deep in the chest) along with indigestion. But heartburn is caused by stomach acids rising into the esophagus.

Who Is at Risk for Indigestion?

People of all ages and of both sexes are affected by indigestion. It's extremely common. An individual's risk increases with excess alcohol consumption, use of drugs that may irritate the stomach (such as aspirin), other conditions where there is an abnormality in the digestive tract such as an ulcer and emotional problems such as anxiety or depression.

What Causes Indigestion?

Indigestion has many causes, including:

Diseases:

• Ulcers
• GERD
• Stomach cancer (rare)
• Gastroparesis (a condition where the stomach doesn't empty properly; this often occurs in diabetics)
• Stomach infections
• Irritable bowel syndrome
• Chronic pancreatitis
• Thyroid disease

Medications:

• Aspirin and many other painkillers
• Estrogen and oral contraceptives
• Steroid medications
• Certain antibiotics
• Thyroid medicines

Lifestyle:

• Eating too much, eating too fast, eating high-fat foods, or eating during stressful situations
• Drinking too much alcohol
• Cigarette smoking
• Stress and fatigue

Swallowing excessive air when eating may increase the symptoms of belching and bloating, which are often associated with indigestion.

Sometimes people have persistent indigestion that is not related to any of these factors. This type of indigestion is called functional, or non-ulcer dyspepsia.

During the middle and later parts of pregnancy, many women have indigestion. This is believed to be caused by a number of pregnancy-related factors including hormones, which relax the muscles of the digestive tract, and the pressure of the growing uterus on the stomach.

How Is Indigestion Diagnosed?

If you are experiencing symptoms of indigestion, make an appointment to see your doctor to rule out a more serious condition. Because indigestion is such a broad term, it is helpful to provide your doctor with a precise description of the discomfort you are experiencing. In describing your indigestion symptoms, try to define where in the abdomen the discomfort usually occurs. Simply reporting pain in the stomach is not detailed enough for your doctor to help identify and treat your problem.

First, your doctor must rule out any underlying conditions. Your doctor may perform several blood tests and you may have X-rays of the stomach or small intestine. Your doctor may also use an instrument to look closely at the inside of the stomach, a procedure called an upper endoscopy. An endoscope, a flexible tube that contains a light and a camera to produce images from inside the body, is used in this procedure.

What Is the Treatment for Indigestion?

Because indigestion is a symptom rather than a disease, treatment usually depends upon the underlying condition causing the indigestion.

Often, episodes of indigestion go away within hours without medical attention. However, if your indigestion symptoms become worse, you should consult a doctor. Here are some helpful tips to alleviate indigestion:

• Try not to chew with your mouth open, talk while chewing, or eat too fast. This causes you to swallow too much air, which can aggravate indigestion.
• Drink fluids after rather than during meals.
• Avoid late-night eating.
• Try to relax after meals.
• Avoid spicy foods.
• Stop smoking.
• Avoid alcoholic beverages.

If indigestion is not relieved after making these changes, your doctor may prescribe medications to alleviate your symptoms.

How Can I Prevent Indigestion?

The best way to prevent indigestion is to avoid the foods and situations that seem to cause indigestion. Keeping a food diary is helpful in identifying foods that cause indigestion. Here are some other suggestions:

• Eat small meals so the stomach does not have to work as hard or as long.
• Eat slowly.
• Avoid foods that contain high amounts of acids, such as citrus fruits and tomatoes.
• Reduce or avoid foods and beverages that contain caffeine.
• If stress is a trigger for your indigestion, re-evaluating your lifestyle may help to reduce stress. Learn new methods for managing stress, such as relaxation and biofeedback techniques.
• Smokers should consider quitting smoking, or at least not smoking right before or after eating, as smoking can irritate the stomach lining.
• Cut back on alcohol consumption because alcohol can irritate the stomach lining.
• Avoid wearing tight-fitting garments because they tend to compress the stomach, which can cause its contents to enter the esophagus.
• Do not exercise with a full stomach. Rather, exercise before a meal or at least one hour after eating a meal.
• Do not lie down right after eating.
• Wait at least three hours after your last meal of the day before going to bed.
• Raise the head of your bed so that your head and chest are higher than your feet. You can do this by placing 6-inch blocks under the bedposts at the head of the bed. Don't use piles of pillows to achieve the same goal. You will only put your head at an angle that can increase pressure on your stomach and make heartburn worse.

When Should I Call the Doctor About Indigestion?

Because indigestion can be a sign of a more serious health problem, call your doctor if you have any of the following symptoms:

• Vomiting or blood in vomit (the vomit may look like coffee grounds).
• Weight loss.
• Loss of appetite.
• Black, tarry stools or visible blood in stools.
• Severe pain in upper right abdomen.
• Pain in upper or lower right abdomen.
• Discomfort unrelated to eating.

Symptoms similar to indigestion may be caused by heart attacks. If indigestion is unusual, accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck or arm, seek medical attention immediately.

webmd

Labels: GERD, Heartburn, indigestion

ecently, the number of patients with GERD has increased in Japan. However, there have been few reports about the pathological findings in the esophageal squamous epithelium, and there are differing opinions among pathologists about the findings considered characteristic of chronic reflux esophagitis.　

Dr. Daisuke Asaoka and his colleagues from Juntendo University (Japan) used a rat model of chronic acid-reflux esophagitis to explore the esophageal mucosal damage macroscopically and microscopically throughout the entire esophagus, including the upper esophagus close to the hypopharynx, and to investigate the protective effects of ecabet sodium (ES) on the esophageal mucosa. This was published in the World Journal of Gastroenterology.

Their research revealed that epithelial thickening occurs at the same time as inflammatory cell infiltration in the middle to lower esophagus in chronic acid-reflux esophagitis. Furthermore, they demonstrated that inflammatory cells infiltrated the epithelium of the upper esophagus close to the hypopharynx, where there was no evidence of ulcers. These findings suggested that the reflux of gastric juice can extend to the upper esophagus close to the hypopharynx.

Moreover, the research also demonstrated that ES inhibited the epithelial thickening of the lower and middle esophagus, which suggested that ES may play a useful defensive role in the prevention of reflux esophagitis.


Source:
Lai-Fu Li
World Journal of Gastroenterology

Labels: esophagitis, GERD

It is well known that non-cardiac chest pain is closely related to gastroesophageal reflux diseases (GERD). Chest pain of esophageal origin can be difficult to distinguish from that caused by cardiac ischemia because the distal esophagus and the heart share a common afferent vagal supply, and GERD can cause episodes of non-cardiac chest pain that resemble ischemic cardiac pain.

A research team led by Dr. Yoshihisa Urita from Toho University School of Medicine investigated the association between gastroesophageal reflux diseases (GERD) and coronary heart diseases. Their study was published on April 14, 2009 in the World Journal of Gastroenterology.

One thousand nine hundred and seventy consecutive patients were enrolled in this study. All of the patients who first attend their hospital were asked to respond to the F-scale questionnaire regardless of their chief complaints. All patients had a careful history taken, and resting echocardiography (ECG) was performed by physicians if the diagnostic necessity arose. Patients with ECG signs of coronary artery ischemia were defined as ST segment depression based on the Minnesota code.

Among 712 patients (36%) with GERD, ECG was performed in 171 (24%), and ischemic changes were detected in eight (5%). Four (50%) of these patients with abnormal findings upon ECG had no chest symptoms such as chest pain, chest oppression, or palpitations. These patients (0.6%; 4/712) were thought to have non-GERD heartburn, which may be related to ischemic heart disease. Of the 281 patients who underwent ECG and did not have GERD symptoms, 20 (7%) had abnormal findings upon ECG. In patients with GERD symptoms and ECG signs of coronary artery ischemia, the prevalence of linked angina was considered to be 0.4% (8/1970 patients).

The study results suggest that an extra-esophageal condition causes GERD symptoms and that angina may be misclassified as GERD. Since patients with GERD have an increased risk of angina pectoris in the year after GERD diagnosis, physicians have to be concerned about missing clinically important CAD while evaluating patients for GERD symptoms.

Reference: Kato H, Ishii T, Akimoto T, Urita Y, Sugimoto M. Prevalence of linked angina and gastroesophageal reflux disease in general practice. World J Gastroenterol 2009; 15(14): 1764-1768. http://www.wjgnet.com/1007-9327/15/1764.asp

Correspondence to: Dr. Yoshihisa Urita, Department of General Medicine and Emergency Care, Toho University School of Medicine, Omori Hospital, 6-11-1, Omori-Nishi, Ota-Ku, Tokyo

Source:
Lai-Fu Li
World Journal of Gastroenterology

Labels: Angina, Gastrointestinal, GERD

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions seen in GI and primary care clinics, however physicians who treat the disease primarily rely on empirical trials of medications and their own observations and experience to manage their patients. Therefore, the American Gastroenterological Association (AGA) Institute has published evidence-based guidelines for the management and treatment of suspected GERD. The guidelines, which are the first produced through AGA's innovative guideline development process, are published in Gastroenterology, the official journal of the AGA Institute.

"There are many methods physicians are using to treat their patients with GERD, without knowing which is the best one," according to John I. Allen, MD, AGAF, chair, AGA Institute Clinical Practice and Quality Management Committee. "The AGA Institute developed this medical position statement on GERD to encapsulate the major management issues leading to consultations for the treatment of the disease to help guide physicians in treating their patients."

According to the authors, high-quality clinical trials for GERD management strategies do not exist. The majority of randomized controlled clinical trials are for pharmacologic therapies for esophageal GERD syndromes, especially acute trials for healing esophagitis. Therefore, many of the highest-level evidence-based recommendations in the guideline are for the acute treatment of heartburn or esophagitis. In developing the guidelines, the authors used the Montreal consensus definition for GERD, "a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications." Troublesome symptoms are those that adversely affect an individual's well-being.

"As we found in our research, much of the current management of patients with GERD is based on experiences from physicians, uncontrolled trials and expert opinion," according to Peter J. Kahrilas, MD, AGAF, Northwestern University's Feinberg School of Medicine and lead author of the guidelines. "We hope the development of these guidelines will help clinicians better treat patients who present with suspected GERD."

The conclusions of the technical review and medical position statement were based on the best available evidence, or in the absence of quality evidence, the expert opinions of the authors and Medical Position Panel convened to critique the technical review and structure the medical position statement. The technical review and the medical position statement together represent the guideline. The strength of the conclusions were determined using the U.S. Preventive Services Task Force grades. Grade A recommendations, which are "strongly recommended based on good evidence that it improves important health outcomes," according to the AGA Institute, include:

I. Antisecretory drugs for the treatment of patients with esophageal GERD syndromes (healing esophagitis, symptomatic relief and maintaining healing of esophagitis). In these uses, proton pump inhibitors (PPIs) are more effective than histamine receptor antagonists (H2RAs), which are more effective than placebo.

II. Long-term use of PPIs for the treatment of patients with esophagitis once they have proven clinically effective. Long-term therapy should be titrated down to the lowest effective dose based on symptom control.

III. When antireflux surgery and PPI therapy are judged to offer similar effectiveness in a patient with an esophageal GERD syndrome, PPI therapy should be recommended as initial therapy because of superior safety.

IV. When a patient with an esophageal GERD syndrome is responsive to, but intolerant of, acid suppressive therapy, antireflux surgery should be recommended as an alternative.

V. Twice-daily PPI therapy as an empirical trial for patients with suspected reflux chest pain syndrome after a cardiac etiology has been carefully considered.

Other recommendations include grade B - "recommended with fair evidence that it improves important outcomes;" grade C - "balance of benefits and harms is too close to justify a general recommendation;" grade D - recommend against, fair evidence that it is ineffective or harms outweigh benefits;" and grade insufficient - "no recommendation, insufficient evidence to recommend for or against."

To develop the guidelines, a set of 12 broad questions were identified by experts in the field to encapsulate the most common management questions faced by clinicians. To review recommendations and grades, view the AGA Medical Position Statement of the Management of Gastroesophageal Reflux Disease. The guidelines were developed through interaction among the authors, the AGA Institute, the Clinical Practice and Quality Management Committee and representatives from the AGA Institute Council.

Source:
Aimee Frank
American Gastroenterological Association

Labels: GERD

For many people, Thanksgiving is about having family near and celebrating, sometimes in excess. That's because for some holiday revelers, perhaps the amount of time spent watching football on the tube is only surpassed by a second activity: eating. And with the turkey, sweet potatoes and pumpkin pie comes heartburn, but how do you know if you have a simple case of it, or something more serious? Simply put, if the heartburn you have affects your quality of life, you may have gastro-esophagael reflux disease, more commonly known as GERD.

"If a person has a burning feeling down in their gut that goes up into the chest, made worse by eating, or exercising or lying down, and this happens several times a week, then that's affecting their life and there's a good chance they have GERD,"said gastroenterologist Joel Richter, M.D., chair of the Department of Medicine at Temple University School of Medicine. "The next step is to see a doctor and have the condition evaluated because there is actually "good" and "bad" GERD."

And how doctors treat the two types are very different. Richter says "good" GERD is the most common; about 80 to 90 percent of patients have it. This group may have occasional to daily heartburn symptoms, but nothing more serious, such as esophageal damage by endoscopy or problems with swallowing.

"For this group, more medication may not be the answer. Rather," says Richter. "Those with intermittent symptoms need to modify their lifestyle by losing weight,reducing their fat intake and not eating late at night before going to bed."

And while they can take proton pump inhibitors, (PPI's) which ease heartburn by alleviating excess stomach acid that flows back into the esophagus, Richter recommends that many will only need to take these pills as needed when their symptoms are bothersome. But for the second group of sufferers who have "bad" or more serious GERD symptoms, a lifetime drug therapy regimen can not only improve their quality of life, but can be life-saving.

"About 10 to 15 percent of GERD patients suffer from a more severe form, in which they have scarring on the esophagus, problems swallowing, and may even have Barrett's Esophagus, in which the cells lining the esophagus can turn cancerous," said Richter. "So, even though PPI's pose the risk of side effects, they are very effective for this group and the benefits of using them far outweigh the risks."

Patients who rely on these drugs when they're not needed put themselves at unnecessary risk for side effects when used long-term, which include an increase in bacterial pneumonia, gastrointestinal infections, and hip fractures, especially in women. Richter warns that before a patient starts self-medicating with PPI's, it's crucial that they find out which type of GERD they're suffering from. The best way to do that is through a set of consults with a doctor. An initial visit will consist of an endoscopy and a review of the patient's medical history to determine what type of pill a patient should be on. A follow up visit to evaluate the patient's response to the drug determines which type of GERD they have.

"These visits are the two pieces to the puzzle when diagnosing someone with GERD," said Richter.

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Labels: GERD, Heartburn

caAccording to the American Cancer Society (ACS), more than 16,000 new esophageal cancer cases are diagnosed each year in the U.S. Unfortunately the survival rate in these cases is only 10 percent. This alarming statistic is due largely to the fact that by the time the majority of cases are diagnosed, the cancerous tumors have grown to the point of inoperability. Raising patient awareness about potential conditions that, if left untreated, could progress into esophageal cancer, will encourage patients to seek the appropriate care through their physician.

Many people are aware that tobacco use increases the risk of developing esophageal cancer; however, there are several other common contributing risk factors including:

- Excessive alcohol consumption;
- Obesity;
- Lye ingestion; and,
- Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn.

A recent ACS Gallup poll revealed that 44 percent of adults in the U.S. have heartburn at least once per month and that approximately 30 percent of esophageal cancer cases can be linked to GERD. GERD is a condition in which acid (with some pepsin and bile) splashes up from the stomach into the esophagus. These three fluids are potentially dangerous to the sensitive esophageal tissue, as they can inflame and damage the lining of the esophagus, a condition known as esophagitis.

If GERD becomes a chronic condition, it can develop into Barrett's esophagus, a precursor to esophageal cancer. Barrett's esophagus is a condition in which the color and composition of the cells lining the lower esophagus change due to repeated exposure to stomach acid. Only a small percentage of people with GERD develop Barrett's esophagus, but once it is diagnosed, patients should be sure to meet with their physician regularly as they are at a greater risk of developing esophageal cancer.

Symptoms of advanced GERD or the presence of Barrett's esophagus include:

- Frequent heartburn. A burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.
- Difficulty swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to trouble swallowing or dysphagia.
- Bleeding. A person may vomit red blood or blood that looks like coffee grounds, or your stools may be black, tarry or bloody.
- Weight loss and loss of appetite.

According to the ACS, prevention of Barrett's esophagus can begin with controlling GERD by making some simple lifestyle changes, such as:

- Losing weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus;
- Eating a diet full of fruits and vegetables, eating smaller and more frequent meals and not eating two to three hours prior to bedtime;
- Smoking cessation, as nicotine relaxes the esophageal sphincter and smoking also stimulates the production of stomach acid;
- Discontinuing the consumption of alcohol.

People with severe GERD and Barrett's esophagus often require aggressive treatment and prevention methods including medications, other nonsurgical medical procedures such as endoscopic therapies, or even laparoscopic and open surgeries. Often times, swallowing difficulty (known as dysphagia) and other symptoms can be treated if identified early.

However, due to the aggressive nature of the disease, the majority of patients who have esophageal cancer are not surgical candidates. In these situations, the primary focus becomes palliative care - providing comfort measures to help maintain quality of life. This includes treating the dysphagia and restoring the patient's ability to swallow food and drink liquids by opening the stricture within the esophagus.

To open the barriers caused by tumor in-growth physicians use an esophageal metal stent. Prior to the stent placement the patient may require dilation of the stricture to allow room for the stent to be positioned, thereby expanding the lumen of the esophagus. Traditionally, the placement of the stent can be a painful process for the patient, yet new technologies are making this procedure easier on the patient and physician.

New, innovative delivery systems enable accurate deployment and recapturability of the stent. This reduces the stent from moving or migrating into the stomach and thus the need for repeat procedures to replace or reposition the stent, one of the more common complications in traditional esophageal stenting.

Raising awareness about the primary pre-cursors to esophageal cancer - GERD and Barrett's esophagus - will encourage patients with these conditions to consult their physicians for the necessary screenings and treatment options. However, when palliative care becomes the primary option for patients with esophageal cancer, recent advancements in medical device technologies enable physicians to more easily implant an esophageal stent and in turn improve patients' quality of life.

Medicalnews

Labels: Cancer, Esophageal, Gastrointestinal, GERD

Labels: asthma, GERD

Labels: acid reflux, GERD

Labels: acid reflux, GERD

Johns Hopkins Health Alerts has just published a review of the new GERD guidelines, for safe, effective treatment of your acid reflux.

Treating GERD Effectively

There are four types of treatments for gastroesophageal reflux disease (GERD): lifestyle measures, medication, surgery, and endoscopic procedures.

Why it is important to treat GERD

Treating GERD is important. Untreated GERD can lead to serious complications, such as esophageal ulcers (nonhealing mucosal defects), esophageal strictures, Barrett's esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer), and even esophageal cancer.

Lifestyle changes to treat GERD

Doctors often recommend lifestyle changes as the first-line treatment for acid reflux. These measures can include elevating the head of the bed during sleep, not eating late at night, and avoiding alcohol or spicy foods.

New findings on effective treatments for GERD

However, a new study reported in "The Archives of Internal Medicine" (Volume 166, page 965) shows that NOT ALL of these changes are helpful in relieving GERD symptoms, and some may be unnecessarily restrictive.

Researchers looked at the results of 100 studies conducted on various lifestyle measures for GERD. Only losing weight and elevating the head of the bed showed a CLEAR BENEFIT in well-designed studies.

Other measures not found to be effective

In comparison, there was little evidence to support avoiding many suspected GERD triggers, such as alcohol, caffeine, chocolate, spicy foods, citrus, carbonated beverages, fatty foods, and mint. The same was true for sleeping on your left side or avoiding food late at night.

Although there was evidence that some of these substances and practices can cause GERD symptoms, evidence was lacking that avoiding them will relieve symptoms.

Bottom line advice on treating GERD

However, if you experience worsening GERD symptoms after eating certain foods or drinking specific beverages you should probably avoid them. In addition, you should certainly give lifestyle changes a chance before trying medication to relieve your GERD symptoms.

For the latest health alerts on GERD (acid reflux), sour stomach, and other digestive disorders, please visit the Johns Hopkins Health Alerts Digestive Disorders Topic Page at: Johns Hopkins Health Alerts Digestive Disorders

This article is exceprted from the annual Johns Hopkins White Paper: Digestive Disorders. For more information about this book, please visit: Johns Hopkins White Paper: Digestive Disorders

Johns Hopkins Health Alerts

Labels: acid reflux, GERD

MedicalNews

According to results of a survey presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, nighttime acid reflux, along with some of the less typical manifestations or symptoms of gastroesophageal reflux disease (GERD), is associated with significant sleep impairment.

In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.

Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.

"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.

Tips for Calming Nighttime Acid Reflux Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances, including arousal from sleep, increased wakefulness and overall poor sleep quality.

Here are several tips to help reduce nighttime acid reflux so you can sleep better:

* Sleep with your head and shoulders elevated
* Wear loose-fitting clothes
* Wait 2 to 3 hours after eating to go to sleep
* Avoid foods that trigger heartburn

Labels: acid reflux, GERD

MedicalNews

New research from scientists at UT Southwestern Medical Center and the Dallas Veterans Affairs Medical Center underscores the importance of preventing recurring acid reflux while also uncovering tantalizing clues on how typical acid reflux can turn potentially cancerous.

In research published in July and August, scientists discovered that people with acid reflux disease, particularly those with a complication of acid reflux called Barrett's esophagus, have altered cells in their esophagus containing shortened telomeres, the ending sequences in DNA strands. Combined with related research to be published this month, the findings indicate that the shortened sequences might allow other cells more prone to cancer to take over.

"The research supports why it is important to prevent reflux, because the more reflux you have and the longer you have it, the more it might predispose you to getting Barrett's esophagus. So you want to suppress that reflux," said Dr. Rhonda Souza, associate professor of internal medicine at UT Southwestern and lead author of the paper which appeared in the American Journal of Physiology -- Gastrointestinal and Liver Physiology.

Heartburn occurs when acid splashes back up from the stomach into the esophagus, the long feeding tube that connects the stomach and throat, causing a burning sensation.

Over time, the persistent acid bath can cause normal skin-like cells in the esophagus to change into tougher, more acid-resistant cells of the type found in the stomach and intestine, a condition called Barrett's esophagus, explained Dr. Stuart Spechler, professor of internal medicine and senior author of the paper. "Unfortunately, those acid-resistant cells are also more prone to cancer," Dr. Spechler said.

Adenocarcinoma of the esophagus, the cancer that is especially associated with Barrett's esophagus, is currently the most rapidly rising cancer in the U.S., with a sixfold increase in cases during the past 30 years, according to the National Cancer Institute.

Understanding how and why the cells change in some cases and not others has been a major challenge for investigators.

Researchers compared telomere length and telomerase activity in biopsy specimens from 38 patients with GERD and 16 control patients. This new line of research suggests that the continuous acid bath affecting esophageal cells causes them to divide more frequently in order to regenerate the damaged lining. However, each time the cells divide, the telomeres at the end of DNA become shorter. When they become too short, the aging cell can no longer divide, Dr. Souza said.

Scientists suspect that when cells can no longer divide, other cells might infiltrate the area to make up for the loss. And those cells may be more likely to generate the acid-resistance that makes them more likely to turn cancerous.

"If the telomeres get short enough, maybe the cells can't regenerate any more and maybe that's why you start to see this change," said Dr. Spechler. "Perhaps the esophagus can't regenerate the normal skin-like squamous cells, and instead, it has to recruit cells from somewhere else and that's why you start getting these changes to intestinal-like cells."

Other studies by this group of UT Southwestern digestive disease specialists suggest the alternate cells that eventually take over might be bone-marrow cells.

"There could be cells circulating from the bone marrow that wouldn't ordinarily end up in the esophagus. But if you shorten the telomeres enough and the esophagus can't regenerate anymore, perhaps these bone-marrow cells might have to replace that tissue, and bone-marrow cells can turn into intestinal tissue," Dr. Spechler said. "This hasn't been proven, but we have some data that supports that."

In research available online prior to printing this month in Diseases of the Esophagus, Drs. Souza, Spechler and colleagues demonstrate that bone-marrow cells come into play to regenerate the esophageal lining in rats that have heavy reflux.

"So the first paper shows that the telomeres are short, suggesting that the normal squamous cells might not be able to divide anymore, so they die out," Dr. Spechler said. "The second paper suggests that the bone-marrow cells may then come and take their place, giving rise to the intestinal cells instead of the normal, skin-like cells."

Further research will be needed to confirm that hypothesis, Dr. Souza said.

"It's an interesting series of experiments," she said. "None of them absolutely prove that this is what's going on, but it's an interesting concept, and it certainly supports the theory that your normal cells poop out and eventually they can't replace the damaged ones, and maybe that's why you get Barrett's esophagus."

If confirmed, the research might also help scientists find a way to prevent the bone-marrow cells from invading or to identify markers that would allow an earlier diagnosis for Barrett's esophagus, which doesn't usually have symptoms.

Labels: acid reflux, GERD

Medicalnews

New, updated guidelines for esophageal reflux testing appear in The American Journal of Gastroenterology. Developed and approved by the American College of Gastroenterology, these guidelines summarize advances in gastroesophageal reflux disease (GERD) diagnostic testing and how they have modified the clinical management of esophageal disorders.

"Gastroenterologists are confronted with an increasing number of patients presenting symptoms of GERD that are unresponsive to drug therapy," says lead author Dr. Ikuo Hirano. "These patients may have typical reflux symptoms of heartburn and regurgitation but also may complain of chest pain, asthma, chronic cough and chronic laryngitis." This confusing list of symptoms, coupled with the fact that many of these patients do not have visible esophageal erosions, makes diagnosis and treatment of GERD a challenge. Furthermore, non-gastrointestinal entities, such as cardiac or pulmonary disease, may produce symptoms that are similar to those attributable to GERD.

Some new technologies offer opportunities for more accurate diagnoses. "Wireless capsule pH monitoring, bile acid reflux monitoring devices and esophageal impedance can all improve the detection of reflux," says Dr. Hirano. These technologies have helped gastroenterologists to discover new forms of reflux, and to better characterize traditional acid reflux.

Of course, all technologies have limitations, and the new guidelines highlight these as well. In addition, recommendations on the clinical applications of esophageal reflux testing are presented.

Labels: GERD