Yasmin WilliamsONE SUPPOSES that at this time of year when there is more eating and alcohol drinking, there is more gastrointestinal reflux and oesophagitis.
Reflux refers to the backflow of acid from the stomach into the oesophagus (gullet)
which connects the mouth to the stomach. A band of muscle referred to as the oesophageal sphincter is found between the end of the stomach and the oesophagus and this acts as a valve preventing the backflow or reflux of stomach contents into the oesophagus.
OESOPHAGITIS
The presence of gastrointestinal reflux or GERD is an indication of malfunctioning of this sphincter. The acidic contents from the stomach and the impaired ability to move the contents rapidly from the oesophagus contribute to the development of irritation and inflammation (not infection) of the oesophageal lining or mucosae. This inflammation is called oesophagitis. Remember this word and the meaning by dissecting it into 'oesoph', which refers to oesophagus or gullet and 'itis', which refers to inflammation.
The most common symptom of GERD is 'heartburn', which is a misleading term as this has nothing to do with the heart. It is a burning feeling which originates in the stomach and radiates up to the neck. However, GERD may present as significant chest pain if, for example, there is much spasm of the muscle in the oesophagus. Sometimes, this may be confused with cardiac or heart pain.
Conversely a person who is having a mild heart attack may mistakenly think that his or her symptom is related to a malfunctioning gastrointestinal tract. Other symptoms of GERD include an acid taste in the mouth and there may be complaints about belching and bloating. Interestingly, a cough particularly at night may be a symptom. This occurs because of irritation of the trachea or windpipe by refluxed acidic material.
THE ENDOSCOPY TEST
Endoscopy, which is usually done by a medical specialist called a gastroenterologist, is perhaps the most common test used to confirm this diagnosis. The test involves passing a flexible tubular instrument down the oesophagus and looking at the oesophageal lining. As necessary, specimens of tissue (biopsies) can be taken and sent to the laboratory for testing. Biopsy will distinguish between narrowing or stricturing of the oesophageal lining due to chronic inflammation and that due to oesophageal cancer. In cases of GERD, barium X-rays may show reflux of barium from stomach into the oesophagus when the patient is put in what is called the Trendelenburg position. One can also do tests to check the acidity in the stomach.
Management of uncomplicated gastrointestinal reflux involves the following:
1). Stop smoking if you are a smoker.
2). Avoid coffee and alcohol which stimulate acid secretion.
3). Avoid certain foods like fats and chocolate which can reduce the competence of the sphincter between stomach and oesophagus and avoid other foods which may directly irritate the lining, for example, spices, coffee and citrus fruits.
4). Avoid large meals as this may aggravate reflux.
5). Avoid eating and then going to sleep shortly after.
6). Raise the head of the bed about six inches to help prevent gravity from refluxing acid into the oesophagus.
7). Lose weight if you are overweight as overweight causes increased pressure on the stomach and increases the likelihood of reflux of stomach contents into the stomach.
8). Watch your posture as this might influence the occurrence of reflux.
Dr. Yasmin Williams is a family doctor and public health specialist; email: yourhealth@gleanerjm.com.
