Home' Nova National : Nova August 2015 Contents NOVA Magazine August 2015
his is a common problem and
is known by the acronym
GERD and stands for Gastro-
Esophageal Reflux Disease.
Over time the reflux of stomach acid
causes reflux esophagitis (meaning
inflammation of the esophagus). GERD
is also called “heartburn,” although it
has nothing to do with the heart. It may
produce a burning discomfort behind
the sternum which may extend up into
the throat or may not produce any
symptoms. If reflux occurs during sleep
when you are horizontal, you may awake
with a sore throat or a husky voice and
an irritating cough.
GERD is caused by the acid contents
of the stomach regurgitating or flowing
backwards into the esophagus. The
lining of the esophagus is not designed to
handle these high acid conditions, which
lead to inflammation, and in severe cases,
scarring and ulceration of the lining of
The stomach produces a lot of
hydrochloric acid during eating and for
good reason, because without it, you
cannot digest proteins efficiently and
you will not absorb calcium and other
minerals from foods.
There is a circular muscle around
the lower esophagus, which divides it
from the stomach, and this normally
remains contracted to prevent back flow
of stomach acid. During swallowing
this muscle normally relaxes, allowing
food to pass from the esophagus into the
stomach, after which it should remain
contracted. If this circular muscle
becomes weakened or too relaxed, reflux
can occur after meals.
If you are overweight and/or have
a fatty liver, this will cause too much
pressure on the stomach, and reflux
becomes worse. If you eat a lot of sugar
or refined carbohydrates such as cakes
and biscuits, this will feed unhealthy
bacteria in the stomach and this will
make your stomach inflamed and overly
sensitive to the hydrochloric acid. Thus is
it vital to avoid sugary foods.
In some people with reflux there
is also a hernia (protrusion) of the
upper part of the stomach through
the diaphragm into the lower chest.
See diagram page 270. This is called a
hiatus hernia and can be hereditary and
is more common with age and in those
who are overweight. A hiatus hernia
will impair the function of the circular
muscle around the lower esophagus.
This increases reflux and heartburn
symptoms. These symptoms are much
worse after eating a large meal and while
If you suffer with long standing
esophageal reflux it is important to
see your gastroenterologist regularly,
because prolonged exposure of the
fragile esophageal mucosa to acid can
result in an increased risk of esophageal
cancer, severe scarring and narrowing
(stricture formation). The passage inside
the esophagus can become so narrowed
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Dr Sandra Cabot discusses the common condition
Gastro-Esophageal Reflux Disease (GERD).
An Extract from Health Bowel Healthy Body by Dr Sandra Cabot
Credit: Ian Sane / Flickr
that a stricture develops. This causes
difficulty in swallowing normal amounts
of food and results in pain, obstruction,
or vomiting up the food that gets stuck.
Surgery to enlarge the lower esophagus
may then become necessary.
In severe cases of reflux esophagitis,
medications to block stomach acid
production should be taken if natural
therapies fail. These are very effective
and examples of these drugs are
cimetidine, famotidine, nizatidine,
rantidine and omeprazole.
The most common drugs used to reduce
acid production by the stomach are
Proton Pump Inhibitors (PPIs) and
Histamine 2 Receptor Antagonists.
Examples of these drugs are
esomeprazole and pantoprazole.
These drugs are amongst the world’s
most commonly prescribed drugs. They
are used to medically treat gastric and
duodenal ulcers and Gastro-Esophageal
Reflux Disease (GERD). They may also
be used to prevent stomach and duodenal
ulcers associated with the use of non-
steroidal anti-inflammatory drugs. PPIs
reduce the production of stomach acid
by blocking the enzyme in the wall of the
stomach that produces acid.
There may be side effects from using
these drugs long term and they include –
• An increased risk of developing
osteoporosis (bone loss). High dose
therapy with PPIs and/or Histamine-2
Receptor Blocker drugs can
significantly increase the risk of
• I mpaired absorption of minerals (such
as magnesium, zinc and calcium)
• An increased risk of vitamin B12
deficiency – this can be serious as B12
is required for the nervous system to
function normally. In people taking
antacid drugs, an annual test for
vitamin B12 blood levels should be
done. If vitamin B12 levels are found
to be low, B12 injections must be given
every 6 weeks.
Long term side effects of these drugs
have even proven to be fatal in some
extreme cases. An article in the JAMA
Internal Medicine 2013 cites a 50%
increased death risk post-discharge from
hospital in elderly patients who have been
given too many drugs (known as poly-
pharmacy), including the proton pump
inhibitor drugs. It is best to use the smallest
dose of these drugs possible to try to avoid
these potentially serious side effects.
Natural therapies and weight control
can often bring great relief to those with
excess stomach acidity or reflux.
Next month we’ll look at simple techniques
to reduce GERD symptoms.
Health Bowel Healthy Body by Dr Sandra
Cabot is available in all good bookstores or
online at cabothealth.com.au . Also available
from Amazon and Apple iBooks as an e-book.
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