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It affects up to one in five adults, and it is a common ailment diagnosed by primary care physicians and specialists. Moreover, it can be a real pain in the neck, or chest rather. I'm talking about gastroesophageal reflux. This big word does not have to be a big deal. Simple lifestyle changes and, in some cases, medication can treat it. So just what is gastroesophageal reflux?
Gastroesophageal reflux is the backflow of acid and other contents from your stomach into the tube the connects the stomach to your mouth, called the esophagus. This reflux can occur naturally on occasion, but when it happens frequently, it can cause problems.
When the backwash of acid and undigested food particles flows back out of the stomach, it can damage the lining of the esophagus. You see, the stomach has a protective lining inside that protects the underlying tissues from the strong stomach acid and other substances that you may eat. Unfortunately, the esophagus does not have that same protection. The harsh back-flow can eat away the esophagus' smooth muscle tissue.
There is a valve at the bottom of your esophagus where it connects to the stomach. It is called the lower esophageal sphincter, or LES. This LES closes after food enters the stomach to prevent it from coming back up. Additionally, your diaphragm is a muscle above the stomach that also helps to support the valve. Sometimes the sphincter relaxes, and stomach contents can escape.
Normal reflux can occur after meals and does not last long. This event rarely occurs when lying down or during sleep.
Abnormal reflux lasts longer and causes troublesome symptoms. Many report feeling discomfort at night when they lay down, rather than just after meals. Chronic reflux causes damage to the digestive system tissues.
If you suspect that you have abnormal reflux or gastroesophageal reflux disease, read on to learn what you can do about it and where to find a quiz to see if you might have reflux.
Gastroesophageal reflux disease (GERD) is caused by the reflux of stomach acid and contents into the esophagus. This condition is related to several factors:
Proton pumps in the stomach wall create enzymes which make stomach acid to break down the food we eat. When they overproduce, reflux is more likely to occur. Coffee is known to increase stomach acid production. Stress also increases stomach acid production. Therefore these can be risk factors for GERD.
The lower esophageal sphincter (LES) closes off the bottom of the esophagus to prevent back-splash. When the muscle tone is relaxed, then the door is not fully closed, and juices can seep back out of the stomach. Smoking and drinking alcohol and caffeinated beverages both contribute to decreased LES tone. These are also risk factors for GERD.
Furthermore, chocolate and mint are known to relax the lower esophageal sphincter.
Moreover, pregnant women have increased progesterone levels. This hormone affects the LES as well.
Two factors that cause increased intra-abdominal pressure are obesity and pregnancy. These both put pressure on the abdominal organs and can lead to gastroesophageal reflux.
An article published in the Gastroenterology Clinics of North America found that obesity, defined as a BMI > 30, was a significant risk factor for reflux and esophagitis (inflammation of the esophagus). The study showed that over one-fourth of participants had weekly reflux symptoms.
A recent study on GERD in pregnancy showed that over 50% of women report reflux symptoms while they are expecting. This can be related to hormonal changes in pregnancy slow digestion and delay stomach emptying.
Reflux can be aggravating and cause symptoms such as:
Less likely but possible signs and symptoms include:
Knowing what we know about reflux and how it happens, there are some simple lifestyle changes you can make if you are suffering from GERD signs and symptoms.
Choose small proportions. Avoid high-fat meals because the fats require the stomach to produce more acid and take longer to digest. Spicy foods (like tomatoes and oranges) can also aggravate reflux.
Maintain a healthy weight.
Sleep habits: Firstly, also avoid eating within three hours of bedtime. Do not lie down after eating. Give your body time to digest the meal.
It can also be helpful to raise your head while resting to let gravity keep the stomach contents down. You can use extra pillows or even raise the head of your bed six to eight inches with bed risers or blocks.
Avoid toxins that could be aggravating your digestion, such as nicotine, alcohol, or excessive caffeine]
Over the counter proton pump inhibitors (PPIs) decrease stomach acid production and may provide some relief. Available options include:
Warning: Do not take these for more than 14 days without talking to your doctor.
There are some urgent signs and symptoms that warrant immediate medical attention. You should call your doctor or seek urgent care for these:
Less serious signs and symptoms that could be related to reflux but should be checked out by a doctor include:
Now that you know what is gastroesophageal reflux, you can make an informed decision about when it is time to talk to your doctor. If you would like to see if you might be suffering from GERD, take this online quiz by the American College of Gastroenterology.
If you still have questions or you would like to discuss your problem with a top-rated doctor, click to schedule an appointment. My Virtual Physician treats conditions, including heartburn, upset stomach, and more. And if you have any suggestions for additional topics that you want to read about, please let us know! And don’t forget to check out our podcasts for more! Share and follow us on social media.
Chang, P., & Friedenberg, F. (2014). Obesity and GERD. Gastroenterology clinics of North America, 43(1), 161–173. https://doi.org/10.1016/j.gtc.2013.11.009
Ramya, R. S., Jayanthi, N., Alexander, P. C., Vijaya, S., & Jayanthi, V. (2014). Gastroesophageal reflux disease in pregnancy: a longitudinal study. Tropical gastroenterology: official journal of the Digestive Diseases Foundation, 35(3), 168–172.
Did you know that many women have ovarian cysts? Most are harmless and resolve without problems. In some cases, serious complications can occur. Here's what you need to know about this common diagnosis:
A cyst is a membranous sac or pocket. Cysts form in many places in the body. The term ovarian cyst refers to a cyst that has formed in or on one of the ovaries.
Women have two ovaries, one on each side of the uterus in the lower abdomen. These ovaries are part of a normal reproductive system. Normally, an ovary releases an egg each month as part of a woman's menstrual cycle. This process of forming a sac-like pocket on the organ is just one type of ovarian cyst.
Most ovarian cysts are small and harmless and commonly occur in regular menstrual periods. A corpus luteum cyst or a follicle cyst may form each month on the ovary when the egg is released. These are called functional cysts. These normally shrink on their own in about 1 to 3 months.
There are multiple other conditions that may cause a cyst to form. Other types of ovarian cysts include endometriomas, dermoid cysts, and cystadenomas. These are less common though. Most cause no problems and may go unnoticed.
In some cases, multiple cysts may occur at once. In polycystic ovary syndrome (PCOS), many small cysts are formed on the ovaries and the normal reproductive cycle may be interrupted. Women with PCOS experience hormone imbalances, which can cause irregular menstrual periods.
According to Dr. David Howard, M.D., Ph.D., what really causes concern is "when a cyst becomes too big, above 5 cm, that's when cysts almost always are going to start causing pain and pressure symptoms." He compares a large cyst to a large piece of fruit hanging from a branch. The size and weight of the cyst can cause the blood supply of the ovary to twist. Any organ that does not get adequate blood flow could potentially die without urgent treatment.
Only about 8% of premenopausal women develop large cysts that need treatment. After menopause, these cysts are less common. Still, ovarian cysts can occur at any age. Although most are not problematic, ovarian cysts can be cancerous and could lead to ovarian cancer. It is important to talk to your physician if you think you have a cyst.
Since ovarian cysts should be checked out by a healthcare provider, you might be asking what are the symptoms?
As we said most cysts are asymptomatic. Many are found incidentally, on ultrasound or on exam.
If a cyst does cause symptoms, you may experience pain or pressure in the low abdomen. Pain or discomfort from an ovarian cyst could feel sharp or dull, and it could come and go. If a cyst breaks open it could cause sudden, severe pain. Also, if a large cyst breaks open it could cause heavy bleeding. If a cyst causes an ovary to twist, this is called torsion and could be serious because it decreases blood flow to the organ. This may be associated with nausea and vomiting.
It is important to talk to your physician if you are concerned about these symptoms. Your provider may do a pelvic exam to feel for a cyst on your ovary. Additionally, they may order further testing. Some tests which may help diagnose an ovarian cyst include ultrasound, pregnancy test to rule out pregnancy, hormone levels, and other blood tests.
There are treatment options for ovarian cysts. These may include pain medication or comfort measures such as heat therapy. Using a heating pad to the painful area may bring some relief. Another option is hormonal birth control methods which can prevent ovulation and therefore lower the risk of forming more cysts.
In about 5-10% of cases, an ovarian cyst may require surgical removal. This may be necessary if your cyst does not go away, grows larger, or causes pain.
An ovarian cystectomy is a surgical procedure that removes the ovarian cyst. In some cases, the doctor may suggest removing the affected ovary. An oophorectomy is a procedure that removes an ovary. After a surgery like this, you may stay in the hospital for 2 to 4 days. You should also avoid strenuous activity or exercise for a time. Your physician will give you instructions depending on your situation.
If you still have questions or you would like to discuss your symptoms with a specialist, Dr. David Howard, M.D., Ph.D. is available for consultation. MyVirtualPhysician treats OB/GYN conditions including irregular periods, vaginal bleeding, hormone imbalances, and more. Click below to schedule an appointment. If you have any suggestions for additional topics you want to read about please let us know! Don’t forget to follow us on social media.
