Have you heard about GERD?

If you haven’t heard of GERD, you know about heartburn and acid reflux (which are sometimes used interchangeably). Heartburn is the symptom you feel when acid splashes up and out of the stomach. Acid reflux is when stomach acid splashes up from the stomach into the esophagus. Gastroesophageal reflux disease (GERD) is severe or chronic acid reflux that can lead to complications. Back in college at Ole Miss I was drinking about 64 ounces of diet soda and morning coffee every day. I was on a diet of salad with salsa as my dressing and snacking on pickles. My mom would ship me Prilosec in bulk in my care packages to help with my chronic acid reflux I had all day. 

GERD occurs when stomach acid, and sometimes bile, backs up (refluxes) into the esophagus (food pipe or the tube that connects your mouth and stomach.) Over time, the backwash of acid can irritate and inflame the lining of the esophagus and cause GERD signs and symptoms. Common symptoms include acid taste, increased belching, hoarseness, dry cough, burning sensation in upper middle chest, chest pressure or pain and difficulty swallowing. In children, vomiting, dysphagia, refusal to eat, or complaints of abdominal pain may be present. It’s important to get GERD under control as prolonged acid exposure can result in esophagitis (esophageal erosions, ulcerations) or stricturing resulting in chest discomfort or difficulty swallowing. Esophageal cancer may also form from chronic acid exposure.  

Most people can manage the discomfort of heartburn with lifestyle changes and over-the-counter medications such as Tums, Rolaids, Zantac, and Pepcid, or the stronger OTC medications such as Prilosec, Prevacid, Zegerid. It is important to note that the stronger OTC drugs are meant to be taken for chronic use to control acid throughout the day but are not as effective for immediate relief of acute reflux symptoms. If you are dependent on these medicines, you may need to consider a surgical procedure called a Laparoscopic Nissan Fundoplication. During this surgery, the surgeon wraps a portion of the stomach around the lower esophagus to basically tighten, reinforce the lower esophageal sphincter muscle. When these signs and symptoms occur at least twice each week or interfere with your daily life, you may want to contact your Doctor regarding further workup and treatment recommendations.

These are some tips to help reduce GERD with lifestyle changes:

• Avoid large, high-fat meals and going to bed shortly after. Avoid eating at least 3-4 hours before lying down. Stay upright and avoid vigorous activity after eating.
• Avoid acidic and spicy foods.
• Avoid garlic, onions, and tomato-based foods.
• Avoid smoking and alcoholic beverages.
• Avoid caffeine-containing foods and beverages, mints, and chocolate (it lowers the sphincter pressure).
• Avoid tightly fitted clothes, especially after a meal.
• Consume a healthy nutritionally complete diet and lose weight if overweight.
• It may help to keep a journal of foods that tend to trigger your symptoms to assist with avoidance.

Sources: http://www.webmd.com/heartburn-gerd/guide/heartburn-gerd-basic-information-causes and Dr. Patrick Saitta, Gastroenterologist at Concorde Medical Group, NYC.

Oh mama! Common GI problems during pregnancy

I’m a 29-year rare breed where I have two sisters-in-law with kids (many many miles away) and two girlfriends with children. Here comes friend #3 with a new bun in the oven talking to me about her body changes and GI issues, and I thought why not see what does go on during those 9 months. Detailed below are the most common GI problems associated with pregnancy including: constipation, hemorrhoids, heartburn, nausea/vomiting, and flatulence/belching.

Constipation

Constipation is a common complaint of pregnant women secondary to the physiologic changes and mechanical obstruction from an enlarging uterus. Increased progesterone levels result in smooth muscle relaxation and subsequent decrease in bowel transit time. Other causes include decreased maternal activity, decreased levels of motilin (hormone produced from endocrine cells to help regulate motility of the digestive tract), increased colonic sodium and water absorption and routine iron supplements (known to make stools dry and difficult to pass).

Tips:

• Are you getting your fiber in? The recommended dietary intake for fiber during pregnancy is 28 g/day. Please refer to my fiber blog for food lists and tips. Many benefit from meal supplementation with 4 to 6 tablespoons of bran.
• Drink lots of fluids as water and juices soften stools and keep digested waste passing through the bowel.
• Regular exercise keep your muscles in shape, it boosts blood circulation and brings more oxygen to all organs (including the bowels) to help them do their jobs more efficiently.
• Probiotics (supplements containing “healthy bacteria”) are being suggested more often in pregnant patients. These supplements can alter the flora of the colon and many patients notice an improvement in their bowel function.
• Don't take a laxative because its can excrete necessary nutrients out of your system, and might be harmful to your baby.

Hemorrhoids
Hemorrhoids are painful, swollen veins in the anus and rectum. Pressure from the enlarging uterus and increased blood flow to the pelvic area can cause the veins in the rectal wall to swell, bulge, and itch. Constipation and straining excessively during a bowel movement to pass hard stools can further aggravate them. They can also develop post-partum as a result of pushing during labor. If you see blood on your tissue when you wipe after a bowel movement or if you have pain or excessive itching at the opening of the rectum, ask your doctor to check for hemorrhoids. If you have hemorrhoids, they will accompany you through the pregnancy and will probably get worse during the pushing stage of delivery. If you take good care of them they might disappear after the birth. 

Prevention tips:

• Avoid constipation. Use all the tips mentioned earlier to keep your stools soft and moving easily through your bowel.
• Try not to strain during bowel movements.
• Put your feet up on a small stool during bowel movements to make the movement easier and don't read on the toilet. 
• Avoid standing still or sitting for very long periods of time.

Tips on managing hemorrhoids:

• Soak in warm water- several times a day. 
• Try applying witch hazel on cotton pads to your anal area.
• Try applying ice packs or cold compresses several times a day to help relieve swelling.
• Pre-moistened wipes may be more comfortable than dry toilet paper. 
• Avoid sitting for long periods of time, rather lie on your side or stand up. If you must sit, take frequent breaks.
• Try an over-the-counter hemorrhoid remedy. Ask your health care provider to recommend a hemorrhoid cream that's safe to use during pregnancy. 
• Consider having hemorrhoid banding procedure by a GI. 

Heartburn
Gastric esophageal reflux is more common during the latter part of your pregnancy and will often occur at night. It is caused by the effect of pressure of the uterus on the intestines and stomach with relaxation of the lower esophageal sphincter muscle. This may result in regurgitation of stomach contents into the esophagus. 

 Tips:

• Sip liquids rather than drinking big, full glasses. Try to get your fluid intake drinking beverages between rather than during meals. 
• Keep your head and upper chest elevated at approximately a 45 degree angle at night
• Eating smaller meals more frequently
• Stay upright for at least 3 hours after a meal before lying down
• Consider antacids (magnesium based are probably safest) but be more cautious with aluminum or calcium based antacids as these can cause constipation, and avoid sodium bicarbonate as it can cause swelling. Also, try to limit fatty foods, spicy foods, sweets/chocolate/peppermints as they can lower esophageal sphincter pressure.

Nausea and vomiting

According to the Mayo clinic, morning sickness affects a large proportion of pregnant women and is most common during the first trimester. Loud noises, motion, bright lights, adverse climates, and odors from hot foods can all trigger the symptoms. A more severe form characterized by excessive vomiting and weight loss, called hyperemesis gravidarum, can lead to fluid and electrolyte imbalance and may result in hospitalization. 

Tips:

• Small, frequent snacks of carbohydrate rich foods may help, while some women find protein meals help.
• Diets high in ginger may help, as well as smelling lemons.
• Wearing loose, comfortable clothing, get plenty of rest, and get appropriate physical activity
• Taking antacid medication before going to bed may help reduce stomach acid levels, and the subsequent morning vomiting.
• Consider that your iron supplements may be causing your nausea and consider switching to a lower dose or a liquid form which may be easier to tolerate. 

Flatulence/belching
Early in pregnancy, there is an increase of progesterone hormones that slows digestion, allowing more time for gas to be produced. The body responds by removing the gas with burps and farts, especially after a large meal. Then as the uterus enlarges, the shift in the crowded abdomen can slow digestion even more. In addition the muscle-relaxing effect of pregnancy hormones leaves less ability to hold the passing of gas.

Tips:

• Eat smaller, frequent meals.
• Exercise stimulates digestion
• Avoid foods that cause gas- onions, broccoli, cabbage, beans, brussel sprouts, cauliflower, fried, fatty foods.
• Try drinking milk icy cold and keep carbonated drinks to a minimum.

I hope my common GI problems either gave you new tips or helped prepare you for your pregnancy.

Resources:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967327/
http://www.babyyourbaby.org/pregnancy/during-pregnancy/what-to-expect.php
http://www.mayoclinic.com/health/morning-sickness/DS01150