GASTRO-INTESTINAL TRACT
GERD / APD
GERD
Several mechanisms operate to prevent the reflux of gastric contents into the oesophagus. When these mechanisms fail gastric contents reflux into the lower oesophagus. This is called gastro-oesophageal reflux disease (GERD).
Reflux oesophagitis occurs when the mucosal defences are unable to counteract the damage produced by refluxed acid, pepsin and bile.
Severe oesophagitis can produce ulceration, bleeding and later on, peptic stricture.
In long-standing oesophagitis the lower oesophageal mucosa may change from squamous to columnar type (Barrett's mucosa). Barrett's mucosa is susceptible to ulcers, strictures and malignant changes (adenocarcinoma of oesophagus).
APD (Acid peptic disease)
Peptic ulcer refers to an ulcer in the lower oesophagus, stomach or duodenum, in the jejunum after surgical anastomosis to stomach, and in the ileum adjacent to a Meckel's diverticulum.
Incidence—10% of all aduls males.
Causes
Sliding hiatus hernia - In this type of herna the oesophagogastric junction slides up through the diaphragm. This results in:
Loss of the obliquity of entry of oesophagus into stomach.
Loss of the reinforcing effect of intra-abdominal pressure on the LES. These two factors facilitate gastro-oesophageal reflux. So hiatus hernia facilitates gastro-oesophageal reflux but does not directly cause it.
Cardiomyotomy and vagotomy reduce the efficiencty of the LES.
Pregnancy, obesity, ascites, weight lifting and straining act by increasing the intra-abdominal pressure.
Cigarette smoking, alcohol, fatty foods and caffeine act by reducing the lower oesophageal sphincter tone.
Impaired gastric emptying due to gastric outlet obstruction, anticholinergic drugs and fatty food act by increasing the gastric content available for reflux.
Large volume meals act by the above mechanism.
Systemic sclerosis.
Drugs (aminophylline, β-agonists, nitrates, calcium channel blockers) that reduce the tone of LES.
Helicobacter pylori
Helicobacter pylori, a spiral shaped bacterium located in the mucous layer of the stomach, may inhibit or exacerbate acid reflux depending on how the infection affects the stomach.
Distal gastritis increases the production of gastric acid. In this condition, the eradication of H. pylori not only reduces the risk of peptic ulceration but also the risk of acid reflux.
Conversely, generalised atrophic gastritis decreases the production of gastric acid; as a result H. pylori eradication may increase the severity of the reflux.
Since chronic H. pylori infection is associated with an increased risk of peptic ulceration and gastric cancer, H. pylori eradication is recommended irrespective of potential effects on GERD.
Symptoms
GERD
Heart burn is deeply placed burning pain behind the sternum radiating to the throat. It occurs after meals, brought on by bending, lifting weight and straining. Heart burn occurs on lying down in bed at night and is then relieved by sitting up.
Regurgitation of gastric contents into the mouth (acid eructation).
Tracheal aspiration with coughing or laryngismus or aspiration pneumonia results from the regurgitated gastric contents in the mouth.
Odynophagia—painful swallowing.
Transient dysphagia to solids due to oesophageal spasm.
Persistent dysphagia to solids due to strictures.
Iron deficiency anaemia due to blood loss.
Extracesophageal symptoms include hoarseness, sore throat, sinusitis, otitis media, chronic cough, laryngitis, non-atopic asthma, recurrent aspiration and pulmonary fibrosis.
APD (Acid peptic disease)
Peptic ulcer is a chronic condition with a natural history of spontaneous relapses and remissions lasting for decades or even life.
The most common presentation is that of recurrent abdominal pain that has three notable characters:
Localisation to the epigastrium
Relationship to food
Periodicity
Epigasric pain. Pains referred to epigastrium, and is so sharply localised that the patient will localise the site with one finger (pointing sign). It is usually burning in character.
Hunger pain. Pain occurs on empty stomach (hunger pain) and is relieved by food or antacids.
Night pain. Typically, the pain wakes the patient from sleep around 3 am, and is relieved by food, milk or antacids.
Pain relief
Pain is usually relieved by food, milk, antacids, belching or vomiting.
In some patients with gastric ulcer, food may precipitate the pain.
Periodicity (episodic pain)
Pain occurs in episodes, sing 1-3 weeks every time, three to four times a year. Between episodes patient is perfectly well.
In the initial stages the episodes are short in duration and less frequent. As the natural history evolves the episodes become longer in duration and more frequent.
Patients are more symptomatic during winter and spring.
Relapses are more common in smokers than in non smokers.
Other symptoms
Water-brash (excessive salvation), heart burns, loss of appetite and vomiting.
Anorexia, nausea, fullness, bloating and dyspepsia.
Rarely the patient might present or the first time with anaemia of chronic blood loss, abrupt haematemesis, acute perforation or gastric outlet obstruction.
Treatments
In mild cases which happen on and off basic diet changes and exercise helps to improve your gastrointestinal health and cures the patients. Small frequent meals and avoiding smoking, alcohol, fatty food etc are few suggestions which are advised . Daily walking is also advised.
In case of severe acute or chronic symptoms patients are evaluated for the underlying and cause and treated according way. Homeopathy helps recover such patients fast and permanently. Correct acute and constitutional medicines help as per the patient symptoms.
Few homeopathic medications which help In such cases are are dictum album, pulsatilla nigricans, Silicea etc.
