Heartburn or Gastroesophageal
Heartburn or Gastroesophageal
Reflux Disease (GERD)
What is GERD?
Gastroesophageal reflux disease (GERD) is a condition that
occurs when the esophageal sphincter that protects the
esophagus from stomach acid, does not close properly.
This allows some the stomach contents to return up the
esophagus. GERD is also called acid reflux or acid
regurgitation, because digestive juices—called acids—rise
up with the food. The esophagus is the tube that carries
food from the mouth to the stomach. The LES is a ring of
muscle at the bottom of the esophagus that acts like a
valve between the esophagus and stomach.
When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.
What causes GERD?
The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. Other factors that may contribute to GERD include obesity, pregnancy, and smoking.
What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.
How is GERD diagnosed?
- Upper Endoscopy – This procedure, usually done on an outpatient basis, allows your doctor to take a look inside your esophagus and stomach.
- Esophageal pH Test – If your treatment for severe heartburn or GERD isn’t working, you may need this test.
- Esophageal Manometry – This tests checks to see whether your esophagus is working properly.
How is GERD treated?
Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery. Lifestyle changes may include:
- Stop smoking
- Avoid foods and beverages that worsen symptoms.
- Lose weight if needed.
- Eat small, frequent meals.
- Wear loose-fitting clothes.
- Avoid lying down for 3 hours after a meal.
What are gallstones?
Gallstones are small, pebble-like substances that develop in
the gallbladder. The gallbladder is a small, pear-shaped sac
located below your liver in the right upper abdomen.
Gallstones form when liquid stored in the gallbladder
hardens into pieces of stone-like material. The liquid—called
bile—helps the body digest fats. Bile is made in the liver, then
stored in the gallbladder until the body needs it. The gallbladder contracts
and pushes the bile into a tube—called the common bile duct—that carries it
to the small intestine, where it helps with digestion. Gallstones can block the
normal flow of bile if they move from the gallbladder and lodge in any of the ducts that carry bile from the liver to the small intestine.
What causes gallstones?
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or often enough. The reason these imbalances occur is not known. The mere presence of gallstones may cause more gallstones to develop.
What are the symptoms of gallstones?
As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause:
- steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours
- pain in the back between the shoulder blades
- pain under the right shoulder
How are gallstones diagnosed?
When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam—the most sensitive and specific test for gallstones. A handheld device, which a technician glides over the abdomen, sends sound waves toward the gallbladder.
- Computerized tomography (CT) scan: The CT scan is a noninvasive x-ray that produces cross-section images of the body. The test may show the gallstones or complications, such as infection and rupture of the gallbladder or bile ducts.
- Cholescintigraphy: The patient is injected with a small amount of non-harmful radioactive material that is absorbed by the gallbladder, which is then stimulated to contract. The test is used to diagnose abnormal contraction of the gallbladder or obstruction of the bile ducts.
How are gallstones treated?
If you have gallstones without symptoms, you do not require treatment. If you are having frequent gallbladder attacks, your doctor will likely recommend you have your gallbladder removed—an operation called a cholecystectomy. Surgery to remove the gallbladder—a nonessential organ—is one of the most common surgeries performed on adults in the United States.
Heart Attack or Cardiac Ischemia
What is cardiac ischemia?
Cardiac ischemia is a term that doctors use to describe patients
who have reduced heart pumping (squeezing) due to coronary
artery disease. These patients often have congestive heart failure.
“Ischemia” means that an organ (such as the heart) is not getting
enough blood and oxygen, and “cardio” means heart. This is more
commonly known as a heart attack.
What causes cardiac ischemia?
Cardiac ischemia results when the arteries that bring blood and oxygen to the
heart are blocked. There is usually a buildup of cholesterol and other
substances, called plaque, in the arteries that bring oxygen to heart muscle
tissue. Over time, the heart muscle does not work well, and it is more difficult for the heart
to fill and pump blood to the body.
Risks for this condition include:
- High blood pressure
- High cholesterol
- High-fat diet
- Personal or family history of heart attack, angina, unstable angina, atherosclerosis, or other coronary artery diseases
- Sedentary lifestyle
What are the symptoms of cardiac ischemia?
Patients with cardiac ischemia often have symptoms of heart failure. Symptoms of angina include:
- Chest pain that occurs behind the breastbone or slightly to the left of it. It may feel like tightness, heavy pressure, squeezing, or crushing pain. The pain may spread to the neck, jaw, back, shoulder, or arm.
- Dizziness or light-headedness
- Feeling of indigestion or heartburn
- Nausea, vomiting, and cold sweats
- Sensation of feeling the heart beat (palpitations)
- Shortness of breath
- Unexplained tiredness after activity (more common in women)
How is cardiac ischemia diagnosed?
This condition is usually diagnosed only if a test shows that the pumping function of the heart is too low. This is called a decreased ejection fraction. Tests used to measure ejection fraction include:
- Gated SPECT
- MRI of heart
How is cardiac ischemia treated?
The goal of treatment is to relieve symptoms and treat the cause of the condition. Possible treatments include bypass surgery, angioplasty (opens up blocked arteries), or a pacemaker insertion. In severe cases a heart transplant may be needed.