Natural Heartburn Cure and Treatment
Gastro-oesophageal reflux disease (including non-erosive gastro-oesophageal reflux and erosive oesophagitis) is associated with heartburn, acid regurgitation, and sometimes, difficulty in swallowing (dysphagia) oesophageal inflammation (oesophagitis), ulceration, and stricture formation may occur and there is an association with asthma.
Dyspepsia covers upper abdominal pain, fullness, early satiety, bloating, and nausea. It can occur with gastric and duodenal ulceration (section 1.3) and gastric cancer but most commonly it is of uncertain origin. Urgent endoscopic investigation is required if dyspepsia is accompanied by 'alarm features' (e.g. bleeding, dys-phagia, recurrent vomiting, or weight loss). Urgent investigation should also be considered for patients over 55 years with unexplained, recent-onset dyspepsia that has not responded to treatment. Patients with dyspepsia should be advised about lifestyle changes (see Gastro-oesophageal reflux disease, below). Some medications may cause dyspepsia these should be stopped, if possible. Antacids may provide some symptomatic relief. If symptoms persist in uninvestigated dyspepsia, treatment involves a proton pump inhibitor (section 1.3.5) for 4 weeks. A proton pump inhibitor can be used intermittently to control symptoms long term. Patients with uninvestigated...
Mild cases of GERD during pregnancy should be treated conservatively antacids or sucralfate are considered the first-line drugs. If symptoms persist, H2 receptor antagonists can be used, with ranitidine having the most established track record in this setting. Proton pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. In these situations, lansoprazole is preferred based on animal data and available experience in pregnant women. Severity of GERD Sporadic uncomplicated heartburn, often in setting of known precipitating factor. Often not the chief complaint. Less than 2-3 episodes per week. No additional symptoms. FIGURE 36-4 General guidelines for the medical management of gastroesophageal reflux disease (GERD). Only medications that suppress acid production or that neutralize acid are shown. Antisecretory Drug Regimens for Treatment and Maintenance of GERD Antisecretory Drug Regimens for Treatment and Maintenance of GERD
A novel approach for the extraction and LC MS MS analysis of omeprazole (used to treat gastroesophageal reflux disease) and its 5-hydroxy metabolite (see Figure 1.21) through automated LLE using the hydrophilic interaction chromatographic mode (HILIC) for HPLC was recently reported by Song and Naidong.136 Thawed and vortex-mixed plasma sample aliquots were transferred into a 96-deep well collection plate using a Packard Multiprobe II robotic liquid handler. Desoxyomeprazole (internal standard, 100 ng mL in 1 1 methanol water, 50 L) was added to each sample, followed by 10 L of ammonium hydroxide (2 in water). Ethyl acetate (0.5 mL) was added to each sample and the plate covered with a dimpled sealing mat. The plate was vortex mixed for 10 min, then centrifuged at 3000 rpm and at 4oC for 5 min.
Over the past 25 years, the number of risk factors for coronary artery disease has increased dramatically. Systemic inflammation and abnormal lipoprotein metabolism are important contributors to the progression of atherosclerotic disease leading to plaque instability 13 . Even so, the vast majority of patients who experience an acute coronary event have no prior symptoms. Further complicating the diagnosis of acute coronary syndrome (ACS) is the frequent occurrence of patients who present symptoms of chest pain that can be attributable to other completely nonrelated events, such as acute gastroesophageal reflux disease. Given the serious life-threatening nature of ACS, an improvement in the early diagnosis of heart attacks would be a major medical advancement.
Maintenance therapy after healing of erosive esophagitis 30 mg PO daily for up to 6 months. GERD 30 mg PO daily for up to 4 weeks. Trade only Delayed-release cap 30, 60 mg. L 2B ESOMEPRAZOLE (Nexium) Erosive esophagitis 20 to 40 mg PO daily for 4 to 8 weeks. Maintenance of erosive esophagitis 20 mg PO daily. ZollingerEllison 40 mg PO bid for 4 to 8 weeks, may repeat for additional 4 to 8 weeks. GERD 20 mg PO daily for 4 weeks. GERD with esophagitis 20 to 40 mg IV daily for 10 days until taking PO. Prevention of NSAID-associated gastric ulcer 20 to 40 mg PO daily for up to 6 months. H. pylori eradication 40 mg PO
Stomach Morphine and other m agonists usually decrease gastric acid secretion, although stimulation sometimes occurs. Activation of opioid receptors on parietal cells enhances secretion, but indirect effects, including increased secretion of somatostatin from the pancreas and reduced release of acetylcholine, predominate in most circumstances. Low doses of morphine decrease gastric motility, prolonging gastric emptying time this can increase the likelihood of esophageal reflux. The tone of the antral portion of the stomach and of the first part of the duodenum is increased, which can make therapeutic intubation of the duodenum more difficult. Passage of the gastric contents through the duodenum may be delayed by as much as 12 hours, and the absorption of orally administered drugs is retarded.
The ingestion of salicylates may result in epigastric distress, nausea, and vomiting. Salicylates also may cause gastric ulceration, exacerbation of peptic ulcer symptoms (heartburn, dyspepsia), GI hemorrhage, and erosive gastritis. These effects occur primarily with aspirin. Because nonacetylated salicylates lack the ability to acetylate COX and thereby irreversibly inhibit its activity, they are weaker inhibitors than aspirin.
With continued presence of H. pylori in the stomach mucosa, acute gastritis makes the transition to chronic gastritis, causing atrophy of the gastric mucosa. This means that glandular cells secreting enzymes and acids are lost, and that surface mucin-secreting foveolar cells proliferate. There is a proportional association between atrophy of the gastric mucosa and the presence of H. pylori23 Recently, it was clearly shown in a Japanese study (1526 patients with an average follow-up of 7.8 years) that gastric cancer develops in persons infected with H. pylori but not in uninfected persons. Those with histology of severe gastric atrophy, corpus-predominant gastritis, or intestinal metaplasia are at increased risk. Persons with H. pylori infection and nonulcer dyspepsia, gastric ulcers, or gastric hyperplastic polyps are also at risk.24
Patients taking cholestyramine and colestipol complain of bloating and dyspepsia, which can be substantially reduced if the drug is completely suspended in liquid several hours before ingestion. Constipation may occur but sometimes can be prevented by adequate daily water intake and psyllium, if necessary. Colesevelam may be less likely to cause the dyspepsia, bloating, and constipation observed in patients treated with cholestyramine or colestipol.
All studies to date strongly suggest that NSAIDs reduce the incidence of and mortality from colon cancer by about half (Wallace & Del Soldato, 2003). The use of NSAIDs is limited by their significant toxicity, which includes (1) gastrointestinal (GI) side effects, which range from dyspepsia to GI bleeding, obstruction, and perforation (2) renal side effects and (3) a large number of additional side effects, some of which are serious, ranging from hypersensitivity reactions to the distinct salicylate intoxication. Among patients using NSAIDs, up to 4 per year suffer serious GI complications and more than 8,000 deaths (Bjorkman, 1999). The gastric damage is caused through two mechanisms (1) direct epithelial damage as a result of their acidic properties and (2) breakdown of mucosal defense mechanisms (leukocyte adherence, decreases in blood flow, and bicarbonate and mucus secretions) due to a reduction of mucosal prostaglandin (PG) synthesis (Wallace, 2008).
Gastroesophageal Reflux Disease In the U.S, GERD is common, and it is estimated that one in five adults has symptoms of heartburn or gastroesophageal regurgitation at least once a week. Although most cases follow a relatively benign course, GERD in some individuals can cause severe erosive esophagitis serious sequelae include stricture formation and Barrett's metaplasia (replacement of squamous by intestinal columnar epithelium), which, in turn, is associated with a small but significant risk of adenocarcinoma. Most of the symptoms of GERD reflect injurious effects of the refluxed gastric content on the esophageal epithelium, providing the rationale for suppression of gastric acid. The goals of GERD therapy are complete resolution of symptoms and healing of esophagitis. Proton pump inhibitors clearly are more effective than H2 receptor antagonists in achieving these goals. Healing rates after 4 weeks and 8 weeks of therapy with proton pump inhibitors are 80 and 90 , respectively,...
Irritable bowel syndrome (IBS) is a diagnosis of exclusion that is based on symptomatology and has been demonstrated to have associated abnormalities of motility and or sensation in different subpopulations. A frequent companion of other disorders without identifiable histo-pathology such as fibromyalgia, noncardiac chest pain, functional dyspepsia, and mixed headaches, it has similarly been associated with significant DSM-IV diagnoses such as anxiety and depression. There exist many diverse hypotheses related to the etiology of IBS. These propose that the pain may be psychosocial in origin, that the pain may be due to motility dysfunction at one or multiple sites in the gut (with dietary modifiers), or that the pain is a manifestation of visceral hyperalgesia. This visceral hyperalgesia may be due to peripheral sensitizers (e.g. mast cells) or altered central nervous system processing. Like many diagnoses of exclusion, it is likely that multiple pathophysiologies are present in...
Based on the preclinical efficacy of GCP II inhibitors in models of stroke, ALS and peripheral neuropathy, a potent and selective GCP II inhibitor was chosen to be administered to 77 individuals in three Phase I clinical trials. In the first trial, doses of up to 1500 mg were administered to volunteers. Oral bioavailability of the drug, particularly in the fasted state, was very good. Plasma levels were achieved that were above those needed to produce effects in animal models of diabetic neuropathy and neuropathic pain. The compound was safe and well tolerated at all doses without any CNS effect (EEG, visual tracking, coordination, etc). Gastrointestinal complaints constituted the most common category of adverse event, with dyspepsia being most commonly reported.
Another frequent complaint in children is functional abdominal pain (FAP). FAP is a broad category of functional diagnostic entities, taking the place of recurrent abdominal pain (RAP).116 V The newest criteria for pediatric functional gastrointestinal disorders define a broad FAP category and include diagnoses, such as functional dyspepsia, irritable bowel syndrome (IBS), and abdominal migraine.117 V Because these definitions are relatively new, the majority of research has used the traditional RAP label and definition. Thus, the research described below applies to FAP as a general category.
Irritable bowel syndrome (IBS) is one of several functional bowel disorders, including noncardiac chest pain, functional dyspepsia, epigastric pain syndrome, postprandial distress syndrome and chronic proctalgia, which represent diagnoses of exclusion that are based on symptomatology 22 . IBS has been demonstrated to be associated with abnormalities of motility and or sensation in different subpopulations. The diagnosis of IBS is given to 40-70 of referrals to gastroenterologists.
Psychophysical studies have demonstrated evidence for hypersensitivity in virtually all clinically relevant visceral pain disorders. This includes hypersensitivity to gastric distension in patients with functional dyspepsia,7 intestinal and rectal distension in patients with irritable bowel syndrome,8, 9 biliary and or pancreatic duct distension in patients with postcholecystectomy syndrome or chronic pancreatitis,10 and bladder distension in patients with interstitial cystitis.11 In these studies, pain could be evoked at intensities of stimulation lower than those required to produce the same quality and intensity of sensation in a healthy population. A more sophisticated testing of visceral sensitivity using random order, graded distension of the rectum in irritable bowel patients suggest that the population of subjects is heterogenous,12 with subgroups demonstrating hyper-sensitivity and others hypervigilance.
Drugs whose pharmacological action primarily involves antagonism of the action of histamine at its H2-receptors find therapeutic application in the treatment of acid-peptic disorders including heartburn, gastroesophageal reflux disease (GERD), erosive esophagitis, gastric and duodenal ulcers, and gastric acid pathologic hypersecretory diseases such as Zollinger-Ellison syndrome. They are also useful in combination with Hi-antihistamines for the treatment of chronic urticaria and for the itching of anaphylaxis and pruritis.59-62 The H2-antagonists are used to treat acid indigestion (an OTC application), GERD, peptic ulcers, and pathologic hy-persecretory disorders, as well as some of the symptoms of urticaria and anaphylaxis. Cimetidine, the original member of this drug class, was developed by a classical structure-activity study beginning with the endogenous agonist, hista-mine as shown in Table 23.4.64 Methylation of the 5-position of the imidazole heterocycle of histamine produced a...
Antacids (usually containing aluminium or magnesium compounds) can often relieve symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reflux (see also section 1.1) they are also sometimes used in functional (non-ulcer) dyspepsia but the evidence of benefit is uncertain. Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime, 4 or more times daily additional doses may be required up to once an hour. Conventional doses e.g. 10 mL 3 or 4 times daily of liquid magnesiumaluminium antacids promote ulcer healing, but less well than antisecretory drugs (section 1.3) proof of a relationship between healing and neutralising capacity is lacking. Liquid preparations are more effective than tablet preparations. Sodium bicarbonate should no longer be prescribed alone for the relief of dyspepsia but it is present as an ingredient in many indigestion remedies. However, it retains a place in the management of urinary-tract disorders (section...
Abdomen, pelvis, groin and or perineum 60 . The onset of the disease may follow an event but is notable for a rapid progression of symptomatology. Depression and anxiety are frequent co-morbidities. In one analysis, Clemens and associates reported that 25 of patients with IC also carried an International Statistical Classification of Diseases (ICD)-9 diagnosis of depressive disorder and 19 carried a diagnosis of anxiety. In this study, compared to controls, patients with IC were also more likely to suffer from fibro-myalgia, gastritis, headaches, esophageal reflux and back pain, and were more likely to have a history of child abuse 63 . Suprapubic tenderness to palpation may accompany a diagnosis of IC. Although a history of frequent urinary tract infections is twice as common in IC patients as in non-IC patients, most report infrequent urinary tract infections (
Each cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors. There is evidence, primarily clinical, that the sensory limb of the reflex exists in and outside of the lower respiratory tract. Although myelinated, rapidly adapting pulmonary stretch receptors (RARs), also known as irritant receptors, are the most likely type of sensory nerve that stimulates the cough center in the brain, afferent C-fibers and slowly adapting pulmonary stretch receptors (SARs) also may modulate cough. RARS, C-fibers, and SARs have been identified in the distal esophageal mucosa however, studies have not been performed to determine whether they can participate in the cough reflex. Although gastroesophageal reflux disease can potentially stimulate the afferent limb of the cough reflex by irritating the upper respiratory tract without aspiration and by irritating the lower respiratory tract by micro- or macroaspiration, there is evidence that...
After coronary artery disease and gastroesophageal reflux, the next most common cause is musculoskeletal chest wall syndromes. Around 70 percent of these patients have chest wall tenderness on palpation that in up to 16 percent can resemble classical angina.101 The most common areas of musculoskeletal chest pain are sternum, xiphoid, left costosternal junctions, and left anterior chest wall.101
The CHAOS study was a prospective, randomized, placebo-controlled, double-blind single-center trial in the East Anglian region of England that examined the effects of AT therapy on coronary artery disease (CAD) (17). A total of 2002 subjects with overt clinical and angiographic evidence of CAD were randomly assigned to receive natural or RRR-AT (n 1035) or placebo (n 967). The first 546 subjects in the AT group were given 800 iu d for a median of 731 d (range 3-981) and the remainder were given 400 iu d for 366 d (range 8-961) however, the two groups were combined for statistical analysis (the trial was not designed to determine dose-response effects of AT on the primary end points). Participants requested 73.2 of all prescribed AT or placebo as follow-up medications. Treatment with AT was well tolerated with only 11 of the 2002 patients (0.55 ) discontinuing therapy due to diarrhea, dyspepsia, or rash. There was no significant difference between the treatment groups for these side...
Heartburn is one of the commonly experienced gastrointestinal symptoms. In fact it is the primary symptom of gastro-oesophageal reflux disease (GERD).45 The symptoms emerge, most often, following oesophageal influx of gastric acid. Thus, heartburn is strongly correlated with acidification of the oesophagus. The heartburn symptoms usually emerge in individuals after meals or nocturnally, often followed by burning substernal pain. The phenomena of gastrointestinal reflux and regurgitation are also clinical disorders frequently observed in infants and children.46 High incidence heartburn has also been observed in asthmatic patients47 and pregnant women on a daily basis.48 Alleviation of symptoms in these cases comes with alginate-based medication. Traditional medication includes antacids, containing Al(OH)3, AlPO4 or combinations thereof with Mg(OH)2 and magnesium trisilicate,49 characterized by a rapid onset in their action. Antacids raise the intragastric pH within minutes and offer...
Surveillance can only be practiced on patients once BE has been diagnosed. Currently, the detection of BE requires endoscopy with biopsy, which is both invasive and expensive. One-time screening endoscopy is recommended in patients over the age of 50 with long-term GERD however, autopsy data have indicated that this fails to diagnose 19 out of 20 patients with BE17 surveillance is thus being performed on the tip of the Barrett's iceberg. There are an estimated 20 million individuals with GERD in the U.S. It would be impractical and prohibitively expensive to endoscope this entire population. Unless a simple but inexpensive alternative to endoscopic diagnosis is found, the vast majority of patients with BE will remain undiagnosed, and the incidence of EAC is unlikely to decrease. The challenge in future may be to develop an inexpensive method of screening a large population, use markers to stratify the risk of cancer development, and then concentrate surveillance efforts on the...
Studies have suggested that in view of the high prevalence of gastroesophageal reflux disease in patients with noncardiac chest pain, it is recommended that a trial of proton-pump inhibitors (PPI) be conducted for four to eight weeks.7,87,90 This has proven to be cost-effective beyond one year7 when compared to investigations for gastrointestinal causes. Furthermore, when compared against placebo, the arms treated with PPI consistently showed a reduction in frequency and intensity of chest pain,90 although some of the studies only included patients with known gastroesophageal reflux disease.
Combination therapy is the cornerstone of postoperative pain management. Problems arise when it is not possible to use one of the constituents of our combinations. For example, NSAIDs may have to be withheld in the patient with severe dyspepsia, previous NSAID allergy, those on anticoagulants, or when there is significant renal impairment. While the worst excesses of pain can be reduced or removed by regional anesthetic techniques, when these are discontinued acetaminophen paracetamol and opioid combinations may not be sufficient to provide good quality relief.
Chronic inflammation arises when C-fibers, which normally transmit noxious information, become activated by chronically inflamed tissue and thus sensitized nociceptors now transmit low-threshold signals to the spinal cord as pain. One of the most important components in inflammation is the production of arachidonic acid metabolites, giving rise to a large number of prostaglandins. These chemicals do not normally activate nociceptors directly but, by contrast, reduce the C-fiber threshold and so sensitize the nociceptors to other mediators and stimuli. Thus the use of both steroids and the nonsteroidal anti-inflammatory (NSAID) drugs is based on their ability to block the enzyme cyclo-oxygenase (COX) which catalyzes the conversion of arachidonic acid to these mediators. The main action of the NSAID is to inhibit COX-1 but as this form is the constitutive enzyme, COX-1 inhibition results in varied gastrointestinal complications ranging in severity from dyspepsia to serious ulcer bleeds...
Patients and tend to be self-limiting. Because their incidence was similar in treatment and placebo groups, they may be related to the composition of the vehicle rather than the NSAID component. Published evidence suggests that topical NSAIDs are associated with fewer systemic side effects compared to oral therapy, although the risk is likely to increase if excessive quantities of topical NSAIDs are used. Hypersensitivity, dyspepsia, asthma, and renal toxicity have all been reported.20'21'22
The most common symptoms associated with these drugs are GI, including anorexia, nausea, dyspepsia, abdominal pain, and diarrhea. These symptoms may be related to the induction of gastric or intestinal ulcers, which is estimated to occur in 15-30 of regular users. Ulceration may range from small superficial erosions to full-thickness perforation of the muscularis mucosa. There may be single or multiple ulcers, and ulceration can be accompanied by gradual blood loss leading to
There is a strong connection between gastric cancer and atrophic gastritis. The most common cause of atrophic gastritis is chronic infection with H. pylori, a Gram-negative curved bacillus that colonizes the mucin layer of the gastric lining. Its presence has been implicated in several upper gastrointestinal conditions, including nonulcer dyspepsia, acute and chronic gastritis, duodenal and gastric ulcer, mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric adenocarcinoma.
The presenting symptoms of gastric adenocarcinoma are protean, nonspecific, and usually occur at a late stage of the disease, contributing to the generally poor prognosis at the time of diagnosis. The most common symptoms are weight loss and abdominal discomfort, though nausea, vomiting, dysphagia, early satiety, dyspepsia, and melena may also occur. Liver, lung, and bone are the most common sites for metastatic disease. Tumors may progress directly through the wall of the stomach, directly invading neighboring tissues, or lead to peritoneal carcinomatosis or drop metastases. Metastatic disease may yield jaundice in the case of liver metastasis, malignant ascites in the presence of carcinomatosis, or bone pain with bony metastasis, for example.
The most common gastrointestinal adverse effect experienced by patients is nausea, occurring in 15-35 of all patients on SSRIs (68, 69). Some patients may also experience vomiting and or diarrhea (33). These tend to decrease over time, in most cases after a few weeks of treatment. For some patients, these symptoms may be quite troublesome and interfere with adherence. In these cases, if lowering the dose is unsuccessful, we recommend specific therapy. Ondansetron or other 5-HT3 blockers (mirtazapine) are very effective for nausea ranitidine may be helpful for dyspepsia loperamide may be used to reduce diarrhea. Occasionally, a medication change is required. For example, if diarrhea is problematic, changing the medication to paroxetine may be helpful.
Frequent adverse effects include headache ( 15 of patients), GI symptoms (e.g., nausea, vomiting, diarrhea, heartburn, flatulence), and rash. More serious reactions include hepatotoxicity, serum sickness reaction, angioedema, and hematologic effects (e.g., leukopenia, neutropenia, punctate basophilia, and monocytosis). Blood studies should be checked weekly during treatment. Estrogen-like effects have been observed in children.
TRPV1 is activated in patients with gastroesophageal reflux disease (GERD), which is characterized by heartburn and chest pain. TRPV1 is expressed in sensory nerves within the mucosa of the esophagus, and its expression is upregulated in esophagitis patients (Matthews et al., 2004). TRPV1 is activated by acid pH and its activation is sensitized by ethanol, which all trigger the burning pain characteristic of GERD (Bhat and Bielefeldt,
The oral administration of bisphosphonates can be accompanied by esophageal and gastrointestinal side effects, such as nausea, dyspepsia, vomiting, gastric pain and diarrhea, and sometimes even esophageal erosions or ulcerations. This effect might be due to the inhibitory effect of the nitrogen-containing bisphosphonates on the mevalonate pathway which leads to an inhibition of keratinocyte growth, or to some direct chemical irritant effect.
Simethicone, a surfactant that may decrease foaming and hence esophageal reflux, is included in many antacid preparations. However, other fixed combinations that are marketed for acid indigestion , particularly those with aspirin, are potentially unsafe in patients predisposed to gas-troduodenal ulcers and should not be used.
The cause for the increase in the incidence of EAC is unclear. Several risk factors for the development of adenocarcinoma of the esophagus have been proposed, including tobacco use, ethanol use, dietary factors, medications, Helicobacter pylori infection, Barrett's esophagus, and gastro-esophageal reflux disease (GERD). Further research into the causes of this malignancy as well as their preceding pathologic conditions will be needed in order to understand the changing epidemiologic conditions. Obesity is a major risk factor for a number of chronic diseases and different types of cancers. A multicenter population-based case-control study revealed that excess weight was a strong risk factor for EAC. Risk rose with increasing BMI (body mass index). Interestingly, the greatest risk was seen in the youngest age group (
Indications hyperlipidaemias of types IIb and IV in patients who have not responded adequately to diet and other appropriate measures Contra-indications peptic ulcer Renal impairment reduce dose if eGFR 30-60 mL minute 1.73 m2 avoid if eGFR less than 30 mL min-ute 1.73m2 Pregnancy manufacturer advises avoid Breast-feeding manufacturer advises avoid Side-effects vasodilatation, flushing, itching, rashes, urticaria, erythema heartburn, epigastric pain, nausea, diarrhoea, headache, malaise, dry eyes rarely angioedema, bronchospasm, anaphylaxis Dose
It should be pointed out that approximately one third of the patients treated long term with sulfasalazine discontinued the drug because of dose-related adverse effects including nausea, dyspepsia, vomiting, headache, rash, gastric distress, especially in patients on a daily dosage of greater than 4 g (or a serum sulfapyridine levels above 50 mg mL).
Reasons, Remedies And Treatments For Heartburns
Find Out The Causes, Signs, Symptoms And All Possible Treatments For Heartburns!