How to Stop Heartburn , livre ebook

HOW TO STOP HEARTBURN
Simple Ways to Heal Heartburn and Acid Reflux
Anil Minocha, M.D., and Christine Adamec

John Wiley Sons, Inc.
New York Chichester Weinheim Brisbane Singapore Toronto
Copyright 2001 All rights reserved
Published by John Wiley Sons, Inc. Published simultaneously in Canada
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 750-4744. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley Sons, Inc., 605 Third Avenue, New York, NY 10158-0012, (212) 850-6011, fax (212) 850-6008, email: PERMREQ@WILEY.COM .
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional person should be sought.
The anecdotal information included in the book is based on composites or hypothetical individuals. Any similarities between the case study descriptions and actual, living persons are purely coincidental.
Library of Congress Cataloging-in-Publication Data
Minocha, Anil.
How to stop heartburn : simple ways to heal heartburn and acid reflux / Anil Minocha and Christine Adamec.
p. cm.
Includes bibliographical references and index.
ISBN 0-471-39139-5 (pbk.)
1. Heartburn-Popular works. 2. Gastroesophageal reflux-Popular works. I. Adamec, Christine A., 1949- II. Title.
RC815.7 .M54 2001 616.3 32-dc21
2001017916
Printed in the United States of America
10 9 8 7 6
Contents
Acknowledgments
Introduction

PART I ALL ABOUT GERD AND HOW TO DIAGNOSE AND TREAT IT

1 What Is GERD and Who Suffers from It?
A Chronic and Often Serious Problem-but One That Few People Know About
Common and Uncommon Symptoms of Acid Reflux
What Is Acid Reflux, or GERD?
Who Gets GERD?
GERD Is Often Not Diagnosed
A Brief Anatomy Lesson
GERD Can Become Dangerous When Ignored or Untreated
A Self-Test for GERD: Do You Have It?
Ten Common Myths about Heartburn-and the Real Truth

2 What s Causing My Heartburn?
When Normal Digestion Goes Awry
Medical Problems That Cause or Are Associated with GERD

3 How Your Physician Comes to a Diagnosis
Taking a Medical History
Considering Your Current Symptoms
The Physical Examination
Diagnostic Tests That Help Determine the Problem
Valuable Information You Should Provide to Your Doctor

4 Finding Medications That Work
Ancient Remedies
Basics on How Acid Reflux Medications Work
Over-the-Counter Remedies
Prescribed Medications for Treating GERD
Deciding on Treatment Strategies
When Cost Enters the Equation
You May Be Taking Drugs That Can Make Your Heartburn Worse

5 Alternative Medicines and Treatments That May Help
Ayurveda
Herbal Therapy
Homeopathic Remedies
Acupressure
Acupuncture
Hydrotherapy
Aromatherapy
Juice Therapy
Yoga
Reflexology

PART II OTHER ILLNESSES AFFECTING OR SIMILAR TO GERD

6 Peptic Ulcers
Treating Ulcers over Time
Causes of Peptic Ulcer Disease
Types of Peptic Ulcers
The Initial Evaluation
Diagnosing and Treating HP or NSAID Ulcers
GERD and Ulcers: What to Do When You Have Both
Ulcers and Stress

7 Hiatal Hernia
What Is a Hiatal Hernia?
Types of Hiatal Hernia
Causes of Hiatal Hernia
Diagnosing a Hiatal Hernia
What to Do When a Hernia and Acid Reflux Co-occur
When Surgery Is Needed

PART III SPECIAL SITUATIONS AND PROBLEMS

8 When Surgery Is Needed to Heal Your Acid Reflux
Who Needs Surgery?
Before Surgery
Questions You Should Ask
Types of Surgery
Just Before Surgery
Undergoing the Surgery
After the Surgery

9 Pregnancy and Acid Reflux
Pregnancy Brings Massive Changes to the Body
Which Pregnant Women Are Most Prone to Suffer from GERD?
When Should a Pregnant Woman Consult a Gastroenterologist?
Important Information about Medications for Pregnant Women
How GERD Is Diagnosed in Pregnant Women
Treating GERD

10 Heartburn in Infants and Children
Symptoms of GERD in Infancy
Determining If a Baby Has GERD
Lifestyle Care Changes and Treatments That a Baby May Need
Common Mistakes Parents Make about Infant GERD
Acid Reflux in Children and Adolescents
GERD in Children with Disabilities
Treating Older Children with GERD

11 How Acid Reflux Affects the Elderly
Possible Causes of GERD in Older People
Symptoms of GERD in the Elderly
The Impact Medications Can Have
Lifestyle Changes

PART IV LIFESTYLE CHANGES THAT WORK

12 You Are What You Eat
Avoiding Serious Problems
The Importance of a Balanced Diet
Why and How Certain Foods Affect Your GERD
What You Should-and Shouldn t-Drink
Evaluating Your Diet
A Sample Food Diary
Creating Your Own Food Diary
A Perfect Diet?

13 You Are What You Sleep
Types of Sleep Disorders
Causes of Suboptimal Sleep
Sleep Solutions
Sweet Dreams!

14 What You Weigh Matters
Why So Many People Are Overweight
Obesity and GERD
Are You Overweight or Obese?
Don t Use the Usual Quick Fix Remedies
Modify Your Behavior First
Sensible Weight Loss Suggestions
Overcoming the Basic Obstacles to Exercise
Consider a Weight Loss Clinic
Medications for Weight Loss
Weight Loss (Bariatric) Surgery for the Extremely Obese
Types of Obesity Surgery
Can-and Should-Obese People Have Antireflux Surgery?

15 Unstress Yourself
The Stress Level Self-test
Actions You Can Take to De-stress Your Life
Other Stress-Reducing Ideas

16 Two Key Lifestyle Changes to Make
Stop Smoking Now!
Choose Your Type of Exercise

17 What the Future Holds
Diagnostic Advances
Advances in Medication
New Procedures
Other Advances
Author s Note

Appendix A When Your Doctor Doesn t Understand
Mistakes Doctors Sometimes Make
Classic Mistakes Some Patients Make
If You Think Your Doctor Is Wrong
Finding Another Physician

Appendix B Glossary of Terms

Appendix C Medications and GERD

Appendix D Resources

Bibliography

Index
Acknowledgments
The authors would like to acknowledge the generous advice and assistance from the following individuals: Rebecca Antonacci, R.D., L.D., dietitian, department of Obstetrics and Gynecology, Southern Illinois University School of Medicine in Springfield, Illinois; Margie Fishbein, R.N., M.B.A.; Mark Fishbein, M.D., Pediatric Gastroenterology and associate professor at the Southern Illinois University School of Medicine in Springfield, Illinois; Esther Gwinnell, M.D., clinical assistant professor at Oregon Health Sciences University in Portland, Oregon; Romesh Khardori, M.D., director of the Obesity Clinic at the Southern Illinois University School of Medicine in Springfield, Illinois; Victoria Nichols-Johnson, M.D., associate professor and chief general department of Ob/Gyn, Obstetrics and Gynecology, at the Southern Illinois University School of Medicine in Springfield, Illinois, and Yogesh Kumar T. Patel, M.D., Department of Gastroenterology, The Carbondale Clinic, Carbondale, Illinois.
We would also like to thank Pam Hobson and Marie Mercer, both reference librarians at the DeGroodt Public Library in Palm Bay, Florida, for their assistance in locating hard-to-find journal articles and books.
Special thanks to our editor, Elizabeth Zack, for her insightful suggestions and her expert editing of our material.
Introduction
Gastroesophageal reflux disease, or GERD (also commonly known as acid reflux), is one of the most common diseases in North America: about 55 million people in the United States and 6 million in Canada suffer from one of its symptoms-daily or at least several times per week. American patients spend over $2 billion a year on over-the-counter heartburn medications, usually self-treating for years before they ever begin to think about consulting a physician. Of course, Europeans, South Americans, and other people worldwide also suffer from GERD-a billion people would be a conservative global estimate.
For most people, the word heartburn connotes a minor inconvenience, an annoying gastric discomfort that can be readily eased by merely popping a few antacids. From Alka-Seltzer s advertising campaigns of decades long past- Top, pop, fizz, fizz, oh what a relief it is -to today s more sophisticated ads for antacid and acid-blocking medications, marketing gurus have effectively promoted this one basic (and erroneous) belief: that heartburn is always a transient and easily curable condition-if you only take the right antacid and just wait a few minutes.
But millions face the pain of severe and chronic heartburn nearly every single day . For them, it is a far more serious problem than an occasional bout of heartburn from overeating or from consuming heavily spiced foods. If left untreated, GERD can escalate to even more painful and disabling conditions, up to and including cancer. Yet in the early stages of GERD, it is easily treatable. In the later stages, after decades of abuse to the esophagus, painful surgery may be the only avenue open to the patient.
In one study of 155 chronic heartburn sufferers who had taken antacids for more than ten years, over half had developed serious illnesses such as ulceration or narrowing of the esophagus. Of these individuals, about 6 percent had developed a precancerous condition. They had received symptomatic relief from antacids over the years, although the number of antacids many of the subjects needed had stea