Dr Darren, I require some advice rather urgently as I have been suffering from indigestion and heartburn for three months now.
When I go to sleep at night i often feel bloated and uncomfortable despite having an early dinner – When I wake up in the morning i feel like my chest is on fire. I often find myself drinking ice cold milk for breakfast to alleviate the symptoms. My wife regularly suggests that I eat yoghurt and swears by it helping her. Do you think this is true?
I am a fairly healthy person with a hectic travelling schedule especially during this time of the year. My weight has been pretty stable for the past four years, however I have picked up 8 kilograms in the last 6 months. My exercise routine is erratic and leaves much to be desired. When i do exercise I find that my chest seems tighter than usual and I struggle to finish my routine. The only other ailment I have is a temperamental right knee which I had operated on for a cartilage tear about 6 years ago. The pain is persistent but does improve with my chronic meds. I have a history of colon cancer in my mother’s family. Should I be worried doctor and what can I do to stop these unpleasant symptoms….

Thank you for sharing your story with us. I am concerned about a few issues you have raised.
This is a very common list of complaints that most people choose to ignore or self treat until matters spiral out of control. You describe the typical features of gastro-oesophageal reflux disease or GERD.
Your history reveals a few risk factors for the condition including stress, lack of sleep, weight gain as well as the most common cause – medication overuse, especially the Anti-inflammatories. You should understand that one of the common causes of reflux disease is a Hiatus Hernia, and as you gain weight, it can worsen the symptoms as the hernia then increases in size.
Your tight chest and possible wheezing during exercise also points to reflux disease. Asthma like symptoms is often caused by silent reflux at night time, leading to silent aspiration with its sequelae.

What is GERD?
Clinically it is a collection of typical symptoms associated with excessive acid production and reflux disease. The syndrome includes burning abdominal pain, heartburn, persistent nausea as well as burping repeatedly after meals. Bloatedness after eating is also present in some cases.

What causes GERD?
Put simply , if the stomach valve or sphincter does not close properly during digestion – Acid pushes up into the oesophagus causing significant harm to the lining of the digestive tract. Inflammation then ensues, leading to further symptoms of discomfort and eventually pain.
In addition to this, the excessive acid secretion by the stomach also plays a role in combination with a pathological organism which grows in the stomach and “drills” holes in the gastric mucosa leading to significant gastritis and ulcers.

What causes increased acid production?
Chronic stress, poor sleep and then specific medical conditions which effect the autonomic nervous system and release of acid into the stomach. The proton pump and the Parietal cells are extremely important for this process.
The role of diet in causing reflux disease is well researched and continues to grow in stature.

What is the way forward?
Control the pH of the gut and the influence of digestive enzymes as well as the effect of cultures on the maintenance of the GIT tract are all part of the leading approach in dealing with this global medical condition.
Early detection and screening for GIT cancers are essential in combatting the disease. For most people the problem of reflux is recurrent unless diagnosed and treated effectively with a multi faceted approach.

What is a gastroscopy and what does it entail?
Basically swallowing a fiber optic camera. This is done under controlled circumstances with conscious sedation in some cases – however this is not always necessary as many people have it done whilst awake. Make sure your specialist is experienced and cautious as this procedure should not have major complications. It is done for a detailed view and if necessary a biopsy of the gastric mucosa of any suspicious lesions seen.

The approach to GERD in a nutshell…
• Persistent symptoms deserve further investigation
• Gastroscopy is bearable – do not fear
• Eradication of harmful organisms in gut is possible (Helicobacter Pylori) – a course of 2 antibiotics is issued
• Medical management with a Proton pump inhibitor decreases acid reflux
• Dietary modifications are effective in treatment
• Genetic predisposition to GIT cancers calls for vigilance
• Weight management can assist GERD – decrease symptomatic hiatus hernias

Place two bricks under the top end of your bed – the increased gradient aids reflux. Try to stop eating 3 hours before bedtime. Avoid alcohol at least 2 hours before going to bed. Include Ph controlling foodstuffs in your diet – go easy on tomatoes and fizzy drinks. Get probiotics into your routine. Regular bowel motion prevents delayed gastric emptying and constipation.
**If your symptoms persist despite these measures as well as using over the counter antacids – seek urgent medical help.
Many people debate whether chillies are good or bad for you – the bottom line is MODERATION, if at all possible.The fact that these thunderous providers of pleasure are addictive , makes us want them more and more when we start.
Research shows that in certain populations the incidence GIT cancers are not increased despite the large amounts of chillies consumed. Is there a genetic protective effect to chillies contributing to cancers. The latest research certainly shows that there could even be a protective effect against stomach cancers in certain populations. What are your thoughts??

I have been suffering from indigestion and heartburn…

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