Gastritis & Reflux
A great deal of public and scientific interest has been generated in a recently discovered infection that occurs in the stomach. Usually the acid in the stomach keeps this organ free of infections. One bacterium, Helicobacter pylori, has evolved a mechanism to tolerate this harsh environment.
When this organism infects the stomach, it produces a brief interval of stomach upset. There may be nausea and vomiting, hunger pangs, and abdominal cramps. It is one of many causes of "intestinal flu" and, as such, passes unremarkably as one of the burdens that we all must bear.
However, unlike other infections that cause stomach upset, when the acute, early symptoms pass, this infection does not go away. It becomes a chronic or longlasting infection in almost everyone it infects. Usually this chronic infection causes no complaints or symptoms; however, the chronic infection will, in some people, lead to the later development of stomach and duodenal ulcers. After very long intervals, probably decades, it may be a factor in the development of some stomach tumors.
Usually your physician treats H. pylori infection if it is present. Unlike many other infections, it does not require urgent or immediate treatment. Your physician needs to consider your other health problems and medications to decide the best time to treat this infection. The complications caused by chronic infection with the H. pylori organism require other treatment. Treatment of the chronic infection may wait until more pressing problems are under control.
Important Points in Treatment
Infection with the H. pylori organism is not difficult to treat, but its treatment does call for three or sometimes four drugs. Even the best treatment has a 10% failure rate and requires retreatment for some patients. The drugs commonly used include the following:
- Omeprazole (Prilosec) or lansoprasol (Prevacid). This medicine suppresses acid in the stomach. The H. pylori organism weakens in the absence of acid and is more susceptible to other drugs.
- Ranitidine (Zantac), nizatidine (Axid), or famotidine (Pepcid). This medicine also suppresses acid in the stomach. The H. pylori organism weakens in the absence of acid and is more susceptible to other drugs.
- Amoxicillin. This antibiotic is a special kind of penicillin.
- Biaxin. This is another kind of antibiotic.
- Metronidazole (Flagyl). This medication is an effective treatment, but it has side effects if you drink alcohol while taking this drug.
- Bismuth (Pepto-Bismol). Bismuth is an excellent drug for infection with H. pylori. The only readily available source of bismuth in the United States is Pepto-Bismol. Bismuth will change stool color to black.
Notify Our Office If ...
- You must interrupt your treatment for more than a single dose of medication.
Heartburn is a common problem. One fifth of adults in the United States have occasional heartburn, and 10% suffer daily attacks. With aging, changes occur in the ability of the esophagus, the swallowing tube that leads from the mouth to the stomach, to work smoothly. There is an associated increase in the occurrence of heartburn as one grows older.
The symptom of heartburn is usually a warm or burning feeling in the middle of the front of the chest. Bending, straining, or stooping often causes heartburn, and it is frequently worse when one lies down. Food or drink can relieve the burning sensation, as does the use of an antacid preparation. Such relief is temporary, for the problem is recurrent. Often particular foods bring on heartburn. Icing on rolls or cake, orange juice, hot (spicy) foods, and hot dogs are common causes. Any individual may have a particular food that brings on the problem, although it may not be the same food that bothers other sufferers. A few patients with severe heartburn experience regurgitation of food and acid into the mouth and throat. Sometimes they are aware of this only as a bitter taste in the mouth on awakening in the morning. On other occasions it is very apparent, producing irritation with coughing and choking.
Nighttime regurgitation while asleep can occur and occasionally permits acid or food to get into the windpipe. This can cause hoarseness and cough that on occasion is the only complaint related to the reflux. Acid coming up into the mouth at night may be the cause of erosion of the teeth. These complications may occur without the development of heartburn.
Important Points in Treatment
If there is evidence of reflux with inflammation of the esophagus, treatment is undertaken to prevent the re- flux and to heal the esophagus. Treatment may involve reducing the amount of acid available for reflux or reducing the reflux itself and frequently involves a combination of drugs to achieve both ends.
Commonly treatment is with medications to decrease acid secretion by the stomach. It is also possible to use antacids to neutralize the acid secretion. Special antacids taken after meals can mechanically prevent the reflux of acid and food and neutralize the acid. Other drugs can strengthen the muscle at the end of the esophagus that keeps the esophagus closed and mechanically prevents reflux from occurring.
Besides using these medicines, you can take several measures to prevent reflux. Reflux occurs more easily when you are lying flat than when sitting or standing. Elevation of the head of your bed on several bricks or elevation of the head of your mattress with a foam wedge can help you take advantage of gravity in the prevention of reflux. Propping up your head on several pillows is usually not helpful because it can still permit pooling of acid at the lower end of the esophagus at the point where one usually bends when elevating the head with a pillow. It is far better to try to raise the entire mattress on a slant to obtain the benefits of gravity.
An increase of pressure within the abdomen causes reflux. To reduce this, you should avoid tight-fitting or elastic garments and girdles or corsets. Bending over also increases pressure in the abdomen as well as adding the negative effect of gravity in causing reflux. This is particularly true if you bend over to pick up a heavy object. It is wiser to stoop down rather than to bend over when picking up something from the floor.
A full stomach refluxes more easily than an empty one. Avoid eating and drinking for 2 hours before bedtime or before taking a nap lying down. Avoid foods that you know by experience promote reflux.
Complications may occur if reflux recurs for a long time without treatment. The acid refluxing into the esophagus may cause inflammation, producing an ulcer with or without bleeding. When the inflammation is severe, particularly with ulcerations, scarring may occur as the esophagus heals. Besides this, the irritation caused by the inflammation in the esophagus may make it clamp down in a muscle spasm that causes difficulty swallowing. Should you have difficulty swallowing foods, report this to your physician. He or she will do an evaluation to find out whether scarring has occurred or whether it is simple muscular spasm from irritation that is causing the difficulty. This will permit a selection of the appropriate therapy to relieve your swallowing difficulties.
Notify Our Office If ...
- You have difficulty swallowing food.
- You experience persistent heartburn.
- You experience unexplained hoarsness.
- You have bouts of wheezing or asthma, particularly at night.
- Your dentist informs you that you are developing dental erosions.