Most Effective GERD Home Remedies

Heartburn and Acid Reflux Cure Program

Acidity is of the most dangerous problem that not only middle aged or old aged people faces but also the young generation is also facing. Untreated and ill treatment of this disease can lead to even heart stroke. The synthetic anti acidic products available in the market causes more harm in the fast relief process and does cure it holistically so that you do not suffer from it now and then. Here comes the best book on step acid reflux treatment written by Jeff Martin, a well renowned researcher and nutrionist.While these easy process stated in this book allows you to get heal of all types of digestive disorders on a permanent solution basis but in addition to it you get a three months direct counseling from Jeff Martin himself while ordering this product direct from this website. The treatment is so easy to follow and a 100% results is well expected but even then in case on is not satisfied with the results can get even 100 % refund. Indeed one of the cheapest and best ways to get rid of the long lasting digestive disorders especially heart burn in a holistic way without drugs and chemicals. More here...

Heartburn and Acid Reflux Cure Program Summary


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Your Health Heartburn

Heartburn occurs when the stomach contents pass back up into the esophagus. This regurgitation can occur when the person vomits, the stomach is overfull, or the person is obese, pregnant, or running. The cardiac sphincter and the diaphragm do not entirely close off the connection to the stomach. It is fairly easy to overcome these barriers and bring stomach contents back up into the tube. Because the pH of the stomach fluids is usually below 4, or about the strength of a car's battery acid, the acid burns the epithelial layers of the esophagus and may cause scarring of the tissue. If this occurs, the esophagus does not fold when empty or propel food properly through peristaltic contractions. The scarring also leaves the tissue susceptible to further damage due to the loss of the stratified epithelial layers that protect the underlying tissue.

Heartburn Nausea and Constipation

During pregnancy, high progesterone levels relax muscular tone and slow down peristalsis in the digestive tract.14 This can be beneficial in that slower food transit times allow for increased nutrient absorption from foods. Absorption efficiency of iron, calcium, and vitamin B12 increases during pregnancy. However, reduced muscle tone can also cause problems. In the lower esophagus, it allows gastric reflux, causing irritation and discomfort ( heartburn ). Reflux can be minimized by eating multiple small meals. Meals should not be eaten immediately prior to physical activity or exercise. Also, because reflux is usually worse when lying down, elevating the head of the bed and not eating or drinking within 3 hours of bedtime can be helpful.14

Diagnosis with differential

GERD is a primary motility disorder, mainly caused by reflux of gastric content during TLESRs inducing symptoms. None of the symptoms asso ciated with GER and GERD are specific. Reflux disease can be a primary condition, or it can be the consequence of other abnormalities (such as neurological impairment, cystic fibrosis, pyloric hypertrophy) favoring GER. The long list of differential diagnoses is discussed under the other headings of this chapter, and depends on the age of the patient and the presenting symptom. Because of lack of space, diagnostic procedures are not discussed in full detail. Detailed information regarding the techniques, indications and pitfalls of radiologic contrast studies, reflux scintiscan-ning, ultrasound, pH metry, endoscopy and manometry can be found in other textbooks or review papers. Interest will be focused on recent developments such as impedancometry. The development of a validated 'infant GERD questionnaire' is likely to be the development in...

Clinical signssymptoms

The most typical, although non-specific, symptoms of esophageal dysfunction are GER, regurgitation and vomiting. While reflux does occur physiologically at all ages, there is a continuum between physiological GER and GERD leading to significant symptoms and complications. GERD is a spectrum of diseases that can best be defined as the symptoms and or signs of esophageal or adjacent organ injury secondary to the reflux of gastric contents into the esophagus or, beyond, into the oral cavity or airways. Presentation may be with decreased food intake and aversive behavior around feeds. There is often clearly abnormal sucking and swallowing. Not surprisingly, the mother-child interaction is affected, making the situation less easily treated.57 There may be poor weight gain. These infants have no apparent malformations, and may be diagnosed as 'non-organic failure to thrive' (NOFTT),58 a 'disorder' that is sometimes attributed to social sensory deprivation, socioeconomic or primary...

Gastric Reflux Disease

Is it heartburn or gastric reflux disease Heartburn is a main symptom of gastric reflux disease however, gastric reflux disease is a more serious health problem. In gastric reflux disease, contents of the stomach flow backward into the esophagus. The symptoms Besides heartburn, symptoms include pain that feels like an ulcer, difficulty swallowing, and regurgitating stomach acid. If you have these ongoing symptoms, check with your doctor.

Have You Ever Wondered 120

. . . what causes heartburn The discomfort of heartburn, or indigestion, occurs when digestive juices (hydrochloric acid) and food from your stomach back up into your esophagus. Your stomach lining is protected from acids that form during digestion, but your esophagus lining is sensitive to the burning sensation of stomach acids. That's why you feel discomfort or pain. Foods themselves don't cause heartburn, but they may aggravate the condition by stimulating acid production. A problem with the esophageal sphincter may be involved, too. Foods high in acids, such as citrus fruit, as well as fatty or highly seasoned foods, may also cause problems for some people. Heartburn isn't dangerous, just uncomfortable. And it can be treated with antacids. Consult your doctor about the best type for you antacids can interfere with other medications. The danger can come if you ignore a heart attack, thinking it's simply heartburn. See page 552 for signs and symptoms of a heart attack. If the pain...

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Babka, J.C. and Castell, D.O. (1973) On the genesis of heartburn the effects of specific foods on the lower esophageal sphincter. Am. J. Dig. Dis. 18 (5), 391397. 7. Castell, D.O. and Vernalis, M.N. undated. Heartburn Fact Sheet. National Digestive Diseases Education and Information Clearinghouse. US Dept of Health and Human Services, Public Health Services, NIH. Inter America Research Associates, Rosslyn, VA. 10. Murphy, D.W. and Castell, D.O. (1988) Chocolate and heartburn evidence of increased esophageal acid exposure after chocolate ingestion. Am. J. Gastroenterol. 83 (6), 633636.

Wearing a weight belt

Don't wear a weight belt when you're just starting out. The weight you use shouldn't be so heavy that you need a belt to lift it (if you have back problems, see a doctor before starting). Wearing a belt can cause you to develop poor lifting habits, such as not consciously tightening your abs as you lift. If you have to wear a belt, remember to loosen it between sets. A tight belt can raise blood pressure and cause ulcer-like symptoms, such as heartburn or abdominal pain. Remember, the belt is designed to help support the lower back, not act as a girdle.

What Is the Stomach and What Does It Do

Our stomach is sealed at both ends by tight muscular enclosures called sphincter muscles. This prevents acidic juices from entering the esophagus at one end and also allows separation between the stomach and small intestine at the other end. If stomach juice is able to reflux into our esophagus it can produce a burning sensation commonly referred to as heartburn. This is why chronic heartburn is routinely treated with antacids, as they attempt to neutralize the acid in the stomach. Other drugs may be used that attempt to decrease acid production by the stomach.

Have You Ever Wondered

if caffeinated drinks are okay during pregnancy There's no conclusive evidence about the effects of caffeine on fetal development. However, moderation is best when you're expecting one or two servings of coffee, tea, or other caffeine-containing drinks a day are enough. Prudent advice Keep caffeine intake below 300 milligrams a day. Refer to chapter 8 for more about caffeinated drinks. For some pregnant women, caffeine can cause nausea and heartburn. For more about caffeine, see chapter 8. Just Heartburn Especially during the last three months, you may complain about heartburn. That may happen as a result of hormonal changes that slow the movement of food through the digestive tract. To relieve your discomfort Sleep with your head elevated to avoid acid reflux.

Irritable Bowel Syndrome

You can also try alternative remedies such as taking enteric-coated capsules of peppermint oil three times a day between meals (skip this one if you have heartburn), or explore yoga, meditation, or hypnosis to lessen stress and anxiety, which can sometimes wind up in your gut. Also, for women who notice IBS flare-ups around the time of menstruation, take evening primrose oil or black cohosh.

Calcium supplements What kind of calcium is in that pill

Calcium carbonate is a versatile compound. Not only does it build strong bones and teeth, but it also neutralizes stomach acid and relieves heartburn. Calcium carbonate antacids can be used as calcium supplements. They're nutritionally sound and generally cost less than products designed solely as nutritional supplements.

Case study bulimia nervosa during pregnancy

T.J. is a 32-year-old Caucasian, married woman, gravida 2, para 1, seeking prenatal care in the 11th week of gestation. Medical history reveals current BN, the onset of which occurred in the third month postpartum of her previous pregnancy. Since the onset of BN at age 27, T.J. has engaged in binge eating-purging cycles at least twice per day, consuming approximately 2,200 kcal of high-fat, high-carbohydrate snack-type foods during each binge with subsequent vomiting. She reports problems with my teeth and frequent heartburn. T.J. denies laxative, diuretic, or enema use, but admits to moderate exercise of fast-paced walking of up to 2 h per day. She was dissatisfied with her body shape and inability to quickly lose weight after her first pregnancy and is fearful that she will lose control of her body weight during this pregnancy. She gained 47 lb during her first pregnancy. T.J. currently weighs 145 lb and is 5' 7 . Laboratory values are within normal limits. She reports having the...

Complications of nonintervention

It is difficult to know the true natural history of GER in infants and children because most patients obtain treatment. Knowledge on the natural history in untreated patients from the initial studies, when effective treatment was unavailable, is extremely limited, because of the limited description and identification of the patients. The paucity of long-term reports, the presence of multiple pathogenic factors and the absence of patho-gnomonic symptoms for complications make it currently impossible to predict, on an individual basis, which child will continue to have GERD into and during adult life. However, we know that untreated GERD may be associated with severe complications such as esophagitis, failure to thrive in children, esophageal stricture and Barrett's esophagus. Recent observations suggest a decreased quality of life in regurgitating infants and their parents, even if the regurgitation has disappeared. A 10-year follow-up of esophagitis showed that over 70 had persisting...

Nutrient deficiencies

Nicotinic acid and vitamin C were deficient in the whole group. In the undernourished, low sodium intake was more pronounced and that was also seen to a minor extent in the whole group. Sodium, potassium, calcium and phosphate intake were deficient only in the undernourished. Interestingly, iron intake was not different between the undernourished and the well-nourished group, in keeping with the laboratory assessments. Iron intake did not correlate with serum hemoglobin, serum iron and vitamin C intake. Calcium intake and milk intake showed no correlation with serum iron level. Low use of antacids was not correlated with serum iron level. Despite iron supplementation, serum iron remained deficient. Anemia occurred in 9 and, low serum iron in 24 . Anemia was more common in the undernourished (83 vs. 50 ) as was the use of iron medication (67 vs. 22 ) and also medication for gastroesophageal reflux (25 versus 16 ). The iron resorption was not influenced by low levels of vitamin C, or...

Natural history and complications

Complications and medical morbidity include iatrogenic tests and interventions from the mis-diagnoses that were often applied to recurrent vomiting. Most are mislabeled as gastroenteritis, gastroesophageal reflux and food poisoning, and are treated in urgent care settings. Some with severe pain, bilious vomiting and intractability have undergone inappropriate laparotomy, appendectomy, cholecystectomy and Nissen fundoplica-tion. Others have been labeled with psychiatric disorders including bulimia and psychogenic vomiting, and have been hospitalized on psychiatric wards, and a few parents have been suspected of Munchausen-by-proxy.39

Food allergies classification

To elicit these symptoms increased between groups, and classic allergy tests such as skin prick tests were helpful only for the first group of early reactors. Knowledge of the time course and likely immunopathogenesis indicates that the early reactions are due to IgE responses and mast cell degranulation, the intermediate reactions follow eosinophil recruitment and the delayed responses are likely to relate to T-cell responses.18 These concepts will be discussed later, in the sections on immunopathogenesis. The Melbourne group have also played an important role in the recognition of the increasing incidence of multiple food allergies, and of the role of food allergy in inducing a spectrum of symptoms not previously associated with allergy.5 The role of food allergy in inducing visceral dysmotility syndromes such as infant colic, gastroesophageal reflux and recurrent abdominal pain will be discussed later.

Specific food allergies

There is increasing recognition that wheat products may play a disproportionate role in inducing intestinal dysmotility, such as gastroesophageal reflux and constipation. There are also reports that wheat and cow's milk may induce behavioral effects, possibly because of their natural content of morphine-like exorphins such as P-casomorphine and gliadomorphine.106,107 While this may also contribute to constipation, such a response would technically be an intolerance rather than a true allergy. However, further work is clearly needed in what is a poorly understood but potentially important area.

Digestion Bowel Movements and Other Pleasant Topics

It will come as no surprise to my older readers to learn that improper digestion is one of the most frequent health complaints in those of us who have reached the golden years. Such difficulties can include dyspepsia, chronic nausea, bloating, weight loss, and chronic constipation.

Have You Ever Wondered 123

. . . if you need more potassium if you're taking a diuretic medication That depends on the diuretic that's been prescribed for you. Talk to your doctor or a registered dietitian for advice. You probably don't need to take a potassium supplement, however. Many foods are great sources, including many fruits and vegetables, and milk. For a list of foods high in potassium, see Potassium Another Reason for Fruits and Veggies in chapter 7. . . . if antacids are okay for ongoing indigestion Although your body may produce less stomach acid with age, you may suffer from indigestion. Antacids, taken as directed, can help. However, excess amounts can deplete your body's phosphorus reserves, which may lead to softening of the bones, called osteomalacia. Taking antacids with calcium at mealtime may prevent your body from fully absorbing iron in food. Talk to your doctor about taking antacids. Symptoms that seem like indigestion could be something more serious.

Myocardial Infarction MI

MI is characterized by crushing chest pains that may radiate to the left arm, neck, or upper abdomen (which may feel like acute indigestion or a gallbladder attack). The affected person usually has shortness of breath, ashen color, clammy hands, and faints. Treatment within one hour of the heart attack is important and usually includes chewing aspirin and administering CPR. Many individuals die each year of their first MI.

Development and normal swallowing function

Newborn Phases Swallowing

The relaxation phase begins as the genioglossus and suspensory muscles pulls the larynx anteriorly and superiorly. The bolus is carried into the esophagus by a series of contraction waves that are a continuation of the pharyngeal stripping action.2 Proposed functions of the UES include prevention of esophageal distension during normal breathing and protection of the airway against aspiration following an episode of acid reflux.1,26 Qualitative abnormalities of the UES have been documented in infants with reflux disease.27

Genetic and environmental factors

It has been demonstrated that physiological reflux, heartburn, acid regurgitation and severe GERD are more frequent in men than in women. Barrett's esophagus is in part genetically determined.24 There is much information (in adults) demonstrating the aggravating effects of alcohol, smoking, drugs, dietary components, etc. on the incidence of GER. A detailed discussion on these environmental factors is beyond the scope of this chapter. Changes in lifestyle in men and women may result in the fact that the differences in incidence in GERD between both sexes may be disappearing. With pH monitoring, we could not demonstrate a male predominance in children. All forms of GERD affect Caucasians more often than African-Americans or Native Americans (adult data).14 However, the same prevalence of troublesome infant regurgitation was found in Caucasian and Indonesian infants.27 The importance of the genetic background was hypothesized by demonstrating that esophagitis and hiatus hernia were more...

Chondroitin Sulfate

Side effects are few and are usually mild digestive problems such as nausea, heartburn, and diarrhea. No allergic reactions have been reported.6 There are no known interactions with any other nutritional supplement, drug, herb, or food. If chitosan is taken, it may decrease absorption. There are no reports of overdosage. Biochemical, hemostatic, and hematological measurements indicate that it is safe.48 The usual dose recommended for benefit is 1200 mg.


Indigestion reduced ability to digest food acid reflux splashing of stomach acid into the throat consuming one's daily food intake, including all necessary nutrients, over five or six (or more) small meals, rather than two or three large ones. Frequent eating can be a great way to maintain one's energy level. This is also a beneficial eating pattern for individuals with gastrointestinal problems such as indigestion and acid reflux. Without a focus on healthy choices, however, grazing can become an easy way to overeat, and could possibly lead to weight gain. see also Dietary Trends, American Eating Habits.


Critical evaluations of published reports on the efficacy of different prokinetics (cisapride, domperidone and metoclopramide) concluded that cisapride was the preferred agent.117,118 According to these assessments, the vast majority of clinical trials on the efficacy of cisapride demonstrated that at least one of the end-points changed favorably as a result of the interven-tion.117 Cisapride is more effective than metoclopramide.118 A Cochrane review on cisapride in children analyzed data from seven trials, including 236 patients they compared the effect of cisapride to that of placebo on symptom presence and improvement.119 It was concluded that there was a statistical difference in the parameter symptoms 'present absent' but that there was no statistically significant difference for 'symptom change' between placebo and cisapride. The Cochrane review also concluded that cisapride compared to placebo significantly reduced the number and duration of acid reflux episodes, since there...


Omega-3 fatty acid supplements should be used with caution in diabetic patients due to potential increases in blood sugar concentrations, in patients at risk for bleeding, and in individuals with high levels of LDL.38 Other reported side effects of the use of fish oil are gastrointestinal symptoms such as gastrointestinal upset, nausea,8485 diarrhea and potentially severe diarrhea at very high doses,85 burping,86 acid reflux indigestion,87 bloating,88 and abdominal pain.89 Small reductions in blood pressure with intake of ro-3 fatty acids have been reported and are dose-respon-sive.90-93 Increase in LDL cholesterol levels by 5 to 10 with ro-3 fatty acid intakes of 1 g day or greater,38 mild elevation in alanine aminotransferase enzyme,94 and rare reports of neurologic and psychiatric effects have also been reported.38


For years, there was nothing but bad news about coffee. Pancreatic cancer. Cystic breasts. High cholesterol. Heart disease. Stroke. Birth defects. Heartburn and reflux. But the worm okay, the coffee bean has turned Later studies show no link at all between drinking coffee and an increased risk of any of these conditions. True, coffee may upset your stomach and keep you up at night, but as Heartburn & Reflux For Dummies (published by Wiley) explains, for most people, these effects are almost always linked to excess consumption. (How much is excess The amount varies from person to person, but when you hit your limit, you'll definitely know. Trust me.)

Oh My Aching Hear

Contrary to the name, heartburn is actually a burning sensation in your lower esophagus that is usually accompanied by a sour taste. Although this dreadful feeling can happen at any time during your pregnancy, it's most common toward the last few months, when your baby is rapidly growing and exerting pressure on your stomach and uterus. What's more, during pregnancy, the valve between your stomach and esophagus can become relaxed, making it easy for the food to occasionally reverse directions. Some simple remedies to ease heartburn Keep a log and track some foods that might be triggering your heartburn. Some common culprits include regular and decaf coffee, colas, spicy foods, greasy fried foods, chocolate, citrus fruits and juices, and tomato-based products.


Dosage For therapeutic purposes, chew one fresh clove daily. (For breath purposes, you might want to follow it up with an Altoid, one of those curiously strong mints ) There are also enteric-coated garlic-powder supplements, but note that the supplement should provide at least 5,000 mg of allicin daily. Consumption of large quantities (five or more cloves daily) can result in heartburn, flatulence, and related gastrointestinal problems.

Diet Ulcer

Dietary factors play a central role in ulcer frequency and severity.3,4 High intakes of sugar and refined carbohydrate can contribute to ul-cers.5 Milk, traditionally recommended to reduce acidity, actually produces only a transient rise in pH. This is often followed by a large rebound increase in acid secretion, which can worsen ulcers. Heavy alcohol consumption can cause erosions and ulceration of the stomach lining. Both decaffeinated and regular coffee can aggravate heartburn and ulcers. Food sensitivities (such as allergy to cow's milk) may contribute to ulcer formation identifying and avoiding the offending foods often improves healing and may prevent recurrence.6 Raw cabbage juice contains large amounts of S-methylmethionine and glutamine, two amino acids that can accelerate healing of ulcers.


Side effects are few and are usually mild digestive problems such as upset stomach, nausea, heartburn, and diarrhea. These suggest that glucosamine is better taken with food. Short-term adverse effects for glucosamine use also include headache, drowsiness, and skin reactions. No allergic reactions have been reported.6 There are no known interactions with any other nutritional supplement, drug, herb, or food. There are no reports of overdosage. Biochemical, hemostatic, and hemato-logical measurements indicate that it is safe.48 The usual dose recommended for benefit is 1500 mg.

Human Studies

There is little published work documenting the role of astaxanthin in humans. Humans fed supplemental astaxanthin accumulate the carotenoid in the lipoproteins present in circulating blood. Serum levels of astaxanthin peaked at 1.2 g mL 6 hours after supplementation of subjects with a 100 mg dose of astaxanthin (0sterlie et al., 1999). 13-Z-astaxanthin was preferentially absorbed relative to all-E or the 9-Z isomers. The effect of geometrical isomerism on solubility may play a role in determining the extent of absorption in humans. The astaxanthin was equally distributed between the lipoprotein fractions (HDL, LDL, and VLDL) within the serum. (It should be noted that this is an extraordinarily large dose of carotenoid when compared to natural dietary intake for other carotenoids.) Astaxanthin has also been administered to Heliobacter pylori-positive nonulcer dyspeptic patients. A 21-day period of treatment of 10 patients with 8 mg of astaxanthin 5 times per day resulted in improvement...

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Mechanism of esophageal reflux resulting from weak lower esophageal sphincter (LES) pressure valve, or inappropriate relaxation of the LES. Mechanism of esophageal reflux resulting from weak lower esophageal sphincter (LES) pressure valve, or inappropriate relaxation of the LES. having a low fat content (1 ). From this, it was hypothesized that the methylxanthines may be partially responsible for this effect. Subsequent studies (9, 10) established that the reduced LES pressure did indeed contribute to esophageal reflux, supporting recommendations that patients suffering from reflux esophagitis should avoid chocolate, particularly solid, dark chocolate, as well as caffeine and fats. Although cocoa and chocolate are habitually blamed for many complaints, there is little scientific research on which to base such generalizations. There appears to be no work to support liver problems. In the kidney, there exist some scattered observations in animals, relating to renal pelvic dilatation and...

Previous page 181

Some patients have tended to report heartburn symptoms following chocolate consumption and reportedly with some frequency. This led Babka and Castell (6) to further investigate this claim. They demonstrated that immediate and sustained lowering of the pressure of the lower sphincter of the esophagus could be induced experimentally with ingestion of chocolate as well as some other foods.


Functional dyspepsia (subset of patients) Gastroesophageal reflux disease (in patients requiring long-term proton pump In adults with peptic esophagitis, the treatment of associated H. pylori infection is a question of debate.102 Some authors have suggested that esophagitis and gastroesophageal reflux disease (GERD) may be exacerbated by eliminating the protecting buffering effect of H. pylori infection.103 Nevertheless, a causal relationship between these phenomena remains unproven, and is mainly based on retrospective analyses or epidemiological hypothesis. The small number of prospective trials in adults has not consistently demonstrated an increased risk of GERD after H. pylori eradica-tion.104


Determination of the exact prevalence of GER and GERD at any age is virtually impossible because most reflux episodes are asymptomatic, show the absence of specific symptoms, undergo self-treatment and lack medical referral. In normal 3-4-month-old infants, three or four episodes of GER are detectable during 5 min of intermittent fluoro-scopic evaluation,5 and up to 31 21 acid reflux episodes are recorded within a 24-h period with pH monitoring.6 About 5-9 of infants have troublesome GERD.6,12 According to parents, heartburn is present in 1.8 of 3-9-year-old healthy children and 3.5 of 1017-year-old adolescents regurgitation is said to occur in 2.3 and 1.4 , respectively, and 0.5 and 1.9 need anti-acid medication. In self-reports, adolescents complain about heartburn in 5.2 and regurgitation in up to 8.2 , while anti-acids are taken by 2.3 and histamine receptor antagonists (H2RA) by 1.3 , suggesting that symptoms of GER are not rare during childhood and are underreported by the...


GERD is associated with severe complications such as esophagitis, Barrett's esophagus, strictures and esophageal adenocarcinoma. The severity of the complications is not clearly related to the duration or severity of symptoms, as severe histological changes are detectable at the first investigation. Differences in esophageal mucosal resistance and genetic factors may partially explain the diversity of lesions and symptoms.16 Esophageal ulcers may be diagnosed in adults with dysphagia, odynopha-gia or esophageal bleeding, but are rarely seen in Reflux esophagitis is reported in 2-5 of the general population.82 Children with GER symptoms present esophagitis in 15-62 , Barrett's esophagus in 1.5-3 and refractory GERD requiring surgery in 6-13 .20-24 In adults undergoing endoscopy, esophagitis is diagnosed in 15-80 .1,17,25,26 The differences in incidence are determined by patient recruitment and availability of acid-blocking drugs over the counter (self-treatment). A 10-year follow-up of...


The principles of surgical repair are to return the abdominal contents to the abdominal cavity and repair the diaphragmatic defect. It may be possible to repair the defect by simply suturing the edges together. However, if the defect is large a patch repair may be undertaken using prosthetic material. The long-term outcome of congenital diaphragmatic hernia is dependent primarily on the degree of pulmonary hypoplasia. The main GI consequence appears to be gastroesophageal reflux, seen in up to 62 of cases.48

Bacterial infections

The greatest risk factors for occurrence of bacterial infections of the esophagus are granulocytopenia (as seen in patients undergoing chemotherapy) and hypochlorhydria or acid suppression.42 Despite often being unrecognized, bacterial esophagitis may have significant clinical relevance. Infection is usually polymicrobial and consists mainly of oral and upper respiratory flora (e.g. Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus viridans). It is possible that these organisms invade and colonize esophageal mucosa damaged by gastroesophageal reflux. Clinical presentation includes classical symptoms such as dysphagia, odynophagia and chest pain. Endoscopic pictures are non-specific and consist of ulcerations, discrete plaques, pseudomembranes and mucosal friability. Histology shows bacteria on Gram stain, but culture is not useful, since non-pathological bacteria can grow as well. The clinical course is usually mild and asymptomatic. At histology, features of bacterial...


Additional histological changes result from esophageal obstruction and the associated stasis. Esophageal obstruction leads to varying degrees of muscular hypertrophy of the muscularis propria, most notably in the inner circular layer.32,36,39 Further findings include small leiomyomas of the inner circular layer, degenerative changes of the muscularis propria as well as focal fibrosis of the muscularis propria (again, predominantly in the inner circular layer).32 Stasis of luminal contents results in both proximal and distal squamous hyperplasia, as well as changes similar to those seen in reflux esophagitis, namely papillomatosis and basal cell hyperplasia.32 However, owing to the increased LES pressure limiting passage of gastric contents, these findings are unlikely to be due to true gastroesophageal reflux.


Scintigraphy is a radionuclide evaluation using technetium-99m-labeled sulfur colloid mixed in the infant's formula. It has been proposed as an alternative and perhaps more sensitive way of quantifying aspiration, transit times, gastroesophageal reflux and pharyngeal residue. Based on a case report, the radionuclide salivagram has also been used to document aspiration of saliva. The major limitations of this technique are the poor definition of the anatomy and the poor sensitivity for detecting aspiration during swallowing in known aspirators. At present, the use of this technique in pediatric patients is limited.51,52

Future trends

Scand J Gastroenterol 1994 29 67. Jaakkimainen RL, Boyle E, Tudiver F. Is Helicobacter pylori associated with non-ulcer dyspepsia and will eradication improve symptoms A meta-analysis. BMJ 1999 319 1040-1044. 77. Splawski JB. Helicobacter pylori and nonulcer dyspepsia is there a relation J Pediatr Gastroenterol Nutr 2002 34 274-277. 109. van der Meer SB, Forget PP, Kuijten RH et al. Gastroesophageal reflux in children with recurrent abdominal pain. Acta Paediatr 1992 81 137-140. Hyams JS, Davis P, Sylvester FA et al. Dyspepsia in children and adolescents a prospective study. J Pediatr Gastroenterol Nutr 2000 30 413-418. Yip WC, Ho TF, Yip YY et al. Value of abdominal sonography in the assessment of children with abdominal pain. J Clin Ultrasound 1998 26 397-400. Schmidt RE, Babcock DS, Farrell MK. Use of abdominal and pelvic ultrasound in the evaluation of chronic abdominal pain. Clin Pediatr (Phila) 1993 32 147-150. Stordal K, Nygaard EA, Bentsen B. Organic...

Clinical aspects

Symptoms depend strictly on the age of the subjects.6,62,63 In infancy and in early childhood, PUD is characterized by vomiting and or digestive bleeding. Children with ulcer may be referred for abdominal pain and or vomiting. Epigastric localization, nocturnal pain, and meal or antacid relief of pain, are typical of so-called 'ulcer-like' dyspepsia, and might frequently be reported by older subjects. Hematemesis, weight loss and other alarm signs should alert the physician and strongly suggest further evaluation.62 A recent report from the Committee on Childhood Functional Gastrointestinal Disorders76 states that 'it seemed more appropriate to apply the most specific diagnostic category to a symptomatic child', defining clinical criteria of functional dyspepsia as in adults. Gastroenterologists working on adults with upper gastrointestinal symptoms prefer to aggregate more symptoms in the complex picture of ulcer-like and dysmotility-like forms of dyspepsia. Recent studies have shown...


In addition to a greater intestinal sensitivity, patients with functional bowel disorders may display abnormal motility. Various types of motor disturbances have been documented in IBS, apparently reflecting dysfunction at one or more levels of the brain-gut axis.34 Although the pathophysiology of IBS is commonly attributed to dysfunction of the large intestine, evidence exists to incriminate the small bowel as well.35 Postprandial motor dysfunction in the small bowel appears to be more prevalent among IBS patients who exhibit underlying visceral hypersensitivity in the fasting state. Abdominal cramping has been associated with the passage of high-amplitude contractions through the ileocecal region.36 Bloating has been explained by an abnormal transit and pooling of gas in conjunction with gut hypersensitivity.33 Manometric studies have demonstrated postprandial antral hypomotility in children and adults with functional dyspepsia.37 However, not all studies have demonstrated...

Dr Ray Wunderlich

A good example is a TV reporter I saw this morning. After coming in to film a segment in the office, she got personally interested in what I do. She is 40 years old. We did a mineral analysis on her and found that she is deficient in five nutrient minerals. She is a perfectly normal, functioning individual of 40 years of age. But when you examine her carefully, it turns out that she has recurrent vaginal yeast infections, some bloating, some gas and indigestion, and she has

Starch Breakdown

The breakdown of starch begins in the mouth, with salivary amylase. It is often assumed that as this is swallowed into an acid stomach the enzymic carbohydrate breakdown is then stopped (although acid hydrolysis may still occur) because salivary amylase is inhibited by a pH below 4. However, starch and its end products and

Side Effects of CAF

CAF ingestion, especially when ingested in larger amounts ( 4 mg kg body weight) may lead to side effects but these are generally mild. CAF can irritate the stomach wall as well as the intestine, which may lead to gastric acid reflux and intestinal motility changes. Occasionally diarrhoea may occur. Studies on the effect of CAF on gastrointestinal function are scarce.

Signs and symptoms

Heartburn The presenting symptoms in children tend to correlate with patient age and can mimic those seen in adults, or they can be more vague, thus requiring a high degree of suspicion for diagnosis. Symptoms in older children (more than 7 years) tend to parallel those seen in adults, so dysphagia and regurgitation predominate, but with subster-nal chest pain and burning also appearing in about half the patients.70 Children aged less than 6 years, particularly infants, more commonly present with respiratory symptoms, complaints, similar to those of gastroesophageal reflux disease (GERD), occasional emesis and failure to thrive.12,71 Regurgitation and dysphagia are the most common symptoms, present in 83 and 71-80 of patients, respectively, followed by failure to thrive in 54-70 .70,72 Especially in non-verbal children, a diagnosis of achalasia should be entertained when presented with a patient experiencing significant chronic respiratory symptoms, such as choking, recurrent...

Menetriers disease

The diagnosis of bile reflux gastropathy should be considered in adults with abdominal pain and bile-stained vomiting, who had previously undergone partial gastric resection or drainage procedures, even though reflux of duodenal contents has been linked to the development of a number of pathological gastric conditions, such as nonspecific gastritis, gastric ulcer, gastric carcinoma and non-ulcer dyspepsia. In adults, an association between bile reflux and intestinal metaplasia in the gastric and cardiac mucosa has been reported, suggesting that the latter represents a defense response against a sustained adverse environment, in the same way that gastric metaplasia develops in the duodenum when subjected to a high acid


Familial visceral myopathy type 2 is quite distinct and was first reported as oculogastrointestinal muscular dystrophy. Recently the mitochondrial-disease nature of the condition has resulted in it being renamed mitochondrial neurogastrointesti-nal encephalomyopathy.20 It is inherited as an autosomal recessive trait and presents with external ophthalmoplegia with ptosis and diplopia, a cardiac conduction defect, mild muscular atrophy and dilatation of the entire gastrointestinal tract with scattered small-bowel diverticulae. Gastrointestinal symptoms with dyspepsia, retrosternal chest pain and weight loss may start during teenage years. In skeletal muscle biopsies a deficiency of cytochrome C oxidase has been demonstrated which results in the ragged red fibers typical of mitochondrial myopathies. Examination of the smooth muscle of the gut shows the presence of fibrosis and degeneration with vacuolation of the smooth muscle cells. Most patients have eventually required total...


GER and GERD are frequent conditions in infants, children and adolescents. Symptomatology differs with age, although the main pathophysiological mechanism, transient relaxations of the LES associated with reflux, is identical at all ages. Although infant regurgitation is likely to disappear with age, little is known about reflux. The majority of symptomatic reflux episodes are acid, but non-acid and gas reflux can also cause symptoms. Complications of reflux disease may be severe and even life threatening, such as esophageal stenosis and Barrett's esophagus. There is no gold standard for a diagnostic technique. A simple questionnaire may be among the best diagnostic aids in infants non-acid reflux is best investigated with impedancometry. Primary GERD is mainly a motility disorder. Guidelines for treatment struggle with the fact that there is no prokinetic drug with a convincing efficacy profile. As a consequence, treatment of GERD focuses on anti-acid drugs, and particularly on PPIs....

Diagnostic testing

A study investigating the presence of gastro-esophageal reflux in children with recurrent abdominal pain concluded that pathological gastroesophageal reflux is a frequent finding in such children.109 Treatment of gastroesophageal reflux in this group of patients resulted in resolution or improvement of abdominal pain in 71 of cases. Another study evaluating findings on endoscopic examinations in 62 Indonesian children with recurrent abdominal pain revealed pathological abnormalities including esophagitis, erosions and duodenitis in 50 of the patients.110 In the absence of peptic ulcers, it is unclear how much these pathological findings contribute to the patients' symptoms. Endoscopy and biopsy performed in children evaluated for dyspepsia demonstrated that most children did not have significant mucosal disease. Inflammation without evidence of peptic ulceration was found in 38 of the patients with H. pylori being identified in only five cases.111 Follow-up at 6 months to 2 years...

Kellogg John Harvey

John Harvey Kellogg was an influential spokesman for vegetarianism, a leader in the invention of nut- and soy-based meat substitutes, a surgeon, and, for over fifty years, the director of the Battle Creek Sanitarium. In partnership with his brother Will, he made the Kellogg name famous. By studying food chemistry, Kellogg learned that an early step in indigestion is the conversion of starch to dextrin, or sugar. Cereal grains have a high starch content, and Kellogg discovered that prolonged baking almost completely dextrinized the starch in multigrain biscuits. He ground these up and served them to his patients, calling the creation granola. In 1889, Kellogg invented the first flaked breakfast cereal, which was made from wheat. He later devised a method of producing corn flakes.

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