heartburn, GERD

[© Atholpady | Dreamstime.com] Acid reflux occurs when stomach acid or its contents flow back and irritate your esophagus lining. Over time, the inflammation can cause complications. Healthy lifestyle choices (like avoiding tight clothing and eating smaller meals) can make a big difference in your symptoms.

Gastroesophageal reflux disease (GERD) or acid reflux disease is a chronic digestive disease that occurs when stomach acid or other stomach contents flow back into the esophagus irritating the lining. Over time, the inflammation can wear away the esophageal lining, causing complications such as bleeding, esophageal narrowing or Barrett’s esophagus (a precancerous condition).

What are common causes?
Causes include an abnormal weakness or relaxation of the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus that allows food and liquid to flow into your stomach — or structural problems, e.g., hiatal hernia, which weaken the mechanism that prevents acid reflux into the esophagus.

What are signs and symptoms?
Symptoms vary and include:

  • Burning in the chest, throat or upper abdomen (heartburn)
  • Acid reflux into the throat causing voice hoarseness, cough, throat irritation; and/or angina or chest pain

How is it diagnosed?
Your doctor may be able to diagnose GERD based on frequent heartburn and other symptoms. Other tests include pH testing, endoscopy and X-rays of the upper digestive tract.

What sort of lifestyle changes can help?
Maintain a healthy weight.
Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If you are at a healthy weight, maintain it. If you are overweight or obese, work to slowly lose weight.

Avoid tight-fitting clothing. This puts pressure on your abdomen and the lower esophageal sphincter.

Avoid food and drink triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion and caffeine may make heartburn worse.

Eat smaller meals. Too much food in your stomach may put pressure on your esophageal sphincter and not allow it to close.

Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.

Elevate the head of your bed. If you regularly experience heartburn at night, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head with additional pillows is not effective.

Don’t smoke. Smoking decreases the lower esophageal sphincter’s ability to function properly.


Common GI Procedures, What you Should Know: March 23, 2016, 7-8:30 p.m. Register now for this free seminar presented by Rudy Rai, M.D. Held in the Howard County General Hospital Wellness Center.

How is it treated?
Most people can manage GERD with lifestyle changes and over-the-counter medications that neutralize stomach acid. Antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.

Medications to reduce acid production, called H-2-receptor blockers, don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions of these medications are available in prescription form.

Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal.

If you don’t experience relief within a few weeks, you may need stronger medications, or even surgery, to reduce symptoms. New surgical options are offering promising results.

Are there any new treatments available in the management of GERD?
In situations where medications aren’t helpful or you wish to avoid long-term medication use, your doctor may recommend surgical options to relieve your symptoms.

Rudy Rai, M.D., is a gastroenterologist in Columbia. To schedule an appointment, call 410-290-6677.



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gluten-free diet

Celiac disease is a genetically predisposed autoimmune disorder that affects the small intestine when gluten is consumed. Many people follow a gluten-free diet when they do not have celiac disease. For those with celiac disease, it is absolutely essential to eat a gluten-free diet. For everyone else who is avoiding gluten, you may be limiting your choices unnecessarily. [© Andresr | Dreamstime.com]

The Gluten-free Phenomenon

In the last few years, the phrase “gluten-free” has become a household term. Whether you are walking down a grocery store aisle or reading a menu at a restaurant, it is no longer uncommon to see these words. For those suffering from celiac disease, these new additions are a welcome sight.

What Is Gluten?
Gluten is the name used for the proteins found in wheat, rye and barley. It acts as glue in foods, helping them maintain their shape, and is found in many foods.

Celiac and Gluten Connection
Celiac disease is an autoimmune disorder that affects the small intestine when gluten is consumed. According to Johns Hopkins Medicine, “When people with celiac disease eat foods containing gluten, their immune system responds by damaging the small intestine. Tiny fingerlike protrusions, called villi, which line the small intestine and enable the absorption of nutrients from food into the bloodstream, are lost. Without these villi, malnutrition occurs, regardless of how much food a person consumes.”

Celiac disease can be confused with irritable bowel syndrome (IBS) or other bowel issues. Patients are diagnosed most often with a blood test, which is a noninvasive approach. However, the gold standard to diagnose celiac disease is through an endoscopy with biopsies of the small intestine. Before any testing for celiac disease, you should continue to include gluten in your diet to ensure accurate results. Many people follow a gluten-free diet when they do not have celiac disease. For those with celiac disease, it is absolutely essential to eat a gluten-free diet. For everyone else who is avoiding gluten, you may be limiting your choices unnecessarily.

Signs of celiac disease can include bloating, gas, indigestion and diarrhea. However, some patients could have constipation or no GI symptoms at all. If you are having digestion issues, you should see your primary care physician first. If there is no diagnosis and symptoms don’t resolve, then you should visit a gastroenterologist who specializes in conditions of the digestive tract.

Anyone can get celiac disease. In fact, about one percent of the population, or nearly three million people, likely have celiac disease and are unaware of it. Celiac disease is a genetically predisposed disorder. Once a family member is diagnosed, you should be aware that you are at a higher risk of having or developing the disease and may want to be tested. However, you can be a carrier of celiac disease and never show symptoms until later in life, if at all. Being a carrier of the gene means you may not have the disease, but may be prone to it. It does not mean you will definitely develop it. Additionally, people with autoimmune disorders such as rheumatoid arthritis, Type 1 diabetes, osteoporosis, abnormal liver function and/or disease, or anemia are at higher risk for celiac disease. If you have one of these autoimmune conditions, you should consider being tested for celiac disease if you have symptoms and are not improving.

Although there is no cure for the disease, there is a lot of research underway for treatment, including prescription drug studies. Currently, the only treatment that is known to ease the symptoms of celiac disease is to eliminate foods containing gluten from your diet.

So What Should I Eat?
The Celiac Foundation’s website or the National Foundation of Celiac Awareness website have a lot of good information on diet options. The most important consideration when choosing your food is to be mindful of reading labels as many unsuspecting foods, and even some medications, contain gluten.

When Am I Going to Feel Better?
If you have celiac disease and start reducing your gluten intake, you should feel better within a couple of weeks. In some cases it takes up to a month before you notice a difference and start feeling better. Often this occurs because you have unknowingly consumed gluten.

Mahmood Solaiman, M.D., is a gastroenterologist with Gastro Associates in Elkridge. Appointments: 410-590-8920.


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flu fighting tips

The best defense from the flu is a flu vaccine, and December is not too late to get one. The best defense from a cold is to wash your hands and avoid contact with airborne germs from coughs or sneezes of others. [© Racorn | Dreamstime.com]

If you’ll be home for the holidays, you’ll likely socialize with family and friends, travel on an airplane or be one of the crowd at the mall… and someone there inevitably will be sick. All it takes is one projectile sneeze, a handshake, a kiss at a party, or a taste of the dip after someone else double dipped and wham! You’re down with a cold or the flu.

Some people may think the flu isn’t all that serious; but you need to remember that it can be a very dangerous—even fatal—illness, especially for the very young, the very old and the immune-compromised. It descends upon our local communities every year, often causing serious illness and sometimes death. And after the holiday season, we begin seeing more cases.

The best defense from the flu is a flu vaccine – and December is not too late to get one. According to the Centers for Disease Control (CDC), it takes about two weeks after receiving the shot to develop antibodies to fight flu. The best defense from a cold is to wash your hands and avoid contact with airborne germs from the coughs or sneezes of others. Eating and sleeping well can also help boost your immunity. Here are some tips for safe socializing this holiday season:

      • wash your hands often
      • don’t share drinks or food
      • let your faithful friends gather near but not too near – try to stay away from people who are sick
      • stay home if you are sick, and
      • cover your cough with a tissue or cough into the inside of your elbow so your hands don’t transmit germs.

What should I do if I get the flu?
If your illness is mild, stay home and avoid contact with other people. Call your doctor’s office to see if a prescription antiviral drug is right for you. You should stay home for at least 24 hours after your fever is gone. However, if you have symptoms and are in a high-risk group, contact your doctor for advice.

What is the difference between the common cold and the flu?
In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness and dry cough are more common and intense. People with colds are more likely to have a runny or stuffy nose. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections or hospitalizations. Special tests done within the first few days of illness can determine if you have the flu.

If you practice good infection prevention, you may be able to avoid looking like Rudolph the Red-Nosed Reindeer this season. Healthy Holidays!

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Flu Myths Dispelled

Mark Landrum, M.D., an infectious disease specialist on staff at Howard County General Hospital, dispels the following myths. (Get more facts about the flu and vaccine, or  find a location offering the flu vaccine.)


  • "I shouldn’t bother with this year’s flu shot, since last year’s shot wasn’t very effective." Actually, an annual flu vaccine is the best protection against this serious disease. Each year, vaccines contain the three most common or likely flu viruses, and some vaccines contain protection against an additional virus. [© Subbotina | Dreamstime.com]
  • “There is no treatment if I have the flu.” On the contrary, staying hydrated and getting rest will help you recover from the flu. A prescription drug given in the first two days of the flu can shorten the duration and severity. See your doctor as soon as you think you have the flu. [© Comzeal | Dreamstime.com]
  • "I could get the flu from the shot." This is a myth. The flu shot is not a live virus, so you cannot get an infection from the vaccine; instead it will boost your immune system. The nasal vaccine protects with a very weak strain of influenza that doesn’t cause significant symptoms.[© Atholpady | Dreamstime.com]
  • “At night or on weekends, I have no options except to go to the Emergency Room.” No, if you have flu-like symptoms and are otherwise in good health, most physicians suggest you stay home and treat symptoms with over-the-counter medications and fluids, or they may prescribe Tamiflu. Some doctors have an on-call answering service for after hours. Urgent care facilities are also a good option when your doctor’s office is closed. If you have difficulty breathing, a prolonged high fever, severe dehydration or relapse after getting better, seek emergency medical care. [© Ronfromyork | Dreamstime.com]

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thanksgiving diet tips

[© Dmitriy Shironosov | Dreamstime.com]

And Any Upcoming Holiday Meal!

Everyone loves the holidays – a time for family and friends gathering and sharing meals and memories. Between turkey and stuffing and pies, this is also a time that is easy to fall off the healthy eating wagon and gain unwanted pounds. However, Thanksgiving does not always have to sabotage your waistline.

Below are some tips to enjoy your Thanksgiving while staying healthy:

  • Don’t overeat: It is easy on Thanksgiving with so many options and food in front of us to overeat. Skip the seconds by waiting at least twenty minutes after your meal to let your body realize if it is full or not. Have the turkey be the only thing that is stuffed this year!
  • Exercise: Put in a little extra exercise around the holidays before treating yourself to your Thanksgiving feast. Increasing the length of your workout and exercising to burn off the calories before you consume them is a good trick. In addition to exercising before your Thanksgiving meal, take a walk after dinner and plan a workout date for the following day.
  • Stay hydrated: Drinking water throughout the day will keep you hydrated and keep hunger pains, that may actually be thirst, to a minimum. Also, go easy on alcohol where calories can sneak up on you.
  • Eat breakfast: Many follow the myth of skipping breakfast to save their appetite for the Thanksgiving feast – but this could actually be detrimental. Not eating until later in the day can easily lead to binging.
  • Eat fewer appetizers: By staying away from appetizers that you can have any day of the year, you save your appetite for the main course.
  • Try healthier recipes: If you are cooking or bringing a dish to Thanksgiving, lighten up your dishes by using less sugar and fat. Typically, no one will notice the difference if you scale back and use lower calorie ingredients.

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IBD symptoms treatment

[© Lensonfocus | Dreamstime.com] Although no cure exists for IBD, dietary changes and medication may help. If left untreated, IBD complications can arise, affecting your quality of life and contributing to an added risk of cancer.

IBS and IBD…do these gastrointestinal disorder acronyms have you confused? Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) share some similar symptoms, but treatment varies significantly between the conditions, making it important to get an accurate diagnosis.

According to Johns Hopkins Medicine,
: the overarching name of two chronic diseases which cause swelling of the intestines or the colon: Crohn’s disease and ulcerative colitis.
IBS: a digestive disorder that causes abdominal pain, diarrhea, constipation, bloating, gas or a combination of these.

Crohn’s disease is a chronic, inflammatory IBD affecting all or only a small part of the gastrointestinal (GI) tract. This autoimmune condition can progress deep into affected tissue. Ulcerative colitis is an IBD where the inner lining of the large intestine and rectum become inflamed and ulcers can form.

The symptoms of IBD vary and are similar to other bowel conditions and include diarrhea, abdominal pain and cramping, fatigue, fistulas, incontinence, rectal bleeding and weight loss.

“IBD symptoms are not only found in the GI tract. Symptoms can be extra-intestinal (outside the intestine) to include arthritis and joint pain, rashes and eye redness,” says Grishma Joy, M.D., a gastroenterologist on staff at HCGH. “You should see a doctor if you have symptoms lasting more than a few weeks and/or have recurrent symptoms, persistent pain, unintentional weight loss and/or rectal bleeding.”

Diagnosing IBD
Initially, testing for IBD begins with blood work and a lab test to check for inflammatory markers in your stool. A colonoscopy, often combined with an upper endoscopy, to collect tissue samples and visualize the GI tract are important tools in diagnosing IBD.

What Causes IBD?
According to Dr. Joy, the exact cause of IBD remains unclear, but we know that genetics and environmental factors can trigger IBD. Potential risk factors include if you:

  • have had your appendix removed
  • used Accutane (a form of vitamin A used to treat severe acne)
  • have a relative with IBD
  • are of Jewish ancestry (although IBD can occur in all ethnic and racial groups)
  • if you have IBS or celiac disease, you can also have IBD.

There is no specific IBD diet, but Dr. Joy suggests the following tips that may decrease your symptoms:

  • include fewer foreign substances in your diet, such as processed foods
  • reduce fresh fruits/raw vegetables: the antigens found in these uncooked foods can trigger a chemical reaction that causes IBD symptoms; instead, cook fruits and vegetables before eating them to eliminate the antigens
  • avoid red meat – it is hard to digest. Animal fat, along with fat in general, causes inflammation. If you are already overweight, you have a higher level of inflammation in your body already, and you should concentrate on avoiding too much fat that will only further increase your inflammation levels.

Treating IBD
Although there is no cure for IBD, several medications are available to help. “Many of the side effects of IBD prescription medications can be concerning. However, it is important for those diagnosed with IBD to understand their importance. If IBD is untreated, your risk of cancer can be increased. Additionally, untreated IBD can result in complications as the disease progresses, including: perforation or tearing of the intestines as a result of deep ulcers; abscess or infection; a fistula attaching to other organs; or malnutrition,” says Dr. Joy. “IBD can really affect quality of life and, as such, those with IBD may suffer from depression. Recognizing and addressing this is a very important aspect of effective management of the disease.”

There are many studies that show over-the-counter probiotics can provide relief from IBD symptoms. However, probiotics do not heal the intestinal lining, so you will need to continue taking your prescription medications.

“There are many new FDA-approved medications showing promise for those with IBD, and much research is in the pipeline,” notes Dr. Joy. “Nevertheless, if you are not responding to medication currently available, surgery can be an effective treatment option that often brings significant relief.”


Grishma Joy, M.D., is a gastroenterologist with Digestive Disease Associates in Columbia.




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