When should I see a gastroenterologist?

You should consult a gastroenterologist if you have frequent or severe heartburn or if you take antacids more than several times a week.  A gastroenterologist can help ensure that you have GORD and not another condition by performing certain tests as indicated and can prescribe effective treatment.  If you experience severe symptoms such as weight loss, difficulty swallowing, persistent vomiting, or vomiting blood, immediate medical attention is required.

If not managed or treated, gastroesophageal reflux disease (GORD) can lead to various complications, including:

Esophagitis: Inflammation of the oesophagus lining due to repeated exposure to stomach acid.

Strictures: Narrowing of the oesophagus caused by scarring from chronic inflammation, leading to swallowing difficulties.

Barrett’s oesophagus: A condition in which the normal tissue lining the oesophagus is replaced with abnormal tissue, increasing the risk of oesophageal cancer.

Oesophageal cancer: people with gastroesophageal reflux disease (GORD) are at an elevated risk of developing adenocarcinoma of the oesophagus, a form of oesophageal cancer.  This type of cancer typically impacts the lower portion of the oesophagus and can manifest with symptoms such as: difficulty swallowing (dysphagia), unexplained weight loss, chest pain, persistent coughing, severe indigestion and intense heartburn.

Oesophageal ulcers: Open sores in the lining of the oesophagus, resulting from the erosion caused by stomach acid.

Oesophageal bleeding: Bleeding can occur from oesophageal ulcers or irritation of the oesophageal lining.

Respiratory problems: Chronic reflux of stomach acid into the throat and airways can lead to asthma, pneumonia, or chronic cough.

Dental complications: The acid from the stomach can erode tooth enamel, leading to dental problems such as cavities and tooth sensitivity.

Sleep disturbances: Nighttime reflux can disrupt sleep patterns and lead to insomnia or daytime fatigue.

Proton pump inhibitors (PPIs) are medications commonly used to reduce stomach acid production and treat conditions like gastroesophageal reflux disease (GERD) and peptic ulcers.  While generally well-tolerated, PPIs can cause certain side effects in a small percentage of individuals.  These side effects may include:

Headache: Some people may experience headaches while taking PPIs.

Gastro-intestinal symptoms such as: nausea and vomiting, diarrhea or constipation, abdominal pain or discomfort, flatulence (gas) and abdominal bloating.

Decreased magnesium levels: Long-term use of PPIs may lower magnesium levels in the body, leading to symptoms such as muscle cramps, tremours, and irregular heartbeat.

Increased risk of fractures: Prolonged use of PPIs has been associated with a slightly increased risk of bone fractures, particularly in older adults.

Increased risk of infections: Some research suggests that long-term PPI use may slightly increase the risk of certain infections, such as pneumonia and Clostridium difficile (C. difficile) infection.

Nutritional deficiencies: Reduced stomach acid production caused by PPIs can impair the absorption of certain nutrients, such as vitamin B12, calcium, magnesium, and other trace elements, potentially leading to deficiencies over time.

It is essential to discuss any concerns or potential side effects with a healthcare provider before starting or discontinuing PPI therapy.  In some cases, alternative treatments or adjustments to dosage may be recommended to minimise side effects while effectively managing the underlying condition.  It is also important to have regular blood tests to monitor for potential deficiencies.

If left untreated, gastro-oesophageal reflux disease (GORD) can indeed become a chronic condition, persisting throughout a person’s life, and presenting with a spectrum of symptoms ranging from mild to severe.  Upon diagnosis of GORD, a healthcare provider typically recommends initial management through lifestyle modifications and dietary adjustments aimed at reducing the reflux of stomach acid through the lower oesophageal sphincter (LOS).

While peppermint can provide relief for an upset stomach, it can exacerbate heartburn.  This is due to the relaxing effect peppermint has on the lower oesophageal sphincter (LOS), which can lead to the leakage of stomach contents into the oesophagus.

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