Know Your Gut: Straight talk on Digestive Problems from a Gastrointestinal Physician

By Andrew G. Plaut

Know Your Gut addresses many issues that arise all the time when patients with heartburn, abdominal pain, gas, bloating, diarrhea, bleeding and many other digestive tract concerns make an appointment with their doctor. It is not only what patients are feeling that is on their mind; they also worry about gastrointestinal cancer, the wisdom and value of having their colon cleaned out, where they got the bacterium Helicobacter pylori that lives in their stomach, and whether or not they have SIBO, a condition better described as small intestinal bacterial overgrowth. What should a person do if heartburn doesn't go away despite treatment. Then there are those who are sure they pass more gas than other people and they wonder why that gas smells badly when the air they swallow doesn't. People also want to know if they can safely treat diarrhea at home instead of going to a doctor or a hospital emergency department, and more importantly, when should they clearly seek urgent medical help. The same holds for nausea and vomiting, which the book points out can be due to scores of things like being pregnant to a severe illness such as meningitis that is a threat to life. And people often ask their doctor and their friends if diarrhea should be treated with Gatorade, and if not, how can one make a fluid at home that will replace fluid lost from diarrhea (the book has a recipe for doing just that). And the confusing issue of what is the difference between diverticulitis and diverticulosis...are they both illnesses? Should gallstones be removed if they are not causing trouble? Is a CT scan useful in detecting colon cancer, and for that matter, should one test the stool for cancer DNA instead of a getting a colonoscopy? Is it wise to have hemorrhoids (piles) removed by surgery? Diet is discussed briefly in the book to indicate which diets are truly useful in handling digestive tract illnesses, and which are not. And then there is constipation---the book explains what's going on, what are the differences among the laxatives that line the shelf of every pharmacy, and what is the value of fiber in treating bowel disorders. And this book leaves no doubt about how to administer the Heimlich maneuver to provide urgent aid to a person who is choking and unable to breathe, and how a dinner companion can immediately know who needs this lifesaving treatment.

Know Your Gut is a book that arose from questions that thousands of patients have asked the author during his many years of providing medical care. It seemed worthwhile to answer them in plain language that doesn't use complex medical terminology, addressing the main goal of every caregiver to be helpful and informative.

• Language: English
• Publisher: BookBaby
• Release date: Apr 27, 2021
• ISBN: 9781098377212

Book preview

Update.

1 | Heartburn

Stomach acid in the wrong place

Symptoms and Causes

Heartburn is a burning sensation in your chest or throat. What causes it is stomach acid moving into the esophagus where it does not belong. This condition is known as acid reflux or GERD (gastroesophageal reflux disease).

The stomach is a remarkable organ that normally produces large amounts of hydrochloric acid and other elements. This gastric acid is much, much stronger than the acid in, for example, lemons or oranges, foods thought of as being highly acidic. Acid volume in the stomach rises when someone thinks about eating food, smells it, and eats it and still goes on hours after a meal is done.

A healthy stomach can tolerate being filled with acid, but the esophagus cannot. When acid gets into the esophagus, this is called acid reflux. It happens when the muscular valve that separates the esophagus from the stomach, called the lower esophageal sphincter, is weak and fails to close fully. This failure to close allows acid to migrate upward into the esophagus.

The lower esophageal valve is normally tight. Take a moment to tightly bend or flex your right index finger and try to pry it open with your left index finger, and you’ll note the power that muscles in a circle have to close tightly.

When the valve does not close, acid reflux occurs. In patients with reflux, acid can and does move upward, especially when acid volume is high (after a big, hearty meal) or when a person is lying flat, most often at bedtime. If you’ve experienced heartburn from acid reflux, you are not alone. This condition bothers many people.

When acid gets into the esophagus, it eventually gets pushed back down to the stomach by the muscle contractions of the esophagus. But an unhealthy or injured esophagus cannot clear itself of acid, and this inability gets worse with repeated reflux. In such cases, it takes time for the esophagus to return to health. Reflux treatments, as discussed below, must continue long enough to allow the esophagus to contract normally again and send refluxed acid back where it came from. While treating reflux for a few days or even a few weeks will quickly improve pain, which is good, much longer treatment is needed for the esophagus to regain its usual function.

Some patients with reflux experience constant nausea or hoarseness as their only symptom (see Chapter 3, Nausea and Vomiting). The severity of symptoms from acid reflux varies greatly from one person to another. The occasional heartburn you feel when lying down after a sizable meal or that awakens you from sleep is usually manageable. However, intense heartburn and other reflux-caused problems such as choking or difficulty with swallowing need careful evaluation by a medical professional.

What to Do if You Have Heartburn from Reflux

First, don’t worry. Acid reflux is treatable. Most patients get temporary and welcome relief from a tablespoon of antacid, a few TUMS®, or some Pepto-Bismol® or milk. Since these remedies are not meant to treat acid reflux fully, however, the symptoms will soon return. Full treatment requires medications that reduce gastric acid production. These are available off the shelf in your pharmacy or by prescription. Over-the-counter forms of these drugs are sometimes at a lower dosage than you may need, so keep in mind that dose is important. Note that higher-dose medications often need prescriptions. Note also that effective treatment takes time, at least six to eight weeks. Pain relief comes first, but esophageal healing is slower. So don’t quit treatment early just because you are feeling better.

Acid-Reducing Drugs

There are two major classes of acid-suppressing drugs: (1) proton pump inhibitors (known as PPIs) such as omeprazole and other PPIs of similar value, and (2) H2 histamine blockers like famotidine. Both classes interrupt stomach acid production, but they differ in how they do this.

If you have been prescribed omeprazole or another PPI, this may be the only drug you need to treat your reflux. Most doctors recommend taking PPIs after you wake up from sleep as that is when your stomach is empty. So, take the morning dose 20 to 30 minutes before having any breakfast. An evening dose of a PPI may become necessary if heartburn returns later in the day or evening, but that first dose upon awakening often does the job.

H2 histamine blockers work differently but are also effective in suppressing stomach acid secretion. These drugs can be used instead of PPIs. If your heartburn persists or is only somewhat improved with either drug alone, we sometimes recommend that patients take both drugs: the PPI in the morning as described above, and an H2 histamine blocker such as famotidine at bedtime. That combination helps many patients who do not fully improve on just one drug.

Please Note: As of this writing, the H2 blocker ranitidine, which was widely prescribed for acid reflux, has at least temporarily been withdrawn from the market. You will not find it at your pharmacy. Famotidine is still available and is equally as effective.

Alternative Remedies for Heartburn

Diet

The other ways you can treat heartburn from reflux are important to know. As mentioned earlier, eating anything prompts the stomach to secrete acid. So, in the two hours before you go to sleep, try not to snack. If you do, try to eat things that do not contain fat. Fatty foods stay in the stomach much longer than vegetables, fruits and grains, so acid production goes on longer. This delay in stomach emptying is not helpful when you are about to lie down for sleep.

Also, if you often have heartburn, try not to eat large or fatty meals. Occasional splurging is OK. After all, you are human! If you do, though, remember to not lie flat right after a big meal. By doing so, you can worsen the problem of acid flowing up into the esophagus.

Bed Elevation

Another home remedy for acid reflux that works is putting your entire bed on a slight slant with your head elevated, something I illustrate for patients with a drawn diagram. Bed elevation is helpful because when you lie down flat, the pool of acid in your stomach can easily flow into the esophagus. But with your entire body at a slight angle, simple gravity keeps stomach acid down where it belongs. To elevate the head of the bed, recruit a friend to help you lift the head end about four to five inches (ten to twelve centimeters) off the floor. Then lower it onto blocks or books so the entire bed frame is now at a slight angle. A bed so elevated does not look strange in the room. You won’t slide downward, and you and others in bed with you will quickly become accustomed to this minor change in position. This method is so effective in preventing reflux that, even if you have just completed eight weeks of therapy, keep the bed elevated.

A further note: bunching up pillows or getting a wedge to elevate your head while sleeping does not work nearly as well as the bed elevation just described.

Some Words of Warning

Medications of all kinds—pills, capsules, and tablets—have coatings that can injure the esophagus. Unless you have restrictions on water intake, if you have reflux, drink plenty of water or other liquids to wash down all medications.

If you are having trouble swallowing, you likely need special care. If such care is not immediately available, it is best to chop food into small pieces before you eat it or make a smoothie that will glide down more easily (see Chapter 2, "Trouble