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Sinusitis and Acid Reflux or GERD
 

Question: What is GERD?
Answer:
The backflow of stomach juices, including acids and occasionally ingested foods, constitutes gastroesophageal reflux disease or GERD.

Question: What are the symptoms of GERD?
Answer:
Common esophageal symptoms of GERD include repeated bouts of heartburn, difficulty swallowing, hoarseness, lump-in-the-throat sensation, chronic cough and throat clearing, and mucus build-up in the throat. People can suffer from one or more of these symptoms.

Question: What is the the relationship between GERD and sinusitis?
Answer:
Sometimes, the symptoms of GERD can mimic some of the symptoms of sinusitis. The sensation of post-nasal draining and the need to clear your throat constantly may be due to post-nasal drainage -- but may also be due to GERD. The sinus specialist may therefore examine you in the office to see if there is physical evidence of GERD.

Acid reflux can sometimes actually contribute to sinusitis! That is to say, the acid can travel all the way up to your nose and sinuses (for instance, while you are lying down asleep), and this acid can inflame the nose and sinus linings. This problem is more common in children -- but it may also be seen in adults.

Question: What causes GERD?
Answer:
There is a one-way valve near the top of the stomach. Stomach acid can escape through a weakened valve and travel up the esophagus -- even up to the voice box and throat -- and produce the symptoms listed above.

Question: How do you diagnose GERD?
Answer:
Heartburn is easily recognized by the family doctor. However, some of the symptoms relating to the throat and voice box should be evaluated by a specialist. The specialist will then perform a complete examination including taking a look at the voice box with a small endoscope placed through the nose. If you have GERD, your sinus specialist may ask you to also see a gastroenterologist.

Question: Are there any diagnostic tests?
Answer:
A gastroenterologist may decide to order some additional tests to evaluate your GERD. A Barium swallow is a series of x-ray films that monitor dye as it travels through the stomach. A PH monitoring test is a 24-hour test to record the back flow of acid from the stomach into the esophagus and even the throat. A small flexible tube is placed in the stomach through the nose and is connected to a small computer to record 24-hour acid reflux. Endoscopy is sometimes performed to evaluate the esophagus for damage from acid burns and to examine the stomach for irritation and ulceration.

Question: How is GERD managed?
Answer:
With lifestyle and dietary changes, with medical treatment, and at times surgical treatment.

Question: Tell me about life style and dietary changes.
Answer:
Don't drink alcohol, and don't smoke. Both nicotine and alcohol irritate the stomach and increase acid production. Also,

  • Avoid clothing that is tight around the waist -- corsets, belts.
  • Avoid bending over.
  • Lose weight.
  • Raise your head when lying down. This is best achieved NOT with pillows, but by raising the head of the bed by 6 to 8 inches. This can be done by sliding blocks under the legs at the head of the bed or a wedge under the head of the mattress.

Question: Tell me about dietary modifications.
Answer:
You may wish to avoid coffee and tea, carbonated beverages, alcohol, fatty fried foods, spicy food, citrus fruits and juices, tomato juice, orange juice, and grapefruit juice, tomatoes, onions, peppermint, spearmint, chocolate, cheeses, and eggs.

Avoid large meals, especially in the evenings. Do not lie down right after eating. Allow three to four hours after supper and lying down. Make the mid day meal the heavier meal of the day and eat small, well-balanced meals.

Question: Tell me about medical treatment.
Answer:
Medical treatment is based on neutralizing stomach acid, reducing or eliminating stomach acid and improving gastric emptying. Neutralizing stomach acid can be achieved by using over-the-counter antacids in liquid or tablet form such as Sucralfate suspension, Maalox, and Ryopan. Reducing or eliminating stomach acids can be achieved with H-2 blockers, which are drugs that depress acid production, such as Cimetadine (Tagamet), Ranitidine (Zantac), or Famotidine (Pepcid). These are also now available over-the-counter at lower dosage.

Antacids and H-2 blockers should be taken one hour apart as antacids may reduce the other drugs' effectiveness. New drugs like Omeprazole (Prilosec) and Nexium completely stop stomach acid production. These drugs are generally prescribed for short-term use.

Improving gastric emptying can be undertaken by Cisapride, Metoclopromide, Bethanachol, and other drugs. These drugs increase the squeezing action of the esophagus and tighten the esophageal sphincter, in addition to making the stomach empty faster.

Question: Tell me about surgical treatment of GERD.
Answer:
Surgical treatment is undertaken as a last resort. If the dietary and medical treatments do not bring relief, or if the patient finds them hard to comply with, they may be candidates for surgery. One procedure is called "fundoplication." It involves wrapping the top of the stomach around the top of the esophagus in order to strengthen support and prevent reflux. If possible, it is preferable to control GERD with medical treatment!

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