Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



PHYSICIANS: JOIN ECMS                  PUBLIC: FIND A PHYSICIAN

 

 

 
12:20 PM
December 10th, 2017

GERD - What You Should Know

What You Should Know about GERD

 
What Is GERD?

 GERD or Gastro-Esophageal-Reflux Disease is a digestive system disorder marked by backward flow of stomach acid, and sometimes bile and pancreatic products, upward into the esophagus.

 

GERD Symptoms

GERD symptoms are of two types: typical and non-typical.

The typical symptoms are digestive symptoms such as heartburn, regurgitation with sudden acidic taste in the mouth, and sudden occasional difficulty swallowing.

 

The atypical symptoms are those often associated with respiratory problems, such as asthma, pneumonia, laryngitis, hoarseness, nighttime coughing, and even dental enamel erosion.

 

Demographics of GERD

GERD has been estimated as affecting, at some time and in some degree, upwards of 25% of Americans. Further, the incidence has been rising in recent years. GERD seems to be more common in Caucasian Americans than in African Americans and is also more common in persons older than 40 years..

 

GERD Risk Factors

Obesity is the most important risk factor in GERD. However, other risk factors are smoking, alcohol, high dietary fat, and increased gram-negative bacteria in the GI tract. Finally, hiatal hernia is a frequent cause of GERD.

 

Causes of GERD 

The esophagus is often called the “food tube,” but this is inappropriate. It suggests that swallowing is a passive procedure, like clothes falling down a laundry chute into a basket in the basement.  

 

Actually, it is movements in the esophagus that propel food along toward the stomach. A sort of valve called the lower esophageal sphincter or LES separates the esophagus and the stomach, helping to keep the stomach contents from returning into the esophagus. Another valve, the pylorus. separates the stomach from the intestines and keeps contents of the intestines, including bile and pancreatic secretions, from returning to the stomach.

 

GERD may be caused when the esophagus does not adequately propel food toward the stomach, when the LES does not adequately keep stomach contents from returning to the esophagus, when the stomach remains too full of contents too long, when bile and pancreas secretions reflux from the small intestine into the stomach and then into the esophagus, or when there is a hiatal hernia.

 

A hiatal hernia permits the migration of part of the stomach from the abdomen into the chest. One of the ways that hiatal hernia can cause GERD is by allowing retention of food into the part of the stomach herniated into the chest.

 

There is another, more sophisticated mechanism by which part of the stomach moving into the chest causes GERD. Here the stomach moving into the chest takes the LES with it. But, the pressure in the chest is negative, this allows the lungs to inflate during breathing. The negative pressure outside the LES assists keeping it open, allowing reflux of gastric contents into the esophagus.

 

Complications of GERD

The most serious complications of GERD are esophagitis, stricture, and Barret esophagus.

 

Esophagitis is damage to the internal lining of the esophagus on continuing exposure to reflux. It occurs in about 50% of untreated GERD patients.

 

Stricture is a narrowing of the esophagus due to deeper tissue injury. It can result in difficulty swallowing and vomiting of undigested food. This typically requires surgical consultation.

 

Barrett esophagus is the most serious complication and affects 8-15% of untreated GERD patients. It changes the character of the lower esophageal lining cells to somewhat resemble those of stomach lining cells. Barrett esophagus increases the risk of esophageal cancer 30-40 times. Barrett esophagus also needs surgical consultation.

 

Treatment of GERD 

Treatment of GERD typically depends on severity and falls into three categories: lifestyle changes, medication, and surgery.

 

Lifestyle changes include

  •      Losing weight
  •      Stopping smoking
  •      Avoiding alcohol, chocolate, citrus, and tomato along with peppermint, coffee, and onion.
  •      Avoiding large meals
  •      Waiting 3 hours after meals before reclining
  •      Elevating the head of the bed by 8 inches
  •  

Medications include

  •      Antacids
  •      Histamine-2 receptor blockers such as ranitidine, cimetidine,famotidine, and nizatidine.
  •      Proton pump inhibitors such as omeprazole, lansoprazole, rabeprazole, and esomeprazole.

 

Surgery

  •      The most common surgery is the Nissen fundoplication, in which a portion of the upper stomach is sutured around the lower part of the esophagus to strengthen the function of the LES.

 

Conclusion

The most important things to remember are that GERD is common, that there are effective treatments for GERD, and that GERD should not be ignored. Left untreated, GERD can result in such serious problems as esophageal stricture and esophageal cancer. Nevertheless, your physician can offer effective treatments for GERD.

 

Thomas Falasca, DO

 

 

References

 

Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Gastroenterol Clin North Am. 2010 Mar. 39(1):39-46.

 

Heartburn across America: a Gallup Organization national survey. 1988.

 

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007 Mar. 11(3):286-90.

 

Loffeld RJ, van der Putten AB. Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy. Digestion. 2003. 68(2-3):141-4.

 

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov. 21(11):953-6.

Patti, M. (2017, October 17). Gastroesophageal Reflux Disease. Retrieved December 07, 2017, from http://emedicine.medscape.com/article/176595-overview

 

Shaheen N, Provenzale D. The epidemiology of gastroesophageal reflux disease. Am J Med Sci. 2003 Nov. 326(5):264-73.

 

 

 
 
 
 

GERD - What You Should Know

 

 See More

GERD - What You Should Know

What You Should Know about GERD

 
What Is GERD?

 GERD or Gastro-Esophageal-Reflux Disease is a digestive system disorder marked by backward flow of stomach acid, and sometimes bile and pancreatic products, upward into the esophagus.

 

GERD Symptoms

GERD symptoms are of two types: typical and non-typical.

The typical symptoms are digestive symptoms such as heartburn, regurgitation with sudden acidic taste in the mouth, and sudden occasional difficulty swallowing.

 

The atypical symptoms are those often associated with respiratory problems, such as asthma, pneumonia, laryngitis, hoarseness, nighttime coughing, and even dental enamel erosion.

 

Demographics of GERD

GERD has been estimated as affecting, at some time and in some degree, upwards of 25% of Americans. Further, the incidence has been rising in recent years. GERD seems to be more common in Caucasian Americans than in African Americans and is also more common in persons older than 40 years..

 

GERD Risk Factors

Obesity is the most important risk factor in GERD. However, other risk factors are smoking, alcohol, high dietary fat, and increased gram-negative bacteria in the GI tract. Finally, hiatal hernia is a frequent cause of GERD.

 

Causes of GERD 

The esophagus is often called the “food tube,” but this is inappropriate. It suggests that swallowing is a passive procedure, like clothes falling down a laundry chute into a basket in the basement.  

 

Actually, it is movements in the esophagus that propel food along toward the stomach. A sort of valve called the lower esophageal sphincter or LES separates the esophagus and the stomach, helping to keep the stomach contents from returning into the esophagus. Another valve, the pylorus. separates the stomach from the intestines and keeps contents of the intestines, including bile and pancreatic secretions, from returning to the stomach.

 

GERD may be caused when the esophagus does not adequately propel food toward the stomach, when the LES does not adequately keep stomach contents from returning to the esophagus, when the stomach remains too full of contents too long, when bile and pancreas secretions reflux from the small intestine into the stomach and then into the esophagus, or when there is a hiatal hernia.

 

A hiatal hernia permits the migration of part of the stomach from the abdomen into the chest. One of the ways that hiatal hernia can cause GERD is by allowing retention of food into the part of the stomach herniated into the chest.

 

There is another, more sophisticated mechanism by which part of the stomach moving into the chest causes GERD. Here the stomach moving into the chest takes the LES with it. But, the pressure in the chest is negative, this allows the lungs to inflate during breathing. The negative pressure outside the LES assists keeping it open, allowing reflux of gastric contents into the esophagus.

 

Complications of GERD

The most serious complications of GERD are esophagitis, stricture, and Barret esophagus.

 

Esophagitis is damage to the internal lining of the esophagus on continuing exposure to reflux. It occurs in about 50% of untreated GERD patients.

 

Stricture is a narrowing of the esophagus due to deeper tissue injury. It can result in difficulty swallowing and vomiting of undigested food. This typically requires surgical consultation.

 

Barrett esophagus is the most serious complication and affects 8-15% of untreated GERD patients. It changes the character of the lower esophageal lining cells to somewhat resemble those of stomach lining cells. Barrett esophagus increases the risk of esophageal cancer 30-40 times. Barrett esophagus also needs surgical consultation.

 

Treatment of GERD 

Treatment of GERD typically depends on severity and falls into three categories: lifestyle changes, medication, and surgery.

 

Lifestyle changes include

  •      Losing weight
  •      Stopping smoking
  •      Avoiding alcohol, chocolate, citrus, and tomato along with peppermint, coffee, and onion.
  •      Avoiding large meals
  •      Waiting 3 hours after meals before reclining
  •      Elevating the head of the bed by 8 inches
  •  

Medications include

  •      Antacids
  •      Histamine-2 receptor blockers such as ranitidine, cimetidine,famotidine, and nizatidine.
  •      Proton pump inhibitors such as omeprazole, lansoprazole, rabeprazole, and esomeprazole.

 

Surgery

  •      The most common surgery is the Nissen fundoplication, in which a portion of the upper stomach is sutured around the lower part of the esophagus to strengthen the function of the LES.

 

Conclusion

The most important things to remember are that GERD is common, that there are effective treatments for GERD, and that GERD should not be ignored. Left untreated, GERD can result in such serious problems as esophageal stricture and esophageal cancer. Nevertheless, your physician can offer effective treatments for GERD.

 

Thomas Falasca, DO

 

 

References

 

Anand G, Katz PO. Gastroesophageal reflux disease and obesity. Gastroenterol Clin North Am. 2010 Mar. 39(1):39-46.

 

Heartburn across America: a Gallup Organization national survey. 1988.

 

Herbella FA, Sweet MP, Tedesco P, Nipomnick I, Patti MG. Gastroesophageal reflux disease and obesity. Pathophysiology and implications for treatment. J Gastrointest Surg. 2007 Mar. 11(3):286-90.

 

Loffeld RJ, van der Putten AB. Rising incidence of reflux oesophagitis in patients undergoing upper gastrointestinal endoscopy. Digestion. 2003. 68(2-3):141-4.

 

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis. 1976 Nov. 21(11):953-6.

Patti, M. (2017, October 17). Gastroesophageal Reflux Disease. Retrieved December 07, 2017, from http://emedicine.medscape.com/article/176595-overview

 

Shaheen N, Provenzale D. The epidemiology of gastroesophageal reflux disease. Am J Med Sci. 2003 Nov. 326(5):264-73.

 

 

 
 
 
 

Asthma and You

Asthma is a common chronic disease that affects 26 million people in the United States.

...See More

Asthma and You

 

 

Asthma and You

 

Asthma is a common chronic disease that affects 26 million people in the United States. Adult-onset asthma, in people over 40, is more frequent among women.

 

On the other hand, asthmatic children, of whom there are seven million in the US, are almost twice as likely to be boys. Moreover, asthma is a common cause of hospitalization of children in the US. Fortunately, about half of children diagnosed with asthma will have a decrease or disappearance of symptoms by early adulthood.

 

What Is Asthma

Asthma is a disease in which the airways become inflamed, episodically obstructed, and hyper-responsive to stimuli. These processes are at least partially reversible. However, after long duration there may be some permanent changes in the airways.

 

Asthma Symptoms

Asthma symptoms include wheezing, coughing, shortness of breath, and chest tightness. These symptoms may occur acutely (suddenly and briefly), sub-acutely (less suddenly and of longer duration), or chronically (slowly and of prolonged duration).

 

Asthma Triggers

Asthma symptom flare-ups may occur in conjunction with exposure to environmental allergens, environmental irritants, viruses, cold air, exercise, gastroesophageal reflux disease (GERD), smoke, paint fumes, nitrous oxide, ozone, or emotional factors. Other triggering factors may be aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and sulfites.

 

Environmental allergens closely associated with asthma flare-ups include household dust mites, dog and cat allergens, fungi, and cockroach allergens.

 

Aspirin sensitivity accompanies asthma in 5-10% of patients in their 20s and 30s. Exposure to a single aspirin or NSAID tablet can provoke an asthma attack in these individuals.

 

Asthma patients are three times more likely than others to have GERD. Gastric acid in the distal esophagus provokes airway reactivity. One fourth of these patients do not realize that they have gastric reflux. Two thirds of these patients have a favorable response of their asthma when treated for GERD.

 

Asthma symptoms are somewhat more likely to occur between 4:00 and 6:00 AM due to the normal cyclical variations in body cortisol.

 

Exercise Induced Asthma

Exercise induced asthma is an asthmatic response to exercise, especially to that occurring in cold dry air. As many as half of those so affected, have asthmatic responses under no conditions other than exercise. This type response occurs more often in children and young adults than in older people.

 

Asthma and Wheezing

Wheezing does not always mean asthma. Other diseases causing wheezing are COPD, heart failure, cystic fibrosis, foreign bodies in the airway, sarcoid, upper respiratory tract infection, and vocal cord dysfunction.

 

Conversely, asthma does not always exhibit wheezing. Mildly afflicted asthmatics may not wheeze. On the other hand, since wheezing is caused by turbulence of air in the airway, severely afflicted asthmatics may not be able to move sufficient air to wheeze.

 

Avoid Environmental Exposures

  • The most effective way to deal with an asthma attack is not to have one. Helpful steps for asthmatics to follow are the following:           
  •           Avoid both first-hand and second-hand exposures to tobacco smoke.     
  •           Clean and dust regularly.

          Wear a facemask while vacuuming.

          Use impervious covers on mattresses and pillows.

          Limit upholstered furniture and window blinds.

          Put clothing away in closets and drawers.

          Wash soft toys often or periodically put them in the freezer.

          Do not allow animals in the bedroom

          Place filtering material over heating and cooling duct vents.

          Wash cats and dogs often.

          Never leave food uncovered.

          Store firewood outdoors.

          Stay inside midday when pollen counts are highest.

          Wear a facemask while gardening.

          Control GERD and sinusitis.

          If possible, exercise indoors in a warm, humid environment rather than outdoors in a cold, dry environment.

          When exercising outdoors, wear a facemask to warm and humidify the inhaled air.

          Avoid foods high in sulfites if sulfite sensitivity exists.

          Avoid aspirin or NSAIDs if sensitive to these.

          If obese, lose 5-10% of body weight to improve asthma control.

 

Medical Treatment

Numerous medical treatments for asthma are available. The medications include short-acting treatments to treat exacerbations and long-acting treatments to reduce the frequency of exacerbations. They include medications of various strengths commensurate with the degree of severity of the asthma. The medications also include drugs of several different families to act together in their primary effect to treat the asthma but with different secondary effects to reduce the side effect impact of the medications.

 

Your doctor has many choices to help you deal with asthma. Close coordination with your doctor will enable you to exercise the optimum control over your asthma.

 

References

Harding, S., Guzzo, M., & Richter, J. (2000). The Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms. American Journal of Respiratory and Critical Care Medicine,162(1), 34-39. doi:10.1164/ajrccm.162.1.9907072

 

Morris, M. J., MD. (2017, August 17). Asthma - Medscape. Retrieved September 08, 2017, from http://emedicine.medscape.com/article/296301-overview

 

 

Thomas Falasca, DO

 

 

 

Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils.So here are ...See More


Snow Shoveling Safety

The Erie County Medical Society wants you to enjoy winter without falling victim to snow shoveling perils.So here are some helpful tips.

 

First and foremost

  • Check with your doctor. Shoveling stresses the heart because of both exertion and cold. Consider hiring someone for the task.
    Do not shovel after eating or smoking as these activities reduce blood flow to the heart.
    Stop if you feel chest pain, or get excessively tired or have shortness of breath. You may need immediate professional care.
    Dress in layers with water-repellant clothing outermost. Remember hats, gloves, and warm socks because substantial body heat is lost from these areas.

 

Choose an appropriate snow shovel.

  • A curved-handled shovel helps keep your back straighter when shoveling.
    Choose a shovel with an appropriate length handle. The length is appropriate when, at the beginning of the shoveling stroke, it allows you to slightly bend your knees and bend your back less than 10 degrees while still holding the handle comfortably.
    A plastic shovel blade adds less weight to the lift than a metal blade.
    A smaller shovel blade may add to the time of the task; but, by picking up less snow, it reduces the risk of a heavy shovel load.

 

Be mindful of your shoveling actions.The American Academy of Orthopedic Surgeons recommends

  • If you must lift snow, squat with legs apart, knees bent, and back straight.
    Lift with the legs instead of bending at the waist; this reduces strain on the back.
    Scoop small amounts of snow with the shovel and walk to the dumping area.
    Outstretched arms exaggerate strain on the back.
    Remove deep snow in layers of an inch or two in thickness.
    Move feet instead of twisting.

 

In addition, remember that

  • Pushing the snow instead of lifting it reduces strain on the back.
    Gripping the snow shovel with your hands at least 12 inches apart increases leverage and decreases body strain.
    Throwing snow over your shoulder is dangerous. It twists the back and predisposes to injury.
    Warming up muscles before shoveling reduces the risk of strains and sprains.
    Frequent breaks to gently stretch back, arms, and legs reduce stress to these areas and distributes over time exertion on the heart.
    Wet snow is especially heavy and one shovelful can weigh 25 pounds.
    Clearing snow early and often to avoid dealing with a large amount of heavy, packed snow.

 

So follow these tips and avoid becoming a snow-shoveling casualty.

 

For more information, consult
· Colorado Spine Institute http://www.coloradospineinstitute.com
· AMERICAN ACADEMY OF ORTHOPEDIC SURGEONS http://orthoinfo.aaos.org/topic.cfm?topic=A00060
· National Safety Council www.nsc.org
· Toronto Emergency Medical Services
http://www.torontoems.ca/main-site/careers/safety-tips/show-shovelling.html

 

Thomas Falasca, DO



Enjoy this fun and informative video from the Boston Public Health Commission!

Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

...See More

Avoiding Frostbite

The cold weather is here and so is the danger of frostbite.

 

What Is It?

Frostbite is tissue injury resulting from the freezing and crystallization of the body fluids within and between the cells.  The ice crystals then damage the cell membranes.  Further damage results from obstruction within the smallest blood vessels and inflammation when blood flow is reestablished.

 

How Will I Know It?

Frostbite can develop insidiously.  It may begin with coldness that progresses to burning or throbbing.  This can eventuate in numbness and then loss of sensation.  The skin may subsequently become pale or bluish. Finally, frostbite causes finger clumsiness, difficulty walking, and severe joint pain.

 

The areas most often affected are fingers, toes, ears, and nose.

 

What Are the Consequences?

A case of frostbite can leave permanent reminders of the event.  Some consequences are minor, such as cold sensitivity.  Others are substantial, such as squamous cell carcinoma, arthritis, limb growth deformities in children, and gangrene.  Frostbite can result in limb amputations or require nose and ear reconstruction surgery. 

 

Who Is at Risk?

Both the very young and very old are at greater risk for frostbite.  They have greater difficulty producing and regulating heat as well as a proportionately greater body surface area from which to lose heat.

 

Groups especially at risk for frostbite are those of African, Middle Eastern, and Pacific Island descent. 

 

Women are usually more sensitive to frostbite than men.

 

People whose hands tend to become white in the cold are especially at risk for frostbite.

 

What to Avoid?

  • Avoid tight clothing.  It restricts circulation thus promoting cold injury.
  • Avoid smoking.  It also restricts circulation.
  • Avoid prolonged inactivity.
  • Avoid getting clothing wet.  The air trapped between the clothing fibers is an insulator that keeps heat from leaving the body.  Water is a conductor that facilitates passage of heat away from the body.

 

What To Do?

  • Seek shelter from wind as well as cold.  A small envelope of warm air surrounds the body and reduces the dissipation of heat.  Wind continuously blows away this envelope, thus accelerating dissipation of heat from the body.
  • Wear several layers of light, loose clothing.  The air trapped between the layers insulates against heat loss.  It is especially important to wear at least two pair of socks.
  • Wear mittens in place of gloves or on top of the gloves.  The reduced surface area of the mitten compared to the glove reduces the dissipation of heart. 
  • Cover the face and head and use a hat that covers the ears.  The face and head have a large blood supply that can rapidly dissipate heat.  Additionally, the ears and nose can easily have their blood flow compromised, predisposing them to frostbite.
  • Wear fabrics that are especially good insulators, such as fleece, polypropylene, and wool.

So be sure to protect yourself from frostbite and enjoy the many pleasant outdoor activities of winter.

 

Thomas Falasca, DO

See More

Asthma -- NHS Video

2017-09-08 20:32:13

Asthma -- NHS Video ...

Flu - US Centers for Disease Control

2017-11-01 15:11:26

How to Know if You Have Flu - US Centers for Disease Control ...

Food Safety from Finnish Food Safety Authority

2017-11-01 15:12:54

Food Poisoning Prevention from Finnish Food Safety Authority ...

Snow-Shoveling Safety - Boston Public Health Commission

2017-11-01 15:13:52

Snow-Shoveling Safety - Boston Public Health Commission ...