WebPAGE : CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION! WE ARE NOT ALONE: A new (informal) Vocal Cord Dysfunction Support Group has formed, for VCD patients, and. Jamie Koufman, MD, F.A.C.S.Founder & Director, Koufman RefluxDirector, Voice Institute of New York. Alkaline water — Health claims about alkaline water abound, but plain water is usually best. I am a patient of Dr. Koufman and would like info. I have reached a. Today I would like to talk about what has become the bane of existence for gastroenterologists: the dreaded diagnosis of laryngopharyngeal reflux. Health Dangers of Eating Late at Night. By Dr. Mercola. Do you eat dinner late at night and go to bed less than three hours later? Do you also suffer from unexplained post- nasal drip, cough, and difficulty swallowing? These could be signs of acid reflux, which, unbeknownst to many, can occur without the telltale signs of heartburn and indigestion. Further, if you want to nip it in the bud, all you may have to do is change your lifestyle to eat dinner earlier. ![]() ![]() Eating late at night, especially if you overeat and/or eat heavy foods, and then lying down shortly after, is a recipe for acid reflux. Adding to the problem, dinner tends to be the largest meal of the day for most Americans, and it's often made up of heavy processed foods in overly large portions. Under the best circumstances (in a young, healthy person), your stomach takes a few hours to empty after you eat a meal. As you get older or if you have acid reflux, the process takes longer. Then, when you lay down to go to sleep, it's much easier for acid to spill out of your full stomach, which is what leads to acid reflux. Even if you don't have heartburn, you could still have acid reflux if you have symptoms like hoarseness, chronic throat clearing, and even asthma. Plus, acid reflux can lead to esophageal cancer, which has risen five- fold since the 1. According to Dr. He reported that he always left his restaurant at 1. There was no medical treatment for this patient, no pills or even surgery to fix his condition. The drugs we are using to treat reflux don't always work, and even when they do, they can have dangerous side effects. My patient's reflux was a lifestyle problem. I told him he had to eat dinner before 7 p. Within six weeks, his reflux was gone. While that may sound like an appropriate remedy, considering the fact that stomach acid is creeping up your esophagus, in most cases, it's actually the worst approach possible. It only temporarily treats the symptoms. PPIs like Nexium, Prilosec, and Prevacid were originally designed to treat a very limited range of severe problems. So if your heartburn is caused by an H. PPI drugs can also cause potentially serious side effects, including pneumonia, bone loss, hip fractures, and infection with Clostridium difficile (a harmful intestinal bacteria). You need to wean yourself off them gradually or else you might experience a severe rebound of your symptoms. In some cases, the problem may end up being worse than before you started taking the medication. They would cycle through periods of feast and famine, and modern research shows this cycling produces a number of biochemical benefits. Today, simply by altering what and when you eat, you can rather dramatically alter how your body operates for the better. One of the simplest ways to do this is via intermittent fasting. There are many methods for doing this, but the one I recommend and personally use is to simply restrict your daily eating to a specific window of time, such as an eight- hour window from 1. This gives you a 1. It also ties in nicely with eating dinner at a reasonable hour (any time prior to 7 p. While sugar is a source of energy for your body, it also promotes insulin resistance when consumed in the amounts found in our modern processed junk food diets. Insulin resistance, in turn, is a primary driver of chronic disease—from heart disease to cancer. Intermittent fasting helps reset your body to use fat as its primary fuel, and mounting evidence confirms that when your body becomes adapted to burning FAT instead of sugar as its primary fuel, you dramatically reduce your risk of chronic disease. Normalizing ghrelin levels, also known as . HGH is also a fat- burning hormone, which helps explain why fasting is so effective for weight loss. Lowering triglyceride levels and improving other biomarkers of disease. Reducing oxidative stress: Fasting decreases the accumulation of oxidative radicals in the cell, and thereby prevents oxidative damage to cellular proteins, lipids, and nucleic acids associated with aging and disease. Intermittent fasting is the most powerful tool I know to address insulin resistance. However, once the resistance is resolved and you are no longer overweight, have high blood pressure, diabetes, or are taking a statin drug you don't need to do it and would only benefit from doing it occasionally. For instance, artificial light, such as a glow from your TV or computer, can serve as a stimulus for keeping you awake and, possibly, eating, when you should really be asleep. The weight gain occurred even though the mice were fed the same amount of food and had similar activity levels, and the researchers believe the findings may hold true for humans as well. However, in a second experiment when researchers restricted meals to times of day when the mice would normally eat, they did not gain weight, even when exposed to light at night. So when your light and dark signals become disrupted it not only changes the times you may normally eat, it also throws your metabolism off kilter, likely leading to weight gain. But this is debatable. Some experts believe that eating your main meal at night may actually be more in- tune with your innate biological clock. Routinely eating at the wrong time may not only disrupt your biological clock and interfere with your sleep, but it may also devastate vital body functions and contribute to disease. According to Ori Hofmekler, author of The Warrior Diet. All your activities, including your feeding, are controlled by your autonomic nervous system, which operates around the circadian clock. During the day, your sympathetic nervous system (SNS) puts your body in an energy spending active mode, whereas during the night your parasympathetic nervous system (PSNS) puts your body in an energy replenishing relaxed and sleepy mode. These two parts of your autonomic nervous system complement each other like yin and yang. Your SNS, which is stimulated by fasting and exercise, keeps you alert and active with an increased capacity to resist stress and hunger throughout the day. And your PSNS, which is stimulated by your nightly feeding, makes you relaxed and sleepy, with a better capacity to digest and replenish nutrients throughout the night. This is how your autonomic nervous system operates under normal conditions. But that system is highly vulnerable to disruption. If you eat at the wrong time such as when having a large meal during the day, you will mess with your autonomic nervous system; you'll inhibit your SNS and instead turn on the PSNS, which will make you sleepy and fatigued rather than alert and active during the working hours of the day. And instead of spending energy and burning fat, you'll store energy and gain fat. This is indeed a lose- lose situation. Ideally, try to give yourself a three- to four- hour window between your last meal of the day and bedtime. Personally, I eat my primary and really only major meal in the mid- afternoon. I snack a bit before and after but this seems to work for me as long as I get enough calories and protein. Eating large amounts of processed foods and sugars is a surefire way to exacerbate acid reflux, as it will upset the bacterial balance in your stomach and intestine. Instead, you'll want to eat a lot of vegetables and other high- quality, ideally organic, unprocessed foods. Also, eliminate food triggers from your diet. Common culprits here include caffeine, alcohol, and nicotine products. This will help balance your bowel flora, which can help eliminate H. It will also aid in proper digestion and assimilation of your food. If you aren't eating fermented foods, you most likely need to supplement with a probiotic on a regular basis. Try to include a variety of cultured foods and beverages in your diet, as each food will inoculate your gut with a variety of different microorganisms. Fermented foods you can easily make at home include: In addition, acid reflux is typically a sign of having too little stomach acid. To encourage your body to make sufficient amounts of hydrochloric acid (stomach acid), you'll also want to make sure you're consuming enough of the raw material on a regular basis. High- quality sea salt (unprocessed salt), such as Himalayan salt, will not only provide you with the chloride your body needs to make hydrochloric acid, it also contains over 8. Having a few teaspoons of cabbage juice before eating, or better yet, fermented cabbage juice from sauerkraut, will do wonders to improve your digestion. Raw, unfiltered apple cider vinegar As mentioned earlier, acid reflux typically results from having too little acid in your stomach. You can easily improve the acid content of your stomach by taking one tablespoon of raw unfiltered apple cider vinegar in a large glass of water. Betaine. Another option is to take a betaine hydrochloric supplement, which is available in health food stores without prescription. You'll want to take as many as you need to get the slightest burning sensation and then decrease by one capsule. This will help your body to better digest your food, and will also help kill the H. Baking soda. One- half to one full teaspoon of baking soda (sodium bicarbonate) in an eight- ounce glass of water may ease the burn of acid reflux as it helps neutralize stomach acid. I would not recommend this is a regular solution but it can sure help in an emergency when you are in excruciating pain. Aloe juice. The juice of the aloe plant naturally helps reduce inflammation, which may ease symptoms of acid reflux. Drink about 1/2 cup of aloe vera juice before meals. If you want to avoid its laxative effect, look for a brand that has removed the laxative component. Ginger root or chamomile tea. Ginger has been found to have a gastroprotective effect by blocking acid and suppressing Helicobacter pylori. According to a 2. This is perhaps not all that surprising, considering the fact that ginger root has been traditionally used against gastric disturbances since ancient times. Gastroesophageal Reflux: Management Guidance for the Pediatrician . The ability to distinguish between GER and GERD is increasingly important to implement best practices in the management of acid reflux in patients across all pediatric age groups, as children with GERD may benefit from further evaluation and treatment, whereas conservative recommendations are the only indicated therapy in those with uncomplicated physiologic reflux. This clinical report endorses the rigorously developed, well- referenced North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and likewise emphasizes important concepts for the general pediatrician. A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist. Accordingly, the evidence basis presented by the guidelines for diagnostic approaches as well as treatments is discussed. Lifestyle changes are emphasized as first- line therapy in both GER and GERD, whereas medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life- threatening complications of GERD. Recent black box warnings from the US Food and Drug Administration are discussed, and caution is underlined when using promoters of gastric emptying and motility. Finally, attention is paid to increasing evidence of inappropriate prescriptions for proton pump inhibitors in the pediatric population. Abbreviations: GER — gastroesophageal reflux. GERD — gastroesophageal reflux disease. GI — gastrointestinal. H2. RA — histamine- 2 receptor antagonist. MII — multiple intraluminal impedance. PPI — proton pump inhibitor. Introduction. Gastroesophageal reflux (GER) occurs in more than two- thirds of otherwise healthy infants and is the topic of discussion with pediatricians at one- quarter of all routine 6- month infant visits. In addition to seeking guidance from their pediatricians, parents often request evaluation by pediatric medical subspecialists. It is, therefore, not surprising that strongly evidence- based guidelines incorporating state- of- the- art approaches to the evaluation and management of pediatric GER have been welcomed by both general pediatricians and pediatric medical subspecialists and surgical specialists. GER, defined as the passage of gastric contents into the esophagus, is distinguished from gastroesophageal reflux disease (GERD), which includes troublesome symptoms or complications associated with GER. Differentiating between GER and GERD lies at the crux of the guidelines jointly developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. These definitions have further been recognized as representing a global consensus. Therefore, it is important that all practitioners who treat children with reflux- related disorders are able to identify and distinguish those children with GERD, who may benefit from further evaluation and treatment, from those with simple GER, in whom conservative recommendations are more appropriate. GER is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults. GER is generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus. Episodes of GER in healthy adults tend to occur after meals, last less than 3 minutes, and cause few or no symptoms. Less is known about the normal physiology of GER in infants and children, but regurgitation or spitting up, as the most visible symptom, is reported to occur daily in 5. In both infants and children, reflux can also be associated with vomiting, defined as a forceful expulsion of gastric contents via a coordinated autonomic and voluntary motor response. Regurgitation and vomiting can be further differentiated from rumination, in which recently ingested food is effortlessly regurgitated into the mouth, masticated, and reswallowed. Rumination syndrome has been identified as a relatively rare clinical entity that involves the voluntary contraction of abdominal muscles. In contrast, both regurgitation and vomiting can be considered common and often nonpathologic manifestations of GER. Symptoms or conditions associated with GERD are classified by the practice guidelines as being either esophageal or extraesophageal. Both classifications can be used to define the disease, which can be further characterized by findings of mucosal injury on upper endoscopy. Esophageal conditions include vomiting, poor weight gain, dysphagia, abdominal or substernal/retrosternal pain, and esophagitis. Extraesophageal conditions have been subclassified according to both established and proposed associations; established extraesophageal manifestations of GERD can include respiratory symptoms, including cough and laryngitis, as well as wheezing in infancy. Although older studies from the 1. GERD may aggravate asthma, recent publications have suggested that the impact of GERD on asthma control is considerably less than previously thought. Other extraesophageal manifestations include dental erosions, and proposed associations include pharyngitis, sinusitis, and recurrent otitis media. Patients can be described clinically by their symptoms or by the endoscopic description of their esophageal mucosa. GERD- associated esophageal injuries and complications found on endoscopy include reflux esophagitis, less commonly peptic stricture, and rarely Barrett esophagus and adenocarcinoma. Although the reported prevalence of GERD in patients of all ages worldwide is increasing,5 GERD is nevertheless far less common than GER. Population- based studies suggest reflux disorders are not as common in Eastern Asia, where the prevalence is 8. Western Europe and North America, where the current prevalence of GERD is estimated to be 1. New epidemiologic and genetic evidence suggests some heritability of GERD and its complications, including erosive esophagitis, Barrett esophagus, and esophageal adenocarcinoma. A few pediatric populations at high risk of GERD have also been identified, including children with neurologic impairment, certain genetic disorders, and esophageal atresia. Table 1). The prevalence of severe, chronic GERD is much higher in pediatric patients with these “GERD- promoting” conditions. These patients may be more prone to experiencing complications of severe GERD than patients who are otherwise healthy. TABLE 1. Pediatric Populations at High Risk for GERD and Its Complications. Population trends hypothesized to contribute to a general increase in the prevalence of GERD include global epidemics of both obesity and asthma. In some instances, GERD can be implicated as either the underlying etiology (ie, recurrent pneumonia in the premature infant exacerbated by GERD) or a direct repercussion (ie, obesity leading to GERD) of such conditions. In the great majority of cases, however, GERD and comorbidities are known to occur simultaneously in patients without a clear causal relationship. Clinical Features of GERDTroublesome symptoms or complications of pediatric GERD are associated with a number of typical clinical presentations in infants and children, depending on patient age. Table 2). Reflux may occur commonly in preterm newborn infants but is generally nonacidic and improves with maturation. A full discussion of reflux in neonates and preterm infants is beyond the scope of this report. TABLE 2. Common Presenting Symptoms of GERD in Pediatric Patients. Guidelines have distinguished between manifestations of GERD in full- term infants (younger than 1 year) from those in children older than 1 year and adolescents. Common symptoms of GERD in infants include regurgitation or vomiting associated with irritability, anorexia or feeding refusal, poor weight gain, dysphagia, presumably painful swallowing, and arching of the back during feedings. Relying on a symptom- based diagnosis of GERD can be difficult in the first year of life, especially because symptoms of GERD in infants do not always resolve with acid- suppression therapy. GERD in infants can also be associated with extraesophageal symptoms of coughing, choking, wheezing, or upper respiratory symptoms. The incidence of GERD is reportedly lower in breastfed infants than in formula- fed infants. In line with the natural history of regurgitation, GERD in infants is considered to have a peak incidence of approximately 5. Common symptoms of GERD in children 1 to 5 years of age include regurgitation, vomiting, abdominal pain, anorexia, and feeding refusal. Generally, GERD causes troublesome symptoms without necessarily interfering with growth; however, children with clinically significant GERD or endoscopically diagnosed esophagitis may also develop an aversion to food, presumably because of a stimulus- response association of eating with pain. This aversion, combined with feeding difficulties associated with repeated episodes of regurgitation, as well as potential and substantial nutrient losses resulting from emesis, may lead to poor weight gain or even malnutrition. Older children and adolescents are most likely to resemble adults in their clinical presentation with GERD and to complain of heartburn, epigastric pain, chest pain, nocturnal pain, dysphagia, and sour burps. When eliciting a history in school- aged children with suspected GERD, it may be important to directly ask patients themselves about their symptoms rather than relying strongly on parent report. In 1 study, adolescents were significantly more likely than their parents to report themselves to be experiencing symptoms of sour burps or nausea.
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