GERD or Gastroesophageal reflux disease is a medical condition that occurs when the acid in the stomach flows back into the esophagus. The esophagus is the tube that connects the mouth to the stomach in the body. This frequent flow back of acid can irritate the lining of the esophagus.

However, this condition is considered normal and can occur in people of all ages, especially senior citizens. Averagely a person experiences mild acid reflux at least twice a week and severe acid reflux once a week. But in most cases, the condition is manageable with specific lifestyle changes and over-the-counter medications. But in some cases, GERD may require strong treatments, such as surgery to treat the symptoms.

Symptoms of GERD

The symptoms of GERD can range from mild to severe depending on the condition of the patient. Some of the common symptoms of the problem include:

  • Chest pain
  • Problem in swallowing
  • The feeling of a blockage or lump in the throat
  • Heartburn
  • Sour or bitter taste in the mouth
  • Churning of food or liquid from the stomach to the mouth
  • Breathing issues such as intense cough or asthma

Causes of GERD

 Typically, the human body has a lower esophageal sphincter (LES) which is the form of a round band of muscle. The LES is located at one end of the esophagus and normally relaxes and opens when the food is swallowed. After the process, the esophagus tightens and closes.

Acid reflux occurs when this normal functioning of the esophagus is disturbed and the LES does not close properly or tightens irregularly. This pushes the digestive juices from the stomach back to the esophagus.

Diagnosing GERD

To confirm the symptoms, the doctor will conduct a physical exam and also assess the symptoms experienced. Moreover, based on the analysis, the doctor will further use any of the below procedures to confirm the diagnosis or evaluate any complications:

  • Barium swallow: In this procedure, the patient is asked to drink a barium solution, which allows the healthcare provider to assess the upper digestive tract by using X-Ray imaging.
  • Upper endoscopy: In this method, the surgeon inserts a flexible, thin tube called an endoscope into the esophagus to examine the insides and also collect a tissue sample for biopsy.
  • Esophageal manometry: This procedure is used to check the length of the esophagus by inserting a flexible tube.
  • Esophageal pH monitoring: This involves inserting a small monitor into the esophagus to understand when and how the acid reflux happens.

Treatment for GERD

To treat GERD and related symptoms, the healthcare provider will ask the patient to make certain lifestyle modifications, especially in the diet, eating habits and other behaviours. Moreover, specific over-the-counter medications can be used to relieve discomfort.

The patient will be advised to refrain from the following food and beverages that can trigger GERD:

  • High-fat, trans-fat food
  • Citrus food
  • Tomato
  • Onions
  • Mint
  • Garlic
  • Alcohol
  • Coffee and tea
  • Soda
  • Pineapple
  • Spicy food

However, in cases, where GERD does not respond to the non-invasive treatments, the healthcare provider might recommend surgery. But in most of the cases, general lifestyle changes are enough to prevent the issue.

That said, in patients that experience complications of GERD, surgery may be the only option. There are multiple types of surgeries to treat GERD.

Risk factors for GERD

Some people are at a higher risk of having GERD than others. These including:

  • Obese people
  • People with hiatal hernia
  • Pregnant women
  • People with connective tissue disorders

Moreover, specific lifestyle habits also increase the risk of GERD in people:

  • Smoking
  • Eating heavy meals
  • Immediately lying down or sleeping after meals
  • Consuming fatty foods such as fried or spicy items
  • Specific beverages such as soda, deep-fried, or alcohol
  • Consuming nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Eating greasy foods
  • Consuming chocolate, coffee, peppermint, etc.

Potential complications of GERD

Generally, GERD is highly manageable and does not cause any significant complications. However, in some cases, the problem can cause life-threatening complications.

Some of the common issues related to GERD include:

  • Inflammation of the esophagus, also known as esophagitis
  • Narrowing or tightening of the esophagus, esophageal stricture
  • Permanent alternations to the lining of the esophagus called Barrett’s esophagus
  • Esophageal cancer
  • Asthma
  • Intense cough
  • Breathing issues
  • Erosion of the tooth enamel
  • Gum disease
  • Other dental problems

To minimise the complications from GERD, it is important to prevent the triggers and get appropriate treatment from a healthcare provider for GERD.

Home Remedies for GERD

Specific lifestyle changes and home remedies such as below can help relieve GERD symptoms. Some steps in this direction could include:

  • Quitting smoking
  • Avoiding high trans-fat food
  • Losing excessive weight
  • Consuming normal and light meals
  • Taking a slow walk after a meal
  • Applying relaxation techniques
  • Limiting wearing tight clothes
  • Chewing gum post food
  • Avoiding food and beverages that trigger GERD

Moreover, in addition to the prescribed medications for GERD, the patient can also take the following herbal remedies to treat GERD:

  • Chamomile tea
  • Liquorice root
  • Marshmallow root
  • Warm lemon water
  • Ginger tea

Overall, it is best to take preventive measures to treat GERD. Moreover, timely consultation with a healthcare provider can help minimise complications, get a long-term cure for GERD and improve the quality of life.

Is a flat belly impossible for a mother?

Is a flat belly impossible for a mother?

Yes, we all heard it several times. When you were in college, you were thin as a lamp post beside the Maa flyover, and everyone used to admire your figure and beauty. But age and motherhood put paid to that, right?

If you relate to this hypothesis, then this article is for you.

Somewhere between arrogant youth and humble old age, our Bharatiya nari undergoes a humbling physical change, which we have no other choice but to label a degeneration.

A slow and steady degradation of physical structure, energy levels, sex appeal and general photogenic-ness. We often call this ageing, but is it really that?

It is not a given that you become shapeless after giving birth to a baby. It is a consequence of a well to do, sedentary life that you have got addicted to. Yes, you may say that you fell ill, broke your leg, sprained your back, got a major abdominal surgery done, and that proved to be the nemesis of your physical and mental well being. Whatever. Bad things do happen in life, and tend to make it very hard to fight back. But it is a fact of nature and life, that if you don’t adapt, if you don’t change to the new reality, you will get crushed by life, and progressively get worse.

In the case of the shapeless belly of Your Majesty, the problem is in two levels:

  1. Your ab wall is weak
  2. You have belly fat

Prenatal exercises are not popular in India. In fact, exercise and physical activity themselves are not popular, with most educated urban women not having any inclination for cycling, running, dancing or swimming, leave alone lifting weights. This lack of exercise leads to weak abdominal muscles. Weak muscles are usually thin. When a baby grows inside the uterus of its mother, the belly wall stretches till it reaches its max at the time of delivery. If the mother is obese or diabetic, the baby may be bigger, leading to more belly size. Similarly, twin pregnancy causes bigger stretching of the belly muscles. The muscle tissues are also softer in pregnancy owing to the hormonal effects of this condition, leading to the vertically oriented six-pack muscles, the recti, get displaced from each other towards the size, leaving the front of the belly more soft and giving to the demands of the enlarging uterus. This condition is called diastasis recti. If the baby is delivered by C-section, then the ab wall is further traumatised by the operation, leading to more weakening of the muscles. This leads to a shapeless belly, protruding in front even from within the confines of a sari. In due course, a swelling may form in the belly button, something the doctor calls an umbilical hernia. Then the alarm bells ring, and frantic searches are made for a good surgeon to fix the problem.

Another reason for the surging middle order is fat accumulation, aka obesity. With motherhood, a few kilos are gained, and the post-delivery busy state taking care of the baby and the rest of the family leads to no time for oneself. What better and easer way of beating the post delivery blues to than by eating? Food intake is higher, whether you agree or not, when we talk of your weight problem. Weight loss in the middle aged woman is very hard. The body naturally needs very few calories to survive, and its hormonal status does not favour fat burning. With a social network come birthdays, anniversaries, more weddings and endless celebrations. Each such occasion is accompanied by epic calorie consumption and weight gain. Oh, and I should not forget vacations. Who wants to eat salads in Bangkok, Benaras or Budapest?

I don’t have easy solutions for either cause of a big belly.

But I do have good solutions, even great ones.

Diastasis recti and small umbilical hernias are nowadays repaired by a keyhole operation called SCOLA. It is a very safe laparoscopic operation which is almost scarless, with the operative scars hidden in the bikini line. It is a daycare operation for practical purposes, and the entire ab wall is reconstructed with stitches and strengthened by a mesh. There is very little pain involved, and no stitches, either.

For weight loss, various options exist. For mildly obese women, a gastric balloon might be a good option. While the procedure (done with an endoscope inserted through the mouth while the patient is under anesthesia) is non-surgical, the patient may have some unpleasant nausea and vomiting for a few days. Weight loss of around 15 kg is usual, and the balloon is removed after 6 to 12 months. One downside of the balloon is its cost (almost comparable to surgery) and another is that the patient may regain all the weight if she does not dial her diet down strongly.

For stronger weight loss, bariatric surgery is the best option.

If you weigh 100 kg, you may reach 60-65 kg easily in a year!

What more, you can keep this going, with some considered lifestyle changes.

Things you need to remember about bariatric surgery are:

  1. It is the strongest weight loss intervention in the world. Nothing else comes close.
  2. It is very safe.
  3. The procedure involves very little pain or discomfort, and you can expect discharge next morning of surgery.
  4. Young women can have scarless options.
  5. Associated diabetes and hypertension are often resolved completely.
  6. It is an investment in your future health and life, so be prepared not to be cheap about it. Cutting corners in surgery is not a great idea, generally.

If you think any of this is relevant to your life, maybe you should contact your doctor.

Pick up that phone then!

Intestinal Obstruction – A cause for immediate attention

Intestinal Obstruction – A cause for immediate attention

Intestinal obstruction is a blockage that keeps food or liquid from passing through your small intestine or large intestine (colon). Intestinal obstruction may be caused by fibrous bands of tissue in the abdomen (adhesions) which form after surgery, inflamed or infected pouches in your intestine (diverticulitis), hernias and tumors.

Without treatment, the blocked parts of the intestine can die, leading to serious problems. However, with prompt medical care, intestinal obstruction often can be successfully treated.


Signs and symptoms of intestinal obstruction include:

  • Crampy abdominal pain that comes and goes Crampy abdominal pain that comes and goesCrampy abdominal pain that comes and goes
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Inability to have a bowel movement or pass gas
  • Swelling of the abdomen (distention)


Common causes of mechanical obstruction, in which something physically blocks the small intestine, include:

  • Intestinal adhesions — bands of fibrous tissue in the abdominal cavity that can form after abdominal or pelvic surgery
  • Hernias — portions of intestine that protrude into another part of your body
  • Tumors in the small intestine
  • Inflammatory bowel diseases, such as Crohn’s disease
  • Twisting of the intestine (volvulus)
  • Telescoping of the intestine (intussusception)


Mechanical obstruction is much less common in the colon. Potential causes include:

  • Colon cancer
  • Diverticulitis — a condition in which small, bulging pouches (diverticula) in the digestive tract become inflamed or infected
  • Twisting of the colon (volvulus)
  • Impacted feces
  • Narrowing of the colon caused by inflammation and scarring (stricture)


Paralytic ileus can cause signs and symptoms of intestinal obstruction, but doesn’t involve a physical blockage. In paralytic ileus, muscle or nerve problems disrupt the normal coordinated muscle contractions of the intestines, slowing or stopping the movement of food and fluid through the digestive system.

Paralytic ileus can affect any part of the intestine. Causes can include:

  • Abdominal surgery
  • Pelvic surgery
  • Infection
  • Certain medications, including antidepressants and pain medications that affect muscles and nerves
  • Muscle and nerve disorders, such as Parkinson’s disease


Diseases and conditions that can increase your risk of intestinal obstruction include:

  • Abdominal or pelvic surgery often causes adhesions — a common intestinal obstruction
  • Crohn’s disease can cause the intestine’s walls to thicken, narrowing the passageway
  • Cancer in your abdomen, especially if you’ve had surgery to remove an abdominal tumor or radiation therapy


Untreated, intestinal obstruction can cause serious, life-threatening complications, including:

  • Tissue death. Intestinal obstruction can cut off the blood supply to part of your intestine. Lack of blood causes the intestinal wall to die. Tissue death can result in a tear (perforation) in the intestinal wall, which can lead to infection.
  • Peritonitis is the medical term for infection in the abdominal cavity. It’s a life-threatening condition that requires immediate medical and often surgical attention.


Tests and procedures used to diagnose intestinal obstruction include:

  • Physical exam. Your doctor will ask about your medical history and your symptoms. He or she will also do a physical exam to assess your situation. The doctor may suspect intestinal obstruction if your abdomen is swollen or tender or if there’s a lump in your abdomen. He or she may listen for bowel sounds with a stethoscope.
  • Imaging tests. To confirm a diagnosis of intestinal obstruction, your doctor may recommend an abdominal X-ray or CT scan. These tests also help your doctor determine if the obstruction is paralytic ileus or a mechanical obstruction, and if the obstruction is partial or complete.


Treatment for intestinal obstruction depends on the cause of your condition, but generally requires hospitalization.


When you arrive at the hospital, the doctors will first work to stabilize you so that you can undergo treatment. This process may include:

  • Placing an intravenous (IV) line into a vein in your arm so that fluids can be given
  • Putting a nasogastric (NG) tube through your nose and into your stomach to suck out air and fluid and relieve abdominal swelling
  • Placing a thin, flexible tube (catheter) into your bladder to drain urine and collect it for testing


If you have mechanical obstruction in which some food and fluid can still get through (partial obstruction), you may not need further treatment after you’ve been stabilized. Your doctor may recommend a special low-fiber diet that is easier for your partially blocked intestine to process. If the obstruction does not clear on its own, you may need surgery to relieve the obstruction.


If nothing is able to pass through your intestine, you’ll usually need surgery to relieve the blockage. The procedure you have will depend on what’s causing the obstruction and which part of your intestine is affected. Surgery typically involves removing the obstruction, as well as any section of your intestine that has died or is damaged.

Alternatively, your doctor may recommend treating the obstruction with a self-expanding metal stent. The wire mesh tube is inserted into your colon via an endoscope passed through your mouth or colon. It forces open the colon so the obstruction can clear. Stents are generally used to treat people with colon cancer or to provide temporary relief for people who are at high risk of emergency surgery. You may still need surgery, once your condition is stable.

Understanding and Treating – GERD – or Gastroesophageal Reflux Disease

Understanding and Treating – GERD – or Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a condition due to back flow of stomach juice or sometime bile  into your esophagus (Food Pipe). This back flow irritate the lining of the esophagus and causes symptoms of GERD. Common sign and symptom of GERD are acid reflux and heartburn.

Though these symptom are quiet common but when these symptoms occur at least twice a week and interfere with your daily activities then it is termed as GERD.


  • A burning sensation in your chest (heartburn), sometimes spreading to the throat, along with a sour taste in your mouth
  • Chest pain
  • Difficulty swallowing (dysphagia)
  • Dry cough
  • Hoarseness or sore throat
  • Regurgitation of food or sour liquid (acid reflux)
  • Sensation of a lump in the throat

GERD is caused by frequent acid reflux — the backup of stomach acid or bile into the esophagus. When you swallow, the lower esophageal sphincter — a circular band of muscle around the bottom part of your esophagus — relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if this valve relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing frequent heartburn and disrupting your daily life. This constant backwash of acid can irritate the lining of your esophagus, causing it to become inflamed (esophagitis). Over time, the inflammation can erode the esophagus, causing complications such as bleeding or breathing problems.





  • Obesity
  • Hiatal hernia
  • Pregnancy
  • Smoking
  • Dry mouth
  • Asthma
  • Diabetes
  • Delayed stomach emptying
  • Connective tissue disorders, such as scleroderma
  • Zollinger-Ellison syndrome.


  • Narrowing of the esophagus (esophageal stricture). Damage to cells in the lower esophagus from acid exposure leads to formation of scar tissue. The scar tissue narrows the food pathway, causing difficulty swallowing.
  • Esophageal ulcer. Stomach acid can severely erode tissues in the esophagus, causing an ulcer to form. The esophageal ulcer may bleed, cause pain and make swallowing difficult.
  • Precancerous changes to the esophagus (Barrett’s esophagus). In Barrett’s esophagus, the color and composition of the tissue lining the lower esophagus change. These changes are associated with an increased risk of esophageal cancer. The risk of cancer is low, but your doctor will likely recommend regular endoscopy exams to look for early warning signs of esophageal cancer.

If you’re bothered by frequent heartburn or other signs and symptoms, your doctor may be able to diagnose GERD with that information alone. Your doctor may also suggest tests and procedures used to diagnose GERD, including:

  • Passing a flexible tube down your throat. Endoscopy is a way to visually examine the inside of your esophagus. During endoscopy, your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat. The endoscope allows your doctor to examine your esophagus and stomach. Your doctor may also use endoscopy to collect a sample of tissue (biopsy) for further testing. Endoscopy is useful in looking for complications of reflux, such as Barrett’s esophagus.
  • A test to monitor the amount of acid in your esophagus. Ambulatory acid (pH) probe tests use an acid-measuring device to identify when, and for how long, stomach acid regurgitates into your esophagus. The acid monitor can be a thin, flexible tube (catheter) that’s threaded through your nose into your esophagus. During the test, the tube stays in place and connects to a small computer that you wear around your waist or with a strap over your shoulder. Or the acid monitor can be a clip that’s placed in your esophagus during endosc The probe transmits a signal to a small computer that you wear around your waist for about two days, and then the probe falls off to be passed in your stool. Your doctor may ask that you stop taking GERD medications to prepare for this test.
  • A test to measure the movement of the esophagus. Esophageal motility testing measures movement and pressure in the esophagus. The test involves placing a catheter through your nose and into your esophagus.
  • An X-ray of your upper digestive system. Sometimes called a barium swallow or upper GI series, this procedure involves drinking a chalky liquid that coats and fills the inside lining of your digestive tract. Then X-rays are taken of your upper digestive tract. The coating allows your doctor to see a silhouette of the shape and condition of your esophagus, stomach and upper intestine (duodenum).


Lifestyle changes may help reduce the frequency of heartburn. Consider trying to:

  • Maintain a healthy weight. Excess weight put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. If your weight is healthy, work to maintain it. If you are overweight or obese, work to slowly lose weight — no more than 0.5 to 1 kilogram a week.
  • Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
  • Avoid foods and drinks that trigger heartburn. Everyone has specific triggers. Common triggers such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine may make heartburn worse. Avoid foods you know will trigger your heartburn.
  • Eat smaller meals. Avoid overeating by eating smaller meals.
  • Don’t lie down after a meal. Wait at least three hours after eating before lying down or going to bed.
  • Elevate the head of your bed. If you regularly experience heartburn at night or while trying to sleep, put gravity to work for you. Place wood or cement blocks under the feet of your bed so that the head end is raised by six to nine inches. If it’s not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up.


Over-the-counter treatments that may help control heartburn include:

  • Antacids that neutralize stomach acid.Antacids, Gelusil, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or constipation.
  • Medications to reduce acid production.Called H-2-receptor blockers, these medications include cimetidine, famotidine), nizatidine or ranitidine. H-2-receptor blockers don’t act as quickly as antacids, but they provide longer relief. Stronger versions of these medications are available in prescription form.
  • Medications that block acid production and heal the esophagus.Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include  omeprazole and pantoprazole etc.
  • Medications to strengthen the lower esophageal sphincter.Called prokinetic agents, these medications help your stomach empty more rapidly and help tighten the valve between the stomach and the esophagus. Side effects, such as fatigue, depression, anxiety and other neurological problems, limit the usefulness of these medications.
  • GERD medications are sometimes combined to increase effectiveness.


If you require long term medicines to control your symptoms it is advised to undergo surgery. Surgery is preferred as long term medicine use has been linked to various complications. Surgery is laparoscopic fundoplication. The surgeon makes three or four small incisions in the abdomen and inserts instruments, including a flexible tube with a tiny camera, through the incisions. This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus.

Understanding the Gallstones and how to deal with Gallstones

Understanding the Gallstones and how to deal with Gallstones

The Gall bladder is an organ which lies just below the liver. It is a side pouch lying to the right of the main channel which carries bile from the liver to the intestine. This channel is called the Common Bile Duct (CBD). The Gall Bladder stores bile that is secreted by the liver. In the gall bladder bile is concentrated. When food is taken and reaches the duodenum, (the first part of the small intestine), the Gall Bladder contracts and the bile reaches the duodenum to mix with food and enhance digestion.

Several patients develop stones in the gall bladder. Why do gall stones develop?

  • Gender: Females are twice as likely as males to develop gallstones. Hormonal variations either natural or ingested appears to increase the level of cholesterol. Gallbladder movement is also decreased in pregnancy, which is a common cause of gallstones.
  • Genetics: Gallstones often run in families, pointing to a possible genetic link.
  • Weight: Overweight people have an increased risk for developing gallstones. The most likely reason is that the amount of bile salts in bile is reduced. Bile salts act almost like soap and dissolves cholesterol. The result of this is that cholesterol starts to drop out of solution. Obesity is a major risk factor for gallstones, especially in women.
  • Diet: Diets rich in fat and cholesterol and poor in fibre increase the risk of gallstones due to a relative increase in cholesterol compared to bile salts and reduced gallbladder emptying.
  • Rapid weight loss: “Crash diets and crash weight losing courses”— causes gall stones as the body metabolizes fat during this period—the liver excretes extra cholesterol into bile, which can cause gallstones. In addition, the gallbladder does not empty properly.
  • Age: People older than age 60 are more likely to develop gallstones than younger people. As people age, the body tends to secrete more cholesterol into bile.
  • Geography: People from Northern and Eastern Indian States are more prone to Gall stone formation. This is probably due to differences in diet.
  • Cholesterol-lowering drugs: Some medicines that lower cholesterol levels in the blood actually do so by increasing the amount of cholesterol excreted into bile. In turn, the risk of gallstones increases.
  • Rapid Red Cell Turnover: Conditions in which Red Blood Cells break down rapidly. The increasing load of pigment is excreted in bile and causes stones to fall from solution in the Gall Bladder. These stones are pigment stones.
  • Diabetes: Diabetics generally have high levels of triglycerides. These types of fatty acids may increase the risk of gallstones.

Pseudolithiasis: – In some patients who have been treated for Typhoid and Paratyphoid fever with the antibiotic called Ceftriaxone, sometimes develop small sludge-like particles in the Gall Bladder. These do NOT require surgery and clear up by themselves once the patient starts to recover. Therefore, the name Pseudo (False) -Lithiasis (Stones).

Of these, cholesterol stones are the vast majority.

Stones can stay asymptomatic but can cause a number of diseases.  The annual incidence of persons with asymptomatic gall stones developing symptoms is 2%.

These can be: –

  • Gall stone colic – pain as a result of stones blocking the neck of the gall bladder
  • Acute Cholecystitis and Empyema – as a result of infection in a blocked gall bladder. Chronic Cholecystitis – chronic infection as a result of stones causing inflammation or infection in the gall bladder
  • Obstructive Jaundice – as a result of the stone travelling down the bile duct.
  • Acute pancreatitis – a deadly disease. The stone may block the mouth of the pancreatic duct. The is sometimes a common channel between the pancreatic and the common bile duct.
  • Gall bladder Cancer – there is an increased incidence in the North Indian states of Gall Bladder cancer a deadly disease. While the relationship with gallstones is not established most studies say that the highest incidence is in women with a single large stone from the Gangetic plain.


The gold-standard of Gall Bladder surgery, where the Gall Bladder has to be removed, is by the Laparoscopic procedure. However, some local conditions prevent this and a small percentage will still need Open Surgery. The decision to convert to open surgery is most often an indication of maturity on the part of the Surgeon.

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