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17 years
I wake up every morning feeling like I want to vomit and I feel like there is hot water on the top of my intestine, and it stays this way for a couple of hours. What should I do?
Sep 17, 2014

Dr. Zakia Dimassi Pediatrics
These are symptoms of gastroesophageal reflux disease (GERD). GERD develops when stomach acid travels up into your throat, resulting in an injury to the lining of the esophagus (swallowing passage) or symptoms caused by too much stomach acid flowing back into the esophagus. In most cases, it occurs because the sphincter (the ring-like muscle that connects the esophagus to the stomach and that contracts to prevent the stomach content from flowing back up into the stomach, fails to contract when it should. Severe GERD occurs when that muscle is weak.

Symptoms of GERD include:
• Heartburn
• Regurgitation
• Belching up a sour substance
• Nausea, particularly in the morning
• Globus, the sensation of something in the throat, sometimes a tickling or burning sensation
• Sensation of drainage down the back of the throat or excessive mucus
• Throat clearing
• Chronic cough
• Post-nasal drip
• Sore throat
• Hoarseness
• Difficulty swallowing
To make the diagnosis of GERD, the doctor will examine your throat and vocal cords with a rigid or flexible telescope. Due to the damage imparted by acid reflux, the larynx (voice box) is typically inflamed: red, irritated, and swollen.

Another diagnostic technique is the pH metry, which measures the amount of acid that refluxes into your throat. This test relies on a probe, or a small tube (catheter), that is inserted through your nose and down into your esophagus. The catheter is kept for a 24-hour period. Although often not necessary, this test can help establish the diagnosis in certain cases.

Most of the time, GERD is well controlled with medications (Proton Pump Inhibitors, or PPI's). In severe and/or refractory (poor response to medical therapy) cases, surgery may be required. The recommended surgery is called a Laparoscopic Nissen Fundoplication, whereby a knot is created around the lower esophageal sphincter to narrow it down and thus prevent reflux from happening.

Lifestyle changes are, luckily, the initial steps to do to help alleviate the symptoms, and they are quite helpful. Many foods and drinks can make worsen your symptoms worse, so they should be eliminated. In addition, being overweight, smoking, and drinking alcohol are all factors that worsen reflux disease. It is important to work on the following areas as well:
1. Caffeine: avoid coffee (highest caffeine content), tea, and caffeinated beverages, including sodas (Pepsi, Coke) and energy drinks. Soft drinks such as Coke and Pepsi are particularly bad, because of their very acidic content (pH of 2.3), and the carbonation leads to belching and further reflux of acid into the throat. Other acidic juices (orange, grapefruit, cranberry) can worsen reflux.
2. Chocolate and mints are also to be avoided.
3. Alcohol, particularly in the late evening and before bedtime, should be stopped
4. Smoking: quitting smoking is essential; it also has many health benefits besides prevention of GERD
5. Food: drop deep fried and fatty, spicy foods. Onions and garlic are also notorious for causing reflux.
6. Weight control: if you’re overweight or obese, you need to shed off the extra kilograms. You also need to avoid tight-fitting clothing.
7. Have your last mean at least 3 hours before bedtime: heavy meals just before going to sleep exacerbates your reflux condition.
8. Sleep with your head elevated at about 45 degrees: placing several pillows under your head does not substitute for raising the head of the bed; in fact, this maneuver can make the problem worse.