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    Any pain due to acid inflammation is hard to ignore and will decrease work efficiency. Therefore, an accurate diagnosis and treatment are important to get your group member back to normal.

    Pain originating from stomach acid can travel up the esophagus (the tube from the stomach to the mouth). Often described as “heartburn”. The medical term is “gastroesophageal reflux disease” or G.E.R.D.

    G.E.R.D. often occurs as a result of weakness in a valve formed by a ring of muscle called the lower esophageal sphincter (LES). The LES is located at the entrance to the stomach and closes as soon as food passes through it. A defect in it allows acid to travel up the esophagus and cause a burning sensation. This relaxation at the stomach-esophagus border is known as a “hiatal hernia,” which occurs when the upper part of the stomach bulges through the large muscle that separates the abdomen from the chest (the “diaphragm”). Discomfort usually starts in the left or mid-upper abdomen and travels up to the breastbone.

    Some patients can even taste the acid in their mouths. A related acid reflux condition is called laryngopharengeal reflux (LPR). In LPR, acid goes all the way up to the throat, causing injury to the vocal cord and throat. Hoarseness, chronic cough, clear-white phlegm, sore throat, and frequent throat clearing are among the symptoms. In severe cases, stomach acid may go down the windpipe, causing a serious lung inflammation known as “aspiration pneumonia.”

    To make the diagnosis of acid reflux disease, the timing of the discomfort is important. Acid reflux discomfort occurs soon after eating but is sometimes seen several hours after a meal. It can be differentiated from other causes of chest pain in that it gets better by drinking milk or taking antacids. Many patients note improvement simply by sitting up straight. As you can imagine, these strategies wouldn’t be effective treatments for chest pain caused by a heart attack.

    GASTRITIS

    Gastritis simply means “inflammation of the stomach”. It relates to damage of the stomach lining caused by infection, irritation, or acid. Gastritis is most commonly caused by infection with the bacteria, Helicobacter pylori. This is the same bacterium responsible for most stomach ulcers. A commercially-available test exists to diagnose it.

    The signs and symptoms of gastritis include:

    • Gnawing or burning in the left-mid upper abdomen that may worsen or improve with food.
    • Nausea and vomiting.
    • Fullness in the upper abdomen after eating.

    Besides an H. pylori infection, risk factors for gastritis include:

    –Regular use of certain pain relievers, especially NSAIDS (ibuprofen, naproxen, and aspirin). These erode the stomach lining over time.

    –Older age. Older adults have an increased risk of gastritis because the stomach lining tends to thin with age.

    –Excessive alcohol use and smoking. Both tobacco and alcohol can make your stomach more vulnerable to digestive juices and cause gastritis.

    –Stress. Chronic stress in survival settings can manifest itself in ways that are both emotional and physical, leading to gastritis.

    –Other diseases and conditions. Gastritis may be associated with other medical conditions, including HIV/AIDS, Crohn’s disease, and parasitic infections.

    –Injury, burns, extreme anxiety, or severe infections.

    PEPTIC ULCERS

    Another cause of pain possibly due to stomach acid is a peptic ulcer. These are open sores that form on the inside of the stomach and, possibly, the upper part of the small intestine (the “duodenum”).  Ulcers can develop as a end result of an untreated gastritis caused by Helicobacter pylori. H. pylori may be transmitted from person to person through contaminated food and water, so proper water filtration and sterilization seems to decrease the likelihood of this infection.

    Long-term use of nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), aspirin, and naproxen (Aleve) may also cause them. Spicy foods and stress, however, are not thought to cause peptic ulcers, although they can certainly make symptoms more severe.

    Symptoms include burning in the stomach area (mid- and upper left abdomen), bloating, belching, nausea, and problems eating certain foods. Patients complain that they feel worse on an empty stomach or at night.

    The main danger with ulcers is bleeding. An ulcer can bleed slowly or quickly. If slow-bleeding, the patient will have a lack of energy, fatigue, and an inability to physically exert themselves. Over time, they will appear pale. A heavily bleeding ulcer usually causes black, sticky stools known as “melena”. It reminds you of tar. Bloody vomit or vomit with the appearance of material that looks like coffee grounds is another sign.

    TREATING ACID-RELATED INFLAMMATION

    There are a number of lifestyle changes that may be effective strategies against acid issues:

    •             Stopping the use of nonsteroidal anti-inflammatory drugs, alcohol, caffeine, and tobacco.

    •             Avoiding highly acidic fruit (like oranges or tomatoes), fatty foods, coffee, onions, peppermint, and certain teas.

    •             Eating smaller meals to cause less stress on the stomach.

    •             Avoiding meals altogether for several hours before bedtime.

    •             Sleeping with both the chest and head elevated 30-45 degrees.

    •             Losing weight if obese.

    Medications used as treatment include:

    •             Antibiotics to kill H. pylori. Test kits are available over the counter to identify the bacterium. Combination therapy with Amoxicillin and metronidazole (available as veterinary equivalents) for 7-14 days with the addition of omeprazole (Prilosec) or bismuth subsalicylate (Pepto-Bismol) is the most available alternative for the austere medic: One dosing option is omeprazole (Prilosec) 40 mg once daily, amoxicillin (Amoxil) 500 mg three times daily, and metronidazole (Flagyl) 400 mg three times daily.

    •             Medications that block acid production. A family of drugs known as proton-pump inhibitors work by blocking the action of cells that produce acid. Over the counter medications in this family are available for stockpiling purposes in long-term survival. They include omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium).

    •             Medications that reduce acid production. Drugs called histamine (H-2) blockers reduce the quantity of acid in the GI tract, soothing gastritis pain. Examples include famotidine (Pepcid) and cimetidine (Tagamet HB).

    •             Antacids that neutralize stomach acid. These meds don’t block or reduce production of acid, but neutralize existing stomach acid. Popular brands include Tums, Rolaids, Maalox, Mylanta, Pepto-Bismol, and Alka-Seltzer.

    Home remedies abound for acid-related discomfort:

    •             Organic apple cider vinegar: Mix one tablespoon in four ounces of water, drink before each meal.

    •             Low-fat milk or yogurt, four-eight ounces as needed.

    •             Aloe Vera Juice: Mix one ounce in two ounces of water before a meal.

    •             Baking soda: Mix one tablespoon in a glass of water and drink right away when you begin to feel heartburn.

    •             Honey lemon tea: Mix one teaspoon lemon juice and one tablespoon of honey with eight ounces of warm water.

    •             Glutamine: An amino acid found in milk and eggs that has an anti-inflammatory effect and reduces acid reflux.

    •             Ginger or helichrysum tea.

    It’s important to remember to communicate with your patients. Many in the preparedness and homesteading community are rugged individualists. They may be unlikely to tell the medic about something they consider trivial, like heartburn. Anyone that is clearly in pain, losing efficiency, or unable to sleep should always be questioned about their symptoms. Offer treatment and support wherever possible.

    Joe Alton MD

    Dr. Alton

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