So often misdiagnosed and unattended to – so often given a prescription for Nexium or something similar – so often, so uncomfortable for the patient – and so often overlooked by the medical profession. Many people with Parkinson’s, after a long usage of medications, suffer needlessly.
What is GERD (acid reflux)?
Gastro Esophageal Reflux Disease, commonly referred to as GERD, or acid reflux, is a condition in which the liquid content of the stomach regurgitates (backs up, or refluxes) into the esophagus. The liquid can inflame and damage the lining of the esophagus although this occurs in a minority of patients. The regurgitated liquid usually contains acid and pepsin that are produced by the stomach. (Pepsin is an enzyme that begins the digestion of proteins in the stomach.) The refluxed liquid also may contain bile that has backed-up into the stomach from the duodenum. (The duodenum is the first part of the small intestine that attaches to the stomach.) Acid is believed to be the most injurious component of the refluxed liquid. Pepsin and bile also may injure the esophagus, but their role in the production of esophageal inflammation and damage (esophagitis) is not as clear as the role of acid.
GERD is a chronic condition. Once it begins, it usually is life-long. If there is injury to the lining of the esophagus (esophagitis), this also is a chronic condition. Moreover, after the esophagus has healed with treatment and treatment is stopped, the injury will return in most patients within a few months. Once treatment for GERD is begun, therefore, it usually will need to be continued indefinitely.
As is often the case, the body has ways (mechanisms) to protect itself from the harmful effects of reflux and acid. For example, most reflux occurs during the day when individuals are upright. In the upright position, the refluxed liquid is more likely to flow back down into the stomach due to the effect of gravity. In addition, while individuals are awake, they repeatedly swallow, whether or not there is reflux. Each swallow carries any refluxed liquid back into the stomach. Finally, the salivary glands in the mouth produce saliva, which contains bicarbonate. With each swallow, bicarbonate-containing saliva travels down the esophagus. The bicarbonate neutralizes the small amount of acid that remains in the esophagus after gravity and swallowing have removed most of the liquid.
Gravity, swallowing, and saliva are important protective mechanisms for the esophagus, but they are effective only when individuals are in the upright position. At night while sleeping, gravity is not in effect, swallowing stops, and the secretion of saliva is reduced. Therefore, reflux that occurs at night is more likely to result in acid remaining in the esophagus longer and causing greater damage to the esophagus.
What causes thrush?
Small amounts of the Candida fungus are present in the mouth, digestive tract, and skin of most healthy people and are normally kept in check by other bacteria and microorganisms in the body. However, certain illnesses, stress, or medications can disturb the delicate balance, causing the fungus Candida to grow out of control, causing infection.
Thrush usually develops suddenly, but it may become chronic, persisting over a long period of time. A common sign of thrush is the presence of creamy white, slightly raised lesions in your mouth—usually on your tongue or inner cheeks—but also sometimes on the roof of your mouth, gums, tonsils, or back of your throat. The lesions, which may have a “cottage cheese” appearance, can be painful and may bleed slightly when you scrape them or brush your teeth. In severe cases, the lesions may spread into your esophagus, or swallowing tube, causing:
• Pain or difficulty swallowing
• A feeling that food gets stuck in the throat or
• Fever, if the infection spreads beyond the esophagus
Thrush can spread to other parts of the body, including the lungs, liver, and skin. This happens more often in people with conditions that weaken the immune system.
How is thrush treated?
While healthy children and adults can be effectively treated, the symptoms may be more severe and difficult to manage in those with weakened immune systems. Antifungal medications, which are generally taken for 10 to 14 days, are often prescribed to treat thrush. These medicines are available in tablets, lozenges, or liquids.
The following practices can help minimize your chance of developing thrush:
Follow good oral hygiene practices. Brush your teeth at least twice a day and floss at least once a day.
Avoid mouthwashes or sprays. These products can destroy the normal balance of microorganisms in your mouth.
See your dentist regularly, especially if you have diabetes or wear dentures.
Limit the amount of sugar and yeast-containing foods you eat. Foods such as bread, beer, and wine encourage Candida growth.
If you smoke, quit. Ask your doctor or dentist about ways to help you kick the habit.
How is thrush diagnosed?
Your medical professional can make the diagnosis by examining your mouth. He or she looks for the distinctive white lesions on your mouth, tongue, or cheeks. Lightly brushing the lesions away reveals a reddened, tender area that may bleed slightly. A microscopic examination of tissue from a lesion can confirm the diagnosis.
Thrush that may extend into your esophagus may require other tests to make the diagnosis. Such tests might include taking a throat culture (swabbing the back of your throat with sterile cotton and studying the microorganisms under a microscope), performing an endoscopy of your esophagus, stomach, and small intestine (examining the lining of these body areas with a lighted camera mounted on the tip of a tube passed through these areas), or taking X-rays of your esophagus.
How is thrush treated?
While healthy children and adults can be effectively treated, the symptoms may be more severe and difficult to manage in those with weakened immune systems. Antifungal medications, which are generally taken for 10 to 14 days, are often prescribed to treat thrush. These medicines are available in tablets, lozenges, or liquids. Your dentist will have a specific treatment approach designed for you based on your age and the cause of the infection. Because the presence of Candida infection can be a symptom of other medical problems, your dentist may suggest you seek care from a medical doctor as well so that any underlying health problems you may have can be treated.