UNDERSTANDING AND MANAGING GERD: A COMPREHENSIVE GUIDE Gastroesophageal reflux disease (GERD) is a common condition that affects millions of people worldwide. It occurs when stomach acid flows back into the tube connecting your mouth and stomach (oesophagus). This backwash (acid reflux) can irritate the lining of your oesophagus, leading to discomfort and other symptoms. Understanding GERD and its management can significantly improve the quality of life for those affected. In this blog, we will explore what GERD is, its symptoms, causes, and various management strategies. WHAT IS GERD? GERD is more than occasional heartburn; it is a recurring condition that can affect one’s quality of life. When functioning normally, the lower oesophageal sphincter (LES) — a ring of muscle at the end of your oesophagus — closes as soon as food passes through it. However, in people with GERD, this muscle is weak or relaxes inappropriately, allowing stomach acid to flow back into the oesophagus. SYMPTOMS OF GERD The most common symptom of GERD is frequent heartburn, a burning sensation in your chest that often occurs after eating and may be worse at night. Other symptoms may include: Regurgitation of food or sour liquid into the throat especially while sleeping. Burning sensation in throat or chest. Feeling of a lump in your throat. Change in voice (Hoarseness). Chronic cough. Pain while talking. Difficulty swallowing. Chest pain. If you experience severe chest pain, especially combined with symptoms like pain in the arm or jaw or difficulty breathing, seek immediate medical attention, as these could be signs of a heart attack. CAUSES AND RISK FACTORS Several factors can increase your risk of GERD, including: Bulging of the top of the stomach up into the diaphragm (hiatal hernia). Heavy meals especially in the evening. Fried or spicy foods. Fizzy and citrus drinks. Delayed stomach emptying. Connective tissue disorders, such as scleroderma. Certain medications. MANAGEMENT AND TREATMENT The management of GERD typically involves lifestyle modifications, medications, and in severe cases, surgery. Here are some strategies: LIFESTYLE CHANGES Diet Avoid foods and drinks that trigger your symptoms, such as fatty foods, spicy foods, chocolate, caffeine, alcohol, and carbonated beverages. Eat smaller meals. Large meals can increase stomach pressure, hence smaller portions are preferable. Weight loss If you’re overweight, losing weight can reduce reflux. Quit smoking Smoking decreases the effectiveness of the lower oesophageal sphincter leading to acid reflux. Elevate the head of your bed Raising the head of your bed by six to eight inches or using an extra pillow while sleeping can help gravity keep gastric acid down in your stomach. MEDICATIONS Antacids These can provide quick relief but don’t heal an inflamed oesophagus damaged by stomach acid. H-2-receptor antagonists (H2RAs) These reduce stomach acid and last longer than antacids, though not as long as proton pump inhibitors (PPIs). Proton pump inhibitors These are stronger acid blockers than H2RAs and allow time for damaged oesophageal tissue to heal. SURGICAL AND OTHER PROCEDURES In severe cases where medication does not help, or if you wish to avoid long-term medication use, surgical options are available: Fundoplication A surgeon wraps the top of your stomach around the lower oesophageal sphincter to tighten the muscle and prevent reflux. LINX device A ring of tiny magnetic beads is wrapped around the junction of the stomach and oesophagus to strengthen the lower oesophageal sphincter. CONCLUSION GERD is a manageable condition with the right combination of lifestyle changes, medication, and, in some cases, surgery. If you suspect you have GERD, it is crucial to consult a healthcare professional for a proper diagnosis and treatment plan. Living with GERD can be challenging, but understanding the condition and taking proactive steps can significantly reduce symptoms and improve your quality of life. TAKE ACTION AGAINST GERD: YOUR PATH TO RELIEF STARTS TODAY! Living with GERD can be challenging, but taking proactive steps can significantly reduce symptoms and improve your quality of life. Remember, effective management of GERD involves a combination of professional medical advice and lifestyle changes. Don’t let GERD control your life—take action today for a healthier, more comfortable tomorrow. Your journey to relief starts now! Make an appointment to see Dr Sandeep Uppal through our appointment booking service or contact us through WhatsApp.

HOARSENESS AND ITS MANAGEMENT Hoarseness, characterized by a change in the voice that can make it sound breathy, strained, or raspy, can arise from a variety of causes ranging from overuse to underlying medical conditions. Effective management begins with a thorough evaluation to pinpoint the specific cause. This can involve a detailed analysis of the patient’s voice habits, medical history, and a series of specialized tests to assess the vocal cords and surrounding structures. Once the root cause is identified, treatment is tailored to the individual’s needs. DIAGNOSIS OF HOARSENESS Diagnosis of hoarseness is a multi-step procedure that Dr Sandeep Uppal and his team at The ENT Clinic take very seriously. Given the range of potential causes, from lifestyle factors to more serious conditions like neoplasms, a comprehensive and methodical approach to diagnosis is essential. Here are some of the key steps involved: PATIENT HISTORY The team will first obtain a thorough history of the patient, including the duration and onset of the hoarseness, any associated symptoms, and other relevant medical and lifestyle factors. VOICE ASSESSMENT Dr Uppal or a speech therapist may evaluate voice quality, pitch, and volume, usually through specific vocal tasks like speaking or singing. DIAGNOSTIC TESTS Laryngoscopy This involves using a small, flexible tube with a light and camera at the end (laryngoscope) to visualise the vocal cords and larynx. Stroboscopy A more advanced version of laryngoscopy, stroboscopy allows the team to assess the vibration of the vocal cords by using a strobe light. This test provides more detailed information. Acoustic Analysis Some cases may require an in-depth analysis of voice frequency and other acoustic properties to understand the extent of the problem. Imaging For some patients, X-rays or MRIs may be necessary to rule out tumours or structural abnormalities that could be affecting voice quality. pH Monitoring If GERD is suspected, a 24-hour pH monitor may be used to measure the acid levels in the throat. Biopsy In cases where neoplasms or other growths are identified, a biopsy may be necessary to rule out cancer. MULTIDISCIPLINARY APPROACH Given the range of potential causes, Dr Sandeep may consult with other specialists such as gastroenterologists, allergists, or neurologists to provide a comprehensive diagnosis. ROLE OF SPEECH THERAPISTS Speech therapists are integral to the team, especially when hoarseness impacts speech quality or communication skills. They assess vocal use and misuse patterns and work with the child to develop healthier vocal habits. Techniques might include vocal exercises to improve pitch and volume control, as well as strategies to avoid straining the voice. COLLABORATION WITH PAEDIATRICIANS In some instances, hoarseness may be a symptom of an underlying health issue such as allergies, acid reflux, or respiratory infections. Dr Sandeep often collaborates with paediatricians to manage these associated conditions effectively, as addressing the root cause can significantly improve vocal quality. GASTROENTEROLOGISTS Reflux Disorders:  One common cause of voice problems and throat irritation is gastroesophageal reflux disease (GERD) and its variant, laryngopharyngeal reflux (LPR). Both conditions involve stomach acid rising up the oesophagus and potentially reaching the throat, irritating the vocal cords. A gastroenterologist can diagnose reflux disorders using methods like endoscopy, pH monitoring, and barium swallow studies. Based on the findings, they can recommend dietary changes, prescribe medications, or in severe cases, recommend surgical interventions. NEUROLOGISTS Neurological Conditions: Some voice and throat issues can be a result of neurological conditions. For example, vocal cord paralysis can be caused by nerve damage, and spasmodic dysphonia is a neurological disorder affecting voice box muscles. A neurologist can perform a range of tests, such as nerve conduction studies, to diagnose the underlying neurological condition. Based on the diagnosis, treatments might include medications, Botox injections, or other therapeutic interventions FINAL DIAGNOSIS Once all tests and consultations are complete, Dr Sandeep and his team will consolidate the findings to arrive at a conclusive diagnosis. This will serve as the basis for a tailored treatment plan designed to effectively manage and, where possible, cure the hoarseness. TREATMENT OF HOARSENESS The treatment approach is determined based on the underlying cause of the hoarseness. Here’s an overview of the potential treatments: VOICE REST AND HYDRATION For cases caused by voice overuse or strain, simply resting the voice can help in recovery. Keeping the throat hydrated can relieve some symptoms. Patients are often advised to drink plenty of water and use humidifiers, especially in dry climates or seasons. VOICE THERAPY A speech therapist can provide exercises and techniques to reduce strain on the vocal cords. This is especially useful for individuals who use their voice frequently, such as singers or public speakers. MEDICATIONS Anti-inflammatory medications Can reduce swelling of the vocal cords in cases of acute laryngitis. Antibiotics Used if bacterial infection is the cause, though hoarseness is more often caused by viral infections, against which antibiotics are ineffective. Antacid medications Useful for patients with hoarseness due to GERD or LPR. Antihistamines and corticosteroids May be prescribed for hoarseness caused by allergies. Lifestyle Modifications Avoiding smoking and limiting alcohol can alleviate hoarseness in many patients. Dietary changes can reduce acid reflux symptoms, which can, in turn, alleviate hoarseness. Surgery In cases where nodules, polyps, cysts, or tumours are causing the hoarseness, surgical intervention may be necessary. Laryngeal papilloma’s, often caused by HPV, might need surgical removal. Botox Injections For conditions like spasmodic dysphonia, Botox injections into the vocal cord muscles can reduce muscle spasms and improve voice quality. Avoidance of Irritants Staying away from irritants, such as smoke or allergens, can prevent and treat hoarseness, especially in chronic cases. AMPLIFY YOUR VOICE: EXPERT SOLUTIONS FOR HOARSENESS Is a hoarse voice holding you back? Speak up and reach out! Dr Sandeep Uppal and our team at The ENT Clinic are eager to help you find your voice again. We know how important it is to be heard clearly, and we’re committed to providing you with the expert care you need. From personalized voice assessments to the latest therapeutic techniques, we have the tools to fine-tune your vocal health. We cater