GERD, anyone?

[MrsNelson78]

I have been having terrible chest pains for the last few months and they got so bad last night that I went to the ER where they told me they thought I had GERD. I have heard other women complain of chest pains and I wonder if it's the same thing or Mirena-related?

[MrsNelson78]

Hi everyone:
As Mirena induces the body to stop producing natural progesterone and brings in the active ingredients of its contraceptive more accurately known as contraceptive steroids: synthetic drugs that act like progesterone (called progestins) to prevent the development of eggs in a woman’s ovary and ovulation, WE receive an extra amount of the same hormone that causes heartburn!

I'm pasting here some findings and suggestions. This might be one of the reasons why my gallblader feels like it is being cooked!!!

Alternative Medicine Encyclopedia: Heartburn (http://www.answers.com/topic/heartburn?cat=health )

Definition
Heartburn is a burning sensation in the chest that can extend to the neck, throat, and face. It usually occurs after eating and is worsened by bending, lifting, or lying down.
Descriiption
Heartburn, sometimes called acid indigestion or gastroesophageal reflux, is very common. More than one third of the population suffers from occasional heartburn, as do about one half of pregnant women. Some 50 million adult Americans complain of frequent heartburn. The occurrence of heartburn generally increases with age; however, it is common—and often overlooked—in infants and children.

Heartburn occurs when digestive juices from the stomach move back up into the esophagus, the tube connecting the throat to the stomach. The upper third of the esophagus consists of skeletal muscle that propels the food downward. The lower two-thirds of the esophagus is smooth muscle. The lower esophageal sphincter (LES) is a thick band of muscle that encircles the esophagus just above the uppermost part of the stomach. This sphincter is usually tightly closed—opening only when food passes from the esophagus into the stomach—and prevents the contents of the stomach from moving back into the delicate esophageal tissue. The stomach has a thick mucous coating that protects it from the strong hydrochloric acid it secretes to digest food. However the much-thinner esophageal mucous coating does not protect against stomach acid. Thus, if the LES opens inappropriately or fails to close completely, stomach acids can back up and burn the esophagus, causing heartburn.

Occasional heartburn is usually harmless. However, frequent or chronic heartburn (recurring more than twice per week) is called gastroesophageal reflux disease (GERD) and requires early management. Repeated episodes of GERD can lead to esophageal inflammation (esophagitis). If the esophagus is repeatedly subjected to stomach acid and digestive enzymes, ulcerations, scarring, and thickening of the esophageal walls can result. This causes a narrowing of the interior of the esophagus that can affect swallowing and the peristaltic movements that send food downward. Repeated esophageal irritation also can result in Barrett's syndrome—changes in the types of cells lining the esophagus. Barrett's esophagus can develop into esophageal cancer. Nighttime heartburn, affecting about 80% of heartburn sufferers, is more damaging to the esophagus than daytime heartburn. It often interferes with sleep and may trigger symptoms in asthma sufferers.


Heartburn is caused by:

a relaxed LES that does not close properly

over-production of stomach acid

increased stomach pressure

a damaged esophagus with increased acid sensitivity

Many factors can contribute to LES malfunction:

irregular eating, skipping meals

smoking

caffeine

stress

some medications, including diazepam (Valium), meperidine (Demerol), theophylline, morphine, prostaglandins, calcium channel blockers, nitrate heart medications, progesterone, and anticholinergic and adrenergic drugs (drugs that limit nerve reactions). The pregnancy hormone progesterone can relax the sphincter muscle at the top of the stomach. This muscle opens to allow food to pass into the stomach from the gullet or oesophagus. The muscle also usually prevents acid from the stomach regurgitating back into the gullet.

paralysis and scleroderma (an autoimmune disease that hardens body organs)

large meals that distend the stomach and prevent the LES from closing

alcohol, which lowers the pressure on the LES, allowing it to relax and open. Alcohol also may irritate the esophageal lining

weakening LES and loss of LES muscle tone with increasing age

Hiatal hernias are common among pregnant women, smokers, the obese, and those over age 50. The hiatus is an opening in the diaphragm (the large muscle that separates the chest cavity and the abdomen) through which the esophagus connects to the stomach. If the hiatus loses its tautness and shape, the stomach may protrude through, forming a pocket just below the LES where stomach acid can be trapped. These hiatal hernias can cause the LES to relax and open. Hiatal hernias may result in frequent and severe heartburn and GERD.
Symptoms
Heartburn itself is a symptom of gastroesophageal reflux and GERD. Heartburn sufferers may salivate excessively or regurgitate stomach contents into their mouths, leaving a sour or bitter taste.
Other symptoms of GERD include:

difficult or painful swallowing

sore throat

hoarseness, laryngitis, wheezing, coughing

pneumonia

gingivitis, bad breath

earache

Head and Neck Manifestations: Head and neck symptoms associated with reflux have an underlying pathophysiology different from that of the gastrointestinal manifestations and may occur in the absence of esophagitis. Those symptoms related to esophageal damage are primarily caused by the LES dysfunction, while the head and neck problems are caused by daytime laryngopharyngeal reflux secondary to dysfunction of the upper esophageal sphincter (UES). The UES is a less well-defined area of the upper esophagus that prevents refluxate from leaving the upper esophagus. Head and neck manifestations can include chronic sore throat, dysphagia (difficulty in swallowing), or odynophagia (pain upon swallowing). The patient may also complain of hoarseness, dysphonia, or a change in the timbre of the voice caused by edema or lesions of the vocal cords. Patients also report laryngospasm or a sensation of something being stuck in the throat, induced by irritation of laryngeal tissues.5 Often, the patient interprets this sensation as something such as viscous mucus stuck in the throat. The patient uses the typical throat-clearing exercises, but they do not help since the sensation is due to damaged tissue rather than viscous materials.1,5 Patients may have halitosis, buccal burning, aerophagia (swallowing air), or a tightness of the pharynx.2,5
Globus hystericus is a choking sensation caused by reflux-induced damage, among other etiologies. The patient reports a lump in the throat, stuck to the point that it cannot be dislodged.13 These patients attempt frequent dry-swallowing.
Pulmonary Problems: Chronic cough, apnea, bronchitis, stridor, hiccups, and sudden infant death syndrome (SIDS) may occur along with heartburn.5 Asthma is increasingly recognized as a reflux-associated problem. Experts estimate that 24% to 98% of patients with asthma have reflux as severe as GERD.11
Chest Pain: Chest pain is a frightening problem for the patient, who assumes that he or she is suffering a heart attack. From 10% to 50% of chest pain that is not cardiac in origin is associated with reflux.11
The aetiology may be decreased LES (lower esophageal sphincter (LES) ) pressure due to elevated hormone levels!!!!
Treatment
Herbal Remedies
These herbal remedies may be used to treat heartburn:

ginger (Zingiber officinalis) as a tea or candied. (Ginger may cause heartburn in some people.)

chamomile (Matricaria chamomilla) tea

slippery elm (Ulmus fulva) tea

cinnamon tea

anise (Pimpinella anisum), caraway, dill, and/or fennel seed tea

cardamom (Elettaria cardamomum) on buttered raisin toast

turmeric (Curcuma domestica) added to warm water

marsh mallow root (Althaea officinalis)

licorice (Glycyrrhiza glabra), especially deglycyrrhizinated licorice (DGL) (The capsules or tablets may be dissolved in the mouth or in tea or two to four chewable 380-mg. wafers are taken about 20 minutes before eating. DGL should not be used more than three times per week, as repeated use can be toxic.)

peppermint tea (Peppermint also can cause heartburn by relaxing the LES.)

Ayurvedic (traditional East Indian) herbs

Homeopathic Remedies
Homeopathic remedies for heartburn include:

Calcarea carbonica

Nux vomica after eating spicy foods

Carbo vegetalis after eating rich foods

Arsenicum album (for burning pain)

Natrum muriaticum (for nervousness, tension, and pain)

Zinc metallicum after eating too fast

Other Remedies
A variety of other remedies and therapies may be used to treat heartburn:

Sodium bicarbonate (baking soda) reduces esophageal acidity immediately. However, its effect is short-lived and it should not be used by people on sodium-restricted diets.

Nutritional remedies include carrots, celery, angelica, fennel, and/or parsley. These can be combined in a juice taken before meals.

Acupressure points Stomach 36, Spleen 6, Pericardium 6, and Conception Vessel 12. CV 12 should not be pressed just after eating or during pregnancy.

In Chinese medicine, foods and herbs that balance and cool the qi (Chinese term for universal life energy), including radishes, radish seed, citrus fruit peels, and cardamom.

Walking after a meal.

Chewing gum after eating to help produce saliva for soothing the esophagus and washing acid back into the stomach.

Relaxation therapy, visualization, and deep breathing.

Allopathic Treatment
Drugs
Occasional heartburn is commonly treated with nonprescriiption antacids that neutralize the pH of stomach acid. The neutralized acid does not burn the esophagus. Antacids usually work within 15 minutes and their effects last one to two hours. Liquid or dissolving antacids usually act faster than tablets. However, antacids, if taken for too long, can cause side effects, including diarrhea or constipation.
Some antacids interfere with medications for kidney or heart disease. Heartburn sufferers with two or more episodes per week, or with an episode lasting more three weeks, should not rely on antacids as the sole treatment, since they may be at risk of kidney damage or other metabolic changes.
Common antacids include Maalox, Mylanta, Alka-Seltzer, Pepto-Bismol, Riopan, and Rolaids. The active ingredient in antacids such as Tums is calcium carbonate. Alginate (Gaviscon) is a foaming agent that coats the esophagus and the stomach to help prevent reflux. Other antacids are made from aluminum hydroxide, magaldrate, or magnesium hydroxide. Some antacids contain baking soda (sodium bicarbonate), which may interfere with vitamin and mineral absorption during pregnancy.
Histamine receptor (H2) blockers, such as famotidine (Pepcid), ranitidine (Zantac), nizatidine (Axid), and cimetidine (Tagamet)****, decrease stomach acid secretion. They relieve heartburn in about 75% of users. However, they take 30 to 45 minutes to act and usually are taken two to four times daily for several weeks. H2 blockers are both over-the-counter (OTC) and prescriiption medicines. They may have side effects or interactions with other medications.
Proton pump inhibitors (PPI) are for severe heartburn. They are the most effective drugs for inhibiting acid production and allowing the esophagus to heal in GERD. It may take up to five days for PPIs to take effect. They cannot be used by people with kidney or liver problems. Although it appears safe to take PPIs for at least 10 years, the lowest effective dosage reduces the risk of side effects that may include headache, diarrhea, stomach pain, and interactions with other medications. Common PPIs include lansoprazole (Prevacid), omeprazole (Prilosec), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Prilosec OTC is available in 20-milligram doses to be taken once a day for 14 days to treat frequent heartburn.
Prokinetics are drugs that strengthen the LES (lower esophageal sphincter) and increase the rate of stomach emptying. These include metoclopramide (Reglan) and bethanechol (Urecholine). These drugs frequently have side effects.
Dietary adjustments to eliminate many causes of heartburn include:

eating smaller, more frequent meals to reduce pressure on the LES

eating slowly, chew thoroughly, and take deep breaths between bites

avoiding caffeine, chocolate, onions, spicy foods, and mint, all of which tend to increase stomach acid and relax the LES

avoiding fatty, fried, and greasy foods. Fatty foods relax the LES and slow stomach emptying, and fat consumption has been linked to GERD

avoiding milk, garlic, peppers, and carbonated beverages

avoiding nicotine

avoiding citrus fruits and juices and tomato-based foods, which are acidic and can irritate an inflamed esophagus

replacing meat at dinner with carbohydrates and easier-to-digest proteins such as rice, beans, and pastas

avoiding alcohol

adding the spice annato (Bix orellana) or bouquet garni to foods

drinking tea made with crushed caraway seeds with meals

controling body weight

Lifestyle changes that can alleviate heartburn include:

avoiding drugs known to contribute to heartburn, including aspirin or other nonsteroidal anti-inflammatories

avoiding clothing that fits tightly around the abdomen

not lying down until the stomach is empty—within about three hours of eating

elevating the head of the bed six to nine inches to prevent nighttime heartburn

avoiding strenuous exercise for two to three hours after a meal

TAGAMET**** This medication is also used to treat hypersecretory conditions in case of hormone induced alopecia (hair loss)

-http://curezone.com/forums/fm.asp?i=1198066#i

[MrsNelson78]

The heartburn after Mirena removal is actually a GOOD thing! It means your body is starting to produce it's own progesterone!!! When you have Mirena your body stops producing the hormone naturally and the Mirena takes over and releases it synthetically.

I had it bad too. I bought some OTC Prilosec because Tums weren't cutting it.

-http://curezone.com/forums/am.asp?i=1180993

[GladItsGone]

I had the worst heartburn I'd ever had: it affected my breathing, too, and it was everyday. I was eating Tums and Zantac like candy.

I also gained weight on Mirena; the doc said the weight gain caused the heartburn.

Last week - exactly one week ago - I had the Mirena taken out, and the heartburn disappeared by the next morning.

(I also peed like mad - the swelling went down. )

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