Diabetes Self-Management Blog

You know the feeling. You wake up in the middle of the night with a burning feeling in your chest or throat. You might have a sour taste in your mouth or feel nauseated. Maybe your throat is sore or you sound hoarse when you talk. Or perhaps you start to wheeze or cough.

Many of us have had some or all of these symptoms at one time or another. I know I’ve had a few of them myself, especially after eating a rich meal too late in the evening. But what if you have them all the time? And what’s causing these unpleasant symptoms?

Meet GERD
Occasional heartburn is one thing. But if you constantly have the symptoms I mentioned above, you might have a condition called gastroesophageal reflux disease, or GERD for short. GERD is a chronic condition in which the stomach acids and sometimes bile flows back into your esophagus (the long tube between your mouth and your stomach). The acids from your stomach irritate and burn the lining of your esophagus and can cause chest pain, a lump in your throat, hoarseness, and a sour taste in your mouth. The acid can also spill into your lungs, leading to wheezing, pain, and shortness of breath. If these symptoms happen a few times a week, your doctor may diagnose you with GERD.

Long-Term Risks
No one likes having heartburn or other symptoms of acid reflux. If you have them, it’s important to get them treated because letting these symptoms go too long may increase your risk of more serious conditions. The constant backflow of acid into your esophagus can lead to:

• Narrowing of your esophagus due to tissue scarring from the acid

• Esophagitis, a condition whereby the lining of the esophagus becomes inflamed, possibly leading to ulcers and bleeding

• Dysphagia, or difficulty swallowing

• Barret’s esophagus, a condition in which the lining of the esophagus changes, increasing the risk for esophageal cancer

• Asthma

Causes of GERD
Your esophagus is joined to your stomach. At this juncture is a ring of muscle, called the lower esophageal sphincter (LES). The LES is like a valve, controlling the opening and closing of the entry to the stomach. After you eat, the sphincter closes so that your food can start to be digested and does not flow back up into your esophagus. The LES “relaxes” when you eat again, allowing your food to enter your stomach. Certain conditions can weaken the LES or prevent it from closely properly, including:

• Hiatal hernia
• Obesity
• Certain asthma medicines
• Pregnancy
• Smoking
• Diabetes
• Delayed stomach emptying

Diabetes and GERD?
The prevalence of GERD is on the rise. At this time, about 33% of Americans have GERD, and it costs about $10 billion each year to treat. There definitely seems to be a link between being overweight and GERD. In fact, people who are overweight are 50% more likely — and those who are obese are 200% more likely — to have GERD than folks who are at a healthy weight. It may be that extra fat in the abdominal area causes the LES to relax; also, chemicals released from fat may relax the LES.

We know that many people with Type 2 diabetes are overweight, so it seems to make sense that GERD is more common in these individuals. But it also appears that having Type 2 diabetes is a risk factor in and of itself for GERD, apart from weight. A study published in 2008 in the World Journal of Gastroenterology found that GERD is present in about 40% of people with diabetes. The researchers also found GERD to be more common in people with diabetes who also had neuropathy, or nerve damage, which is a common complication of diabetes. People in this study who had diabetes and neuropathy were more likely to have GERD, regardless of weight, compared to people without neuropathy.

Gastroparesis, which is a type of neuropathy that affects the digestive tract, can boost the risk of GERD. With gastroparesis, the stomach may be very slow to empty as a result of nerve damage. Food sits around in the stomach for too long, which builds up pressure in the stomach. This pressure can cause the LES to relax, allowing reflux of stomach contents into the esophagus. Other symptoms of gastroparesis, by the way, include nausea, vomiting, bloating, and early satiety, or fullness.

Fortunately, there are ways to help manage, if not cure, GERD, and we’ll take a look at these next week.

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