... ask the Boogor Doctor ... » Reflux/GERD

Rhinitis, Sinusitis, Otitis, Laryngitis, Adenoiditis, Tonsillitis Are All Connected

Russell A. Faust, PhD, MD — Thu, 25 Nov 2010 07:00:51 +0000

Cut From the Same Cloth

The Unified Airway Model helps explain why children who have rhinitis also get more than their share of otitis (ear infections) or adenoiditis or tonsillitis or sinusitis or asthma exacerbations, etc.

All these anatomic regions have a similar lining, and when one area becomes inflamed or infected, they can all become inflamed.

In a sense, they’re all cut from the same cloth. They’re all connected in that way.

It's All Connected

This figure above suggests that the nose, with rhinitis, holds a central position in all this. That may or may not be the case, I don’t know. On the other hand, a stuffy nose does seem to commonly precede the other infections to follow.

The Unified Airway Model suggests that it doesn’t really matter where the inflammation starts in the aero-digestive tract, that the mediators of inflammation will trigger responses in all of these places, regardless. Anecdotal observation suggests that there is truth in that.

Nearest Neighbors

The figure below simply provides some sense of the anatomic, physical proximity of these areas to one another. It is easy to see how any infection of the nose, sinuses, tonsils, adenoids, can all affect the ears, and vice versa.

Simple physical proximity. They’re all connected in that way, too.

Anatomic Proximity of Rhinitis, Sinusitis, Adenoiditis, Otitis, Laryngitis, Tonsillitis

So, What To Do With This Information?

Well, for one thing, this information serves to make you aware (if you weren’t already). To make you alert for the sinusitis that lingers for weeks following that “simple cold.” To be alert for the asthma exacerbation following the ear infection, or for the ear infection to follow that stuffy nose, or ear infections that are related to reflux.
You CAN do something to prevent the spread of inflammation throughout the Unified Airway: Optimize nasal hygiene.
Because the nose seems to hold a central position in all of this, it gives me an excuse to once-again recommend great nasal hygiene:
- If your little boogorhead gets an otitis after every stuffy nose, consider saline nasal rinses to prevent that.
- If your little boogorhead has a severe asthma exacerbation associated with every sinusitis, or with allergic rhinitis, consider doing nasal saline rinses to prevent that.
- Check Resources, below, for additional information and tips on how to manage the child with a constellation of respiratory challenges.

If you haven’t already, visit the boogor doctor’s Amazon Store over on the right column of the blog. (for transparency: I am an affiliate, and anything that you purchase through that link helps to support the expenses of this site).

On that link you will find some great products for optimizing nasal hygiene, and for doing saline nasal rinses. Be sure to check out the Nasopure products.

While you’re there, check out the books that I have personally selected, that I have bought for my own library, and that I highly recommend – for those with asthma, rhinitis, sinusitis, food allergies, or reflux.

Thanks

As always, thanks for visiting, and see you here again. I appreciate your comments and questions. Keep ‘em coming.

Please let me know what you would like to hear more about. Please, “be excellent to one another.”

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

If this blog is helpful for you, please subscribe:

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

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Stay Informed.

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I promise to continue to work hard to help empower you with knowledge: to improve your health and the health of your children. RF

Resources

10 Previous posts on this blog that you might find useful:

Allergic Rhinitis CAN be Controlled – Here’s How

Stop Breathing: Your Air is Killing You (and what to do about it)

Can Your Child’s Allergies be Cured with Drops Under the Tongue?

Nasal and Sinus Anatomy and Histology

3-Year-Old Boy Hospitalized with Severe Sinusitis: Easy Cure

Reflux and Otitis: Does GERD Cause Ear Infections?

Saline Nasal Rinses: Last in 4-Part Series

Saline Rinses: If Once/Day is Good, is 4 Times Per Day Even Better?

The 8 Basic Principles to Control Your Child’s Sinusitis

What Air Pollution Does to Your Nose and Sinuses

Reflux in Children – Causes and Treatments

Russell A. Faust, PhD, MD — Thu, 18 Nov 2010 09:00:16 +0000

So, my last post discussed the role of reflux in asthma. Note that medical research shows that reflux plays a big role in rhinitis, sinusitis, and otitis also. This article discusses causes and treatments for reflux.

What Causes Reflux?

Let’s start the answer by saying “we don’t know”. The rest is mostly speculation, educated guessing. At the bottom of the esophagus (swallowing tube) there is a tightening of muscle where it enters the stomach (called the “lower esophageal sphincter”). This muscle is affected by many things. As you might imagine, anything that loosens that muscle will allow reflux to worsen. Some things that loosen that muscle include caffeine, alcohol, tobacco, mint teas, tight clothing (pressing on the stomach externally), lying down, and even obesity. Some medications also worsen reflux. Let’s assume that your infant isn’t smoking cigarettes, drinking alcohol or coffee. You can see that most of these factors should not be a problem for babies or children, although obesity is becoming more of a problem in children. The biggest factor for reflux in infants is position – they spend most of their time lying down.

What To Do About It?

General Considerations

Manage stress. Stress and emotional turmoil will crank up the stomach acid, and have other negative effects. Too much can contribute to reflux, GERD. As always, to the best of your ability, provide your child with unconditional love, emotional support, and a safe and secure home environment.
Consider an Elimination Diet protocol. Some specific foods or food groups may be causing reflux or respiratory symptoms (asthma, rhinitis, etc.). Eliminating your child’s symptoms may be as simple as getting rid of a food from their diet. This topic deserves a LONG post all by itself. Take a look at Dr. Jonega’s site (www.allergynutrition.com), take a look at her books (on my Amazon Store here), and search the web for “elimination diet”.
Exercise. For children (adults too), make certain they are active. This will benefit their general health. It will help eliminate reflux. Get them up off the couch, pry them away from the video game and the TV, get them outside!!
Supplement with a multi-vitamin that contains zinc. Zinc is necessary for a healthy GI tract.
Consider using a probiotic for any child who is being treated for reflux (any treatment – conventional or alternative).

Infants

Simple things can help: after feeding try to keep them upright for awhile. If sleeping, try to place them on a slight incline, or prop up their bedding slightly under the head of the crib. Thickening their feedings can help them keep from refluxing. Rice cereal is a good thickener. For this to help, the formula or milk needs to be as thick as stage 1 baby food or tomato sauce (NOT paste!). Note that breast milk contains an enzyme that breaks down the cereal, so it will be good and thick to start, but thins out a few minutes later. You may want to thicken only an ounce at a time to prevent this from happening. Also note that thickened formula will not come out of a regular bottle nipple. Most bottle manufacturers have cross cut nipples and variable flow nipples. Ask your pharmacist to order some for you. Finally: Not ALL reflux will be cured by thickening.

What Other Treatments Are Available?

For starters, “conventional” medicine uses something that is over-the-counter for adults (considered relatively safe):

Zantac (generic: Ranitidine)

I have had good results with this in my pediatric patients with asthma, rhinitis, sinusitis, and otitis. It is a prescription for children. I use this mostly as a diagnostic technique: if I suspect reflux as a key factor in a child’s asthma, rhinitis, sinusitis, or otitis, I will place them on Ranitidine. If they clearly improve, we have our diagnosis. We then try to reduce the reflux without drugs. Keep reading …

Natural Alternatives

Here are some “natural” alternatives to consider (see my previous article, A Few Words on Being Natural (http://wp.me/pR4iB-k5) for my thoughts on whether “natural” is always better):

DGL

In the 1940’s licorice was discovered to be effective in treating peptic ulcers. Unfortunately, side effects included high blood pressure, potassium loss, and fluid retention (just another example of “natural” not always being a universally positive remedy). Over time it was discovered that these side effects were caused by a chemical in licorice – glycyrrhizin. The solution is called “de-glycyrrhizinized licorice”, or DGL, where about 97% of the glycyrrhizin has been removed. Research has shown that DGL is a good anti-inflammatory. It has been effective against the esophagitis and other symptoms caused by GERD. How to use DGL? It usually comes as a chewy tablet, kind of like a gummy-bear. Chewing the tablet helps activate the DGL by mixing with saliva.

NOTE that safety information for DGL in children are not available. Dosing information is not available for children. Therefore, this option is only available for treating adult reflux. If you use DGL, store it out of reach of children – the gummy-bear resemblance to candy can be appealing to children.

Barley Grass

That’s a pic of barley grass above (credit, Matt Lavin). Barley grass consumption by humans dates back at least 7,000 years, and active cultivation of barley dates back to Mesopotamia, to about 2500 BC. Barley has amino acids and chlorophyll, and seems to contain effective anti-inflammatory ingredients. In addition, it has 11 times the calcium of cow’s milk, more than 4 times the iron from spinach, 7 times the Vitamin C of oranges, and is loaded with Vitamin B1. Sounds impressive. There has been very little scholarly research on the effects of Barley Grass in humans. It is used as an anti-inflammatory for reflux, similar to DGL. How to use Barley Grass? Dried barley grass is usually boiled and consumed as a tea, or mixed into water or juice.

Melatonin?

You’ve heard of Melatonin? Helps us sleep. This mostly speculation, but some integrative and holistic docs who are pretty smart speculate that our Melatonin also helps reduce reflux. How? Melatonin increases the muscle tone in the Lower Esophageal Sphincter. This might reduce upward flow of gastric contents. That is, increasing the tone in the LES might reduce reflux. Still speculation, but it makes sense that the natural hormone that helps us sleep would also help reduce reflux while we are lying down.

Histamine?

No – don’t give histamine to treat reflux. Reduce histamine to reduce reflux.

For my own reflux, Dr. Joneja’s histamine-restricted diet has made a huge difference! Check her site under Resources, below. It is a GREAT resource for those with food allergies, intolerance, and reflux. She has many free downloads. She has an amazing site! Check it out!

Quercetin

Quercetin is a bioflavonoid. It inhibits release of both histamine and leukotrienes. As a result, it is a strong anti-inflammatory agent. It occurs naturally in onions, garlic, and many dark-colored fruits and vegetables. Ask your pharmacist or naturopathic doctor (ND) about dosing for children. Even better, simply include natural sources in your child’s diet (in your diet too, while you’re at it). As a general principal, it is always better to get your nutrients directly from the source – your food.

Acupuncture

As good at managing reflux as powerful proton pump inhibitors (PPI’s) for difficult-to-treat reflux. I don’t use PPI’s in my patients. To find a Licensed Acupunturist near you, contact the American Academy of Medical Acupunture (see Resources, below).

Nutritional Supplements

There are studies suggesting that magnesium and other elements play a role in histamine release. Be certain that your little tyke has as well-rounded a diet as possible (see Littlestomaks.com for suggestions). The goal, of course, is for them to obtain all of their nutrients from a well-balanced diet. This is a huge challenge, especially in toddlers. Supplement with a good multi-vitamin to be sure. This simple step will help minimize reflux, and help keep them healthy in general. Be certain that the multi-vitamin includes Zinc. Nearly all of us are deficient in Zinc, and it helps the lining of the GI tract to heal, to repair itself. Ginger can have a “gastro-protective” effect – it protects the stomach. BUT: Caution should be taken when using ginger (Zingiber officinale), as some studies have found increased GI distress with high doses or prolonged use. So: if you have reflux, don’t over-do the ginger. Finally, ask your doctor – naturopath, pediatrician, or pediatric ENT. Check the website of the American Board of Integrative Holistic Medicine to locate an integrative healer near you: http://integrativeholisticdoctors.org/D/locate_physician.html

Surgery

As a LAST resort: For those children with life-threatening complications of reflux – failure to thrive, severe asthma, recurrent pneumonia from aspiration, etc. – and these other approaches just are not working – surgery may be a consideration. The most common and most successful is a procedure that tightens the lower esophageal sphincter, the muscle surrounding the esophagus where it enters the stomach. I do not personally perform this procedure, and can only say that some of my patients have experienced life-changing success from surgery to stop their reflux. Beyond that, ask your doc, search the web. . Reminder: the goal of these articles is to educate and inform. This is not medical advice. All treatment should be undertaken with the advice and guidance of a physician who has knowledge of your full medical history, your physical exam and any laboratory test details. See disclaimer: http://wp.me/PR4iB-r Future posts will examine the studies showing how reflux affects rhinitis and sinusitis, and what we can do about it. . I appreciate your comments and questions. Keep ‘em coming. Please, “be excellent to one another.” I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday. Click here to subscribe for free weekly updates: (http://eepurl.com/FGnP) Type in your best email address (the one you actually use). When the confirmation email from boogor doctor arrives, click on the link to give your okay to receive free weekly updates, occasional book or product reviews, without needing to visit the website. It’s free, it’s convenient. No ads. No spam. You can un-subscribe at any time.

Stay Informed.

Stay Healthy.

Best of health and success to you and your families. Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources

American Academy of Medical Acupunture. Tel: 323-938-5514. Website: www.medicalacupuncture.org

Dr. Janice Joneja, PhD, RD (Registered Dietician): http://www.allergynutrition.com/)

This is an outstanding resource for allergy and nutrition information, including food allergies and reflux.

I owe a great debt of gratitude to Dr. Robert Ivker for helping to eliminate chronic sinusitis and reflux from my life.

Refer to his site for further details on steps that you can take: www.physicianhealer.com He is an outstanding resource for Respiratory Health.

Of note, he is an original founder of the American Board of Integrative Holistic Medicine.

Image Credit: Image by Matt Lavin, Flickr: http://www.flickr.com/photos/plant_diversity/

From this blog:

Is Reflux Causing Your Child’s Asthma? http://wp.me/pR4iB-uV

Things You Should Know About Asthma: http://wp.me/pR4iB-7k

A Few Words About “Being Natural”: http://wp.me/pR4iB-k5

Reflux and Otitis: Does GERD Cause Ear Infections? http://wp.me/pR4iB-fZ

Is REFLUX Causing Your Child’s Asthma?

Russell A. Faust, PhD, MD — Thu, 11 Nov 2010 09:00:41 +0000

What is Reflux?

Simply stated, reflux – or Gastro-esophageal reflux (GER) – is the regurgitation of gastric contents into the esophagus, or even higher, into the mouth or nose (lovely image, no?).

You see babies with reflux all the time. You know, babies “spitting up”. Gastro-esophageal reflux (GER) is common among infants, but it usually resolves on its own – it is estimated that 50% of 2-month-old infants have reflux of gastric contents (regurgitate, or “urp up”) at least twice per day, but only 1% of them still do it at 12 months old.

Most infants simply out-grow it. As they spend more time upright, they reflux less. For nearly all babies with reflux, it goes away without intervention. Most of these infants who are “spitty babies” do not seem bothered by this; most they don’t have symptoms.

So – for most babies with reflux – they don’t have symptoms, and it goes away by itself.

Groovy.

A small minority of babies will have symptoms from GER, and some do not outgrow it. When GER is abnormal, it gains the designation GERD: gastro-esophageal reflux disease.

One of the ways that reflux can show itself in babies, infants, and children is asthma. “Reactive airway disease.”

How Does Reflux Cause Asthma?

There are probably 2 mechanisms involved.

(1) The first involves inflammation from the reflux. Reflux causes inflammation of the esophagus – esophagitis.

Various biochemicals from that inflammation cause a reaction in other parts of the aero-digestive system. See my article on the Unified Airway Model for more.

(2) The second mechanism involves nerve reflexes that are triggered by the irritated esophagus – the esophagitis.

These reflexes cause bronchospasm – commonly known as asthma. There is evidence that both of these mechanisms contribute to reactive airway disease.

[Aside: although we are focused on asthma here, reflux can be a factor in rhinitis, sinusitis, otitis, and almost any "itis" of the upper airway - see future posts.]

Of course, what you want to know is:

Does MY Child Have Reflux ?

Two Common Tests:

Esophagoscopy

There are several ways to look for reflux, or to look for evidence of reflux. One of the ways that we can tell that reflux is causing inflammation is to look at the esophagus – if there are inflammatory changes (esophagitis) then we consider the reflux to be a significant problem.

Back in one of the earlier studies looking for a link between respiratory symptoms and reflux, we asked, “what is the prevalence of reflux among infants and children with difficulty breathing?”

When we looked at the esophagus of infants and children who were taken to the operating room for airway evaluation (a group of children who had breathing difficulties, like severe asthma, stridor (squeaky breath sounds), apnea, recurrent pneumonias, so that endoscopy in the operating room was indicated), we found that 71% had reflux esophagitis!

That doesn’t prove that their reflux was the cause, but suggests a strong link between reflux esophagitis and breathing difficulties in babies and children.

pH Probe

Another way to look for reflux is to measure pH (acidity) of the esophagus over time using a pH probe – a long catheter placed through the nose into the esophagus, left in place at least 24 hours to record the pH (no, not a lot of fun). When this has been done with infants and children, multiple studies have found that episodic stridor and apnea are correlated to gastric acid refluxing into the esophagus.

One limitation of using a pH probe to diagnose reflux is that some people (especially babies and children) have non-acid reflux.

That means that the pH probe will not detect the reflux (it isn’t acidic), even though they are refluxing, and even though the reflux is causing symptoms. A newer probe that can detect even non-acid reflux is the combination pH / impedance probe. Its use is similar to the usual pH probe, just as uncomfortable.

So, if your child has asthma, is there an easy way to tell whether reflux is a factor?

Treatment as a Diagnosis

Other studies have shown that episodes of reactive airway, asthma, and wheezing all correlate with reflux by pH probe; ALL of these symptoms improved significantly after medical or surgical treatment of the reflux.

Treating children who have these breathing difficulties (for example, asthma, stridor, or apnea) for reflux can relieve their breathing symptoms.

One study found that 82% of asthmatics have reflux; 70% asthma improved by treating them for reflux.

Sounds promising, yes?

To conclude, perhaps the simplest way of finding out whether reflux is the cause of your child’s symptoms is this: treat them as if they have reflux, see whether their symptoms improve.

Next week we will review the treatments for reflux – conventional and alternative approaches.

I appreciate your comments and questions. Keep ‘em coming. Please, “be excellent to one another.”

I invite you to subscribe (it’s FREE) to this blog for weekly updates – you won’t be swamped by updates, I simply cannot write for the blog everyday.

Click here to subscribe for free weekly updates: (http://eepurl.com/FGnP)

It’s free, it’s convenient. No ads, no spam. You can un-subscribe at any time.

Stay Informed.

Stay Healthy.

Best of health and success to you and your families.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources (this blog):

Things You Should Know About Reflux: http://wp.me/pR4iB-7k

Things You Should Know About Asthma: http://wp.me/pR4iB-7b

What is the Unified Airway? http://wp.me/pR4iB-gS

Use Plants to Purify Your Air: http://wp.me/pR4iB-bs

Reflux and Otitis: Does GER Cause Ear Infections? http://wp.me/pR4iB-fZ

Stop Breathing: Your Air is Killing You (and what to do about it): http://wp.me/pR4iB-5E

... ask the Boogor Doctor ... » Reflux/GERD

Top 15 Posts So Far

In case you are new to this site, or joined us only recently, here is a list of the Top 15 Most Popular articles over this first year (most popular first):

Stay Informed.

Stay Healthy.

Rhinitis, Sinusitis, Otitis, Laryngitis, Adenoiditis, Tonsillitis Are All Connected

Cut From the Same Cloth

In a sense, they’re all cut from the same cloth. They’re all connected in that way.

Nearest Neighbors

Simple physical proximity. They’re all connected in that way, too.

So, What To Do With This Information?

Thanks

Stay Informed.

Stay Healthy.

Resources

Reflux in Children – Causes and Treatments

What Causes Reflux?

What To Do About It?

General Considerations

Infants

What Other Treatments Are Available?

Zantac (generic: Ranitidine)

Natural Alternatives

DGL

Barley Grass

Melatonin?

Histamine?

Quercetin

Acupuncture

Nutritional Supplements

Surgery

Stay Informed.

Stay Healthy.

Resources

Is REFLUX Causing Your Child’s Asthma?

What is Reflux?

Simply stated, reflux – or Gastro-esophageal reflux (GER) – is the regurgitation of gastric contents into the esophagus, or even higher, into the mouth or nose (lovely image, no?).

How Does Reflux Cause Asthma?

Of course, what you want to know is:

Does MY Child Have Reflux ?

Two Common Tests:

Esophagoscopy

pH Probe

Treatment as a Diagnosis

Next week we will review the treatments for reflux – conventional and alternative approaches.

Stay Informed.

Stay Healthy.

Resources (this blog):