Truncal or Centripetal obesity is common in India. It increases the abdominal pressure and results increase in transient relaxation of lower esophageal sphincter. So this results in reflux of stomach acid to the esophagus. Prolonged reflux of acid may change the epithelial layer and mucosa of esophagus. In the west there is a increase in esophageal cancer in the last 20-30 years. These is mainly because of the food life-style and obesity.
As the food habits in India is changing the western pattern, similar increase in obesity and esophageal malignancy is to be expected in near future. So healthy food habits is the mainstay to fight both obesity, acidity and malignancy. Children are to be specially trained for healthy food habits; as obesity is also seen increasingly among them. The high fat, fructose and carbohydrate containing junk food needs to be avoided. Soft drinks and fructose containing drink increases the calorie intake.
Multiple factors results in acid reflux in both adults and children. Smoking is an important factor, as it decreases the saliva secretion in the oral cavity. Fat, chocolates and some citrus fruits cause relaxation of the lower esophageal sphincter resulting in acid reflux.
The treatment of acid reflux consists of both dietary changes and medications. Dietary modification consists (1) Avoid smoking, frequent tea and chocolates (2) Frequent small volume meals (3) dinner should be taken atleast 2-3 hous before sleeping and to walk atleast 30-45 minutes after the meals.
Many medications are available which suppress the acid secretion and increase the peristaltic movement of the esophagus and stomach. Medications should be preferable taken after the guidance of the doctors, as prolonged use of the drugs may results in few complications.
However there are few alarm symptoms when present, patient should consult a Gastroenterologist. These are (1) Upper gastrointestinal tract bleeding or passage of black tarry stool (2) Difficulty in swallowing (3) Weight loss > 5 kg (4) Family history of malignancy. Prolonged reflux of acid in esophagus results in few complication such as esophageal ulceration, esophageal stricture and raely esophageal malignancy. There are also chances of developing extra esophageal symptoms such as laryngitis, vocal cord inflammation, chronic cough and pneumonitis.
Recently the has been many advances in endoscopic diagnosis and management of acid reflux. Endoscopic is a commonly used diagnostic tool to see the esophagus, stomach and small intestine. High definition endoscopy can visualize the mucosal changes of acid reflux and can also grade the mucosal damage in the esophagus. Endoscopy is also very useful to screen esophageal and stomach cancer. Early esophageal cancer which has a very good prognosis can be only picked up by high definition endoscopy.
So more and more awareness is needed among the people for healthy food habits, weight control and screening techniques.