13 Possible Causes Of Acid Reflux (Heartburn): Physiology & Lifestyle, Prevention Tips Included

When it comes to acid regurgitation it refers to a situation where the material present in the stomach goes involuntarily into the mouth. Often this is a problem associated with gastroesophageal reflux. In particular, if the valve separating the esophagus from the stomach is severely damaged, the stomach juices can trace freely through the throat. The problem is particularly severe as it occurs during the night, causing sudden awakening. Among the possible complications of acid regurgitation are teeth damage, pneumonia and pulmonary fibrosis.

Possible Causes Of Acid Reflux (Heartburn)

What diseases can be associated with acid regurgitation?

The pathologies that can be associated with acid regurgitation are as follows:




1. Achalasia

Achalasia is a disorder of the motility of the esophagus. This condition is characterized by a perforated oesophageal peristalsis and the absence of the lower esophageal sphincter (muscle valve located between the esophagus and the stomach) during swallowing. Consequently, achalasia makes it difficult to transit food along the esophagus.

Achalasia is due to an alteration of the nerves that control the smooth esophageal musculature. It has been noted that people with this disorder have a decrease in the fibers and nerve cells surrounding the esophagus. This phenomenon causes insufficient stimulation. For this reason, the esophagus remains contracted, preventing swallowing. The exact etiology of acacia is not yet known. Occasionally, the disorder can be found in association with esophageal cancer and some infections, as in the case of Chagas disease. Achalasia can manifest itself at any age, but usually starts in the age of 20 to 60.

The symptoms of achalasia are:

Abdominal pain, flatulence, stomach burns, dysphagia, chest pain, upper abdominal pain, hemorrhage, nausea, throat node, obesity, weight loss, stomach pain, rheumatoid arthritis, regurgitation Acid, intense salivation, choking, cough, vomiting

The onset of esophageal achalasia is insidious and progression occurs gradually over months or years.The first symptoms are a growing difficulty in swallowing solid and liquid foods (dysphagia) and the regurgitation of un-digested foodstuffs. This results in hypersalivation (excessive salivation), alytosis, pyrosis (retrosternal burning), frequent eruptions and choking. Undigested food regurgitation can cause coughing and aspiration attacks in the bronchopulmonary tree (abgestest pneumonia). Chest pain is less common, but may occur at swallowing or spontaneously. Over the years, achalasia involves weight loss, anemia and malnutrition.

With the progression of the disease, the esophagus can deform, stretch or stretch. Possible achalasia complications include gastroesophageal reflux disease and esophagitis. Diagnosis is generally defined by radiographic studies with barium, endoscopy and esophageal manometry.

Botulinum toxin injections and certain drugs (such as nitroderivatives and calcium antagonists) may be used temporarily for mild or moderate oesophageal achalasia. Alternatively, endoscopic therapy (esophageal dilatation with balloon) and some surgical procedures (such as Heller’s myotomy, surgery involving the sectioning of the muscular layer at the base of the esophagus) may be indicated. Patients with achalasia also exhibit a slight increase in the risk of developing neoplastic processes at the esophagus level. Therefore, your doctor may periodically recommend endoscopic controls for the prevention and early diagnosis of esophageal cancer.

2. Diphtheria

Diphtheria is an acute infectious disease, very contagious, caused by a gram-negative bacterium called Corynebacterium diphtheriae. Depending on the bacterial strain involved, diphtheria may affect renal pharyngeal (respiratory diphtheria) or the skin. Some strains of C. diphtheriae, moreover, once entered our body, produce a toxin that can cause inflammation and necrosis of local tissues and organs, including the heart, nerves and kidneys. Diphtheria is transmitted by direct contact with an infected person (respiratory droplets, contact with nasopharyngeal secretions or infected skin lesions) or by contact with contaminated objects.

The symptoms of diphtheria are:

Lowering of the voice, afony, anorexia, anuria, arrhythmia, asthenia, shivering, dysphagia, dysphonia, dyspnoea, edema, erythema, pharyngitis, fever, tingling of the legs, hypotension, swollen lips, enlarged lymph nodes, sore throat, Swelling of the throat, numbness or swelling in the neck, nausea, odyphagia, oliguria, paralysis of vocal cords, throat plaques, proteinuria, colds, rhinoceroses, acid regurgitation, rhinorrhea, urine blood, choking, stroke, tachycardia, coughs, nasal bleeding, vomiting. Symptoms of diphtheria vary depending on the infection site and the infectious strain (i.e. if the latter is or is not oxygen). After an incubation period of 2-7 days, oropharyngeal infections occur with sore throat, loss of appetite, fever and irritation of the external nostrils and upper lip.

Diphtheria-infectionIf a toxin-producing strain is involved, within 2-3 days, patients develop on the surface of the tonsils and throat the characteristics of pseudomembranous plaques (diphtheric membranes) of gray, inflamed, fibrinous and adherent margins. Local edema may cause a visible swelling of the neck (bull neck), hoarseness, sore throat and dyspnoea. In addition, tachycardia, nausea, vomiting, chills, headache and respiratory tract obstruction (for postponement of diphtheria) may occur.

Diphtheria skin formations, on the other hand, causes variable skin lesions. Some patients show skin ulcers that cause pain, erythema and exudate. Others present gangrenous manifestations. Diphtheria usually has a benign course, but in some cases cardiac and neurological complications may arise. At the heart rate, ventricular arrhythmias may develop with complete cardiac arrest, myocarditis, and heart failure. The toxic effects on the nervous system, however, result in loss of ocular accommodation, palatal paralysis, dysphagia, reflux in the nasal cavities during swallowing and peripheral neuropathy (both motor and sensitized).

Diphtheria diagnosis is based on clinical examination and is confirmed by Gram’s coloring studies for bacterial research. Differential diagnosis is related to bacterial and viral pharyngitis, infectious mononucleosis, oral syphilis, and candidiasis. Therapy involves the administration of antidipteric serum (neutralizes diphtheria toxins still circulating in the body) and antibiotics such as penicillin or erythromycin. Diphtheria prevention is based on vaccination with the trivalent vaccine against diphtheria, tetanus and pertussis (DTP). For this reason, diphtheria is now rare in developed countries.

3. Esophageal diverticula

Esophageal diverticula is a squash extroflexion of the esophagus mucosa, communicating with the lumen of the organ. To make the idea, they resemble small pockets, similar to those left by a finger pressed from the inside against the walls of a malleable tube.

Esophageal-diverticulaThere are several types of esophageal diverticula, each with a different origin. First of all, they can be distinguished in congenital (i.e. present from birth, very rare condition) or acquired. Acquired esophageal diverticula may be pulse and traction. Pulse drivers are due to increased endoluminal pressure, associated with disorders of esophageal motility.

From this binomial, a gradual mucous and subcutaneous extroflexion is produced through a weakening area of ​​the muscular wall of the esophagus. Zenker’s diverticulum is the most common driving impulse. Traumatic diverticula, however, extend to the entire thickness of the esophageal wall and are due to secondary scarring phenomena to inflammatory processes that have affected the organs near the esophagus (e.g. bronchopneumonia).

The symptoms of esophageal diverticula are:

Lowering of the voice, halitosis, anorexia, dysphagia, hematemesis, piceal stools, mediastinitis, melena, throat node, weight loss, gastrointestinal perforation, pneumomediastin, raucedine, acid regurgitation, rumination, muscle spasms, coughing.

Esophageal diverticula may be asymptomatic or cause alopecia, dysphagia (difficulties during swallowing) and other problems. The stagnation of ingested food inside the diverticular pocket, for example, can give rise to regurgitation episodes when the patient bends forward or relaxes. If the regurgitation is at night, abgestive pneumonia may occur. Possible complications are the onset of inflammation and infection, in addition to perforation of the diverticulum itself. If the diverticulum pocket reaches large dimensions, a palpable swelling on the neck may occur.

Esophageal diverticula are diagnosed with Rx with barited meal. Esophagus-gastroscopy can also be of great help. Usually, no specific treatment is required, although surgical resection is sometimes required for large or symptomatic diverticula. Remember that this is not an exhaustive list and it would be better to consult your own trusted physician if symptoms persist.

4. Zenker’s diverticulum

Zenker’s diverticulum is a pouch-like formation, which can be found in the back wall of the pharynx just above the esophagus. In this case the ingested food stops, so the digestion is slowed down and the bolus tends to go back up. Zenker’s diverticulum is the consequence of a weakening of the muscular wall: an increase in internal pressure on the organ can induce a gradual extraflexion through the area that with a weaker lining. In the onset of the disorder, the anomalies of the esophageal peristalsis can also contribute, which normally facilitates the passage of food into the stomach.

The symptoms of Zenker diverticulum are:

Halitosis (fowl breath), anorexia, retrosternal burning, dysphagia, dyspnoea, chest pain, stomach pain, upper abdominal pain, hemorrhage, mass or swelling in the neck, nausea, throat nose, weight loss, rhinitis, acid regurgitation, choking, cough, vomiting. Zenker‘s diverticulitis can cause dysphagia, which is a difficulty during swallowing or a feeling of obstruction, as food finds an obstacle to its descent. In addition, food regurgitation events may occur when the patient bends forward or relaxes. Other manifestations include halitosis and tightness in the chest. Zenker’s diverticula may occasionally cause breathing problems, as the food, coming upwards, causes a feeling of suffocation. If the regurgitation is at night, an ab ingestis pneumonia may occur.

Possible complications are the onset of inflammation and infection, due to the foods introduced that accumulate at the level of Zenker’s diverticulum. In rare cases, it may be the perforation or bleeding of the same. Frequently, the diverticulum pocket reaches such dimensions as to feel a cervical mass at the palpation.

Diagnosis is obtained by radiography with contrast medium, endoscopy and esophageal manometry. Zenker’s diverticulum is usually surgically removed because it tends to grow in volume and makes it harder to feed.

5. Hiatal hernia

Hernia is the protrusion of an organ or tissue outside the body cavity that hosts it. Thus, hernia is the partial or complete protrusion (or herniation) of the stomach through the healed esophageal, a small diaphragm hole that allows the passage of the esophagus. This organ is linked to the stomach through a region called lower esophageal sphincter (LES), home to a complex valve form capable of preventing gastric uplift in the esophagus.

The symptoms of Hiatal hernia are:

Arophagia, anorexia, bitter mouth, retrosternal burning, stomach burns, bad digestion, contagious dysphagia, dyspnoea, chest pain, stomach pain, upper abdominal pain, sternum pain, gastrointestinal bleeding, epigastralgia, Haemorrhage, extrasystoles, pharyngitis, picea stools, nausea, stomach heaviness, acid regurgitation, intense salivation, salivary blood, swollen stomach, tracheitis, vomiting

Generally, small hernias at an early stage do not cause any particular symptoms. However, when the stomach portion is large, the gastric uptake in the esophagus causes symptoms such as burning, regurgitation, and chest pain in the retrosternal area. When symptoms are severe, they often occur, or are accompanied by coughing, dyspnoea, asthma, sore throat, difficulty swallowing or chest pain, it is good to report it promptly to the treating physician.

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Indigestion (or dyspepsia) indicates a sudden and transient disorder of digestive functions, which implies a series of more or less severe intensity symptoms. Often, it is one of the most immediate consequences of a too substantial meal, especially if it is based on foods that are difficult to digest, such as fried, intingules and fats. At the base of an indigestion there may also be excessive consumption of carbonated and alcoholic beverages. Indigestion also causes the introduction of too hot or too cold foods or beverages or unleavened products. Sometimes, the disorder is due to the consumption of ‘new’ foods in relation to their habits. Even stress, some drugs (e.g. non-steroidal anti-inflammatory drugs, iron, etc.) and cigarette smoking may predispose to digestive disorders.

In case the indigestion is not sporadic, but a recurring problem, it may indicate the presence of more serious illnesses. Indeed, it can also be found in the case of gastroesophageal reflux, cholecystitis, gastritis, pancreatitis, gastric ulcer or duodenal ulcer disease.

Down, stomach burns, abdominal cramps, stomach cramps, stomach pain, upper abdominal pain, epigastral pain, haemorrhage, abdominal swelling, headache, nausea, stomach hemorrhage, acid regurgitation, bloating, cold sweating, vomiting

Symptoms usually appear one or two hours after the meal and are mostly due to the upper abdomen. When the stomach works to digest, it tells you in a variety of ways, for example with pain (cramping, dull or burning) and tension located at the upper abdomen, but also with a sense of heaviness and stomach burning, regurgitation of juices Acids, nausea, vomiting, dyspnoea and eruptions. These symptoms can be accompanied by cold sweating and headaches.

In case of sporadic indigestion, it is possible to use antacid drugs, which can neutralize the excess of gastric acid, favor digestion, and thus relieve painful symptoms. If you have to repeat yourself frequently, your doctor may advise specific and more powerful medicines (such as proton pump inhibitors) after careful examination and due diligence.

To prevent an indigestion, simply follow a few simple rules: consume the meals in peace, chewing each bite well and avoiding the binge.

6. Food intolerance

Food intolerance is an adverse reaction of the organism to certain foods. Unlike what happens in food allergies, this reaction does not depend on the abnormal activation of the immune system with its antibodies. Moreover, it is less severe, it manifests itself gradually and is proportional to the amount of food that is ingested (almost as if the organism ‘gets intoxicated’). We can therefore consider eating intolerance as a malaise that is triggered by the ingestion of particular foods, including common use, such as wheat, dairy products and eggs.

Food-IntoleranceThere are several types of food intolerances. Those enzymes are determined by the inability to metabolize some food components. The most common enzymatic intolerance is that of lactose contained in milk. Another example of intolerance due to the deficiency of an enzyme is favism. Intolerances may also occur due to the presence in some food substances of a pharmacological activity (or produced by the intestine from them), such as vasoactive amines (e.g., histamine and tyramine), caffeine and ethyl alcohol.

Food additives (flavor enhancers, sweeteners, preservatives, etc.) are also often involved. Probably there is a predisposition to inherited inherited intolerances, but other factors such as illnesses, stress, unbalanced diet and changes in the intestinal bacterial flora may also contribute to it.

Food intolerance can be manifested in acne, anorexia, asthenia, increased appetite, weight gain, tongue bubbles, tongue tongue, stomach burns, dizziness, bad digestion, colic, abdominal cramps, stomach cramps, depression, diarrhea, difficulty concentrating, dyspnea, Abdominal pain, flatulence, abdominal swelling, abdominal gorgoglia, faecal incontinence, insomnia, thinness, stomach ache, headache, meteorism, nausea, dry skin, itching, colds, abdominal distension, Acid regurgitation, water retention, drowsiness, constipation, bloatingIn case the indigestion is not sporadic, but a recurring problem, it may indicate the presence of more serious illnesses. Indeed, it can also be found in the case of gastroesophageal reflux, cholecystitis, gastritis, pancreatitis, gastric ulcer or duodenal ulcer disease.

The symptoms of food intolerance are:

Down, stomach burns, abdominal cramps, stomach cramps, stomach pain, upper abdominal pain, epigastral pain, haemorrhage, abdominal swelling, headache, nausea, stomach hemorrhage, acid regurgitation, bloating, cold sweating, vomiting, acne, anorexia, asthenia, increased appetite, weight gain, tongue bubbles, tongue tongue, stomach burns, dizziness, bad digestion, colic, abdominal cramps, stomach cramps, depression, diarrhea, difficulty concentrating, dyspnea, abdominal pain, flatulence, abdominal swelling, abdominal rumbling, faecal incontinence, insomnia, thinness, stomach ache, headache, meteorism, nausea, dry skin, itching, colds, abdominal distension, acid regurgitation, water retention, drowsiness, constipation, bloating.

Symptoms usually appear one or two hours after the meal and are mostly due to the upper abdomen. When the stomach works to digest, it tells you in a variety of ways, for example with pain (cramping, dull or burning) and tension located at the upper abdomen, but also with a sense of heaviness and stomach burning, regurgitation of juices Acids, nausea, vomiting, dyspnoea and eruptions. These symptoms can be accompanied by cold sweating and headaches.

In case of sporadic indigestion, it is possible to use antacid drugs, which can neutralize the excess of gastric acid, favor digestion, and thus relieve painful symptoms. If you have to repeat yourself frequently, your doctor may advise specific and more powerful medicines (such as proton pump inhibitors) after careful examination and due diligence.

To prevent an indigestion, simply follow a few simple rules: consume the meals in peace, chewing each bite well and avoiding the binge.

Food intolerances can cause many recurrent and persistent disorders, especially in the gastrointestinal, dermatological or respiratory tract. Unlike allergies, the symptoms do not manifest violently immediately after ingestion of foods, but may occur over time. As for the digestive system, abdominal swelling, flatulence, abdomen, appetite or excessive appetite, nausea, constipation or diarrhea and prolonged or difficult digestion can occur. In addition, food intolerance can cause water retention, sudden changes in weight, hyperacidity, gastritis, irritable bowel syndrome or colitis.

Among the respiratory manifestations of food intolerance are colds and other recurrent airway infections. From a dermatological point of view, dermatitis, urticaria, acne and other skin rashes can develop. In addition, dizziness, headache, drowsiness, chronic fatigue, anxiety, insomnia, and mild depression may occur.




In the case of food intolerance it is necessary to eliminate a certain product for a few months, under medical supervision, the foods responsible for the disorder, replacing them with others capable of satisfying the nutritional requirements of the organism. After the withdrawal period, you may try to reintroduce these foods gradually into the diet.

7. Obesity

Obesity and overweight are disabling conditions and pose a high risk to health. Overweight and obesity is a cause of physical disability, reduced work ability, and predisposing the occurrence of many chronic diseases, such as cardiovascular and metabolic endocrine disorders, greatly reduce life expectancy. Obesity is a pathological condition that unfortunately appears to be steadily increasing, especially in western countries. The spread of this disorder has now become epidemic in many Western countries, but not only. The main causes of this spread are to be found mainly in eating habits characterized by a high energy consumption of food and sedentary nature.

Obesity and overweight There are in fact undeniable organic causes – hypothyrodism, inheritance and others – which predispose to obesity, but overall it is the ‘obesogenic environment’, understood as behavioral and nutritional factors that favor the greater incidence of the phenomenon and chronic Metabolic-metabolic alterations in overweight: diabetes, heart attack, osteoarthritis, sleep apnea syndrome, and some forms of cancer.

Dramatically, type 2 diabetes mellitus and some cardio-circulatory disorders, previously thought to be adult exclusive conditions, are increasingly common in obese children today. Infant obesity is not a problem at all. This condition is linked to clinical manifestations that occur early in the young age and can progress to real chronic illnesses.

The symptoms of obesity are:

Menstrual cycle changes, amenorrhea, arrhythmia, asthenia, increased appetite, weight gain, large child for gestational age, bromoidosis, decreased sexual desire, cardiomegaly, cardiopalm, catalase, swollen ankles, cruralgia, depression, erectile dysfunction Bladder dysfunction, dyspnoea, abdominal distension, knee pain, chest pain, hip pain, joint pain, postpartum hemorrhage, erythema, skin erosions, shortness of breath, swollen legs, tired legs, heavy legs, abdominal swelling, Insomnia, insulin resistance, hypercapnia, hyperphagia, hyperglycaemia, hyperhidrosis, hypertension, hypertriglyceridemia, hyperuricaemia, hypofertility, hypoxia, social isolation, lymphedema, back pain, decubitus wounds, uterine prolapse, pruritus, rheumatism,, Snoring, choking, nephrotic syndrome, drowsiness, chapped heels.

The consequences of obesity depend not only on the absolute amount of excess fat but also on its distribution. Excessive accumulation of body fat determines a series of short and medium-term consequences. Obesity has an increased risk of developing joint problems (back, knee and ankles), which can develop into arthrosis and circulatory disorders (such as venous and lymphatic edema, venous insufficiency, and cellulite). People with lots of extra pounds easily get breathless after a low-intensity physical activity and sweat profusely. If excessive fat at the neckline compresses airways while sleeping, an obstructive sleep apnea may appear. This disorder can cause snoring and excessive daytime sleepiness. Increased sweating and secretions in the skin folds make intertriginous infections and other skin disorders particularly common.

Obesity is also a risk factor for non-alcoholic steato-hepatitis (which can lead to cirrhosis of the liver) and reproductive system disorders such as low levels of testosterone in men and polycystic ovary syndrome in women. Excess weight also predisposes to gastroesophageal reflux, cholelithiasis, gout, deep venous thrombosis, pulmonary embolism, and various malignant tumor forms (especially colon and breast cancer). In the long term, obesity may predispose to dyslipidemia, insulin resistance and arterial hypertension (metabolic syndrome), often leading to type 2 diabetes mellitus and cardiovascular disease such as coronary heart disease, stroke and myocardial infarction. Obesity also leads to social and psychological problems.

The diagnosis is based on the body mass index (IMC, calculated by dividing the weight in kg per square of the height expressed in meters) and measuring the circumference of the waist. The World Health Organization (WHO) defines obesity with an IMC equal to or greater than 30. In some cases, the body composition analysis must be performed. Fasting blood glucose and lipemia should be systematically measured in patients with a wide waist circumference or a family history of type 2 diabetes mellitus or premature cardiovascular disease.

Obesity treatment consists in reducing body weight, under close medical supervision, following proper nutrition, and by carrying out a regular physical exercise program that is appropriate to your ability. In some cases, the use of drugs (e.g. sibutramine and orlistat) is foreseen. In patients with severe obesity, an alternative is bariatric surgery.

If not treated, obesity tends to get worse. After weight loss, most people return to pre-treatment weight within 5 years. Consequently, obesity requires a permanent management program similar to that of any other chronic disorder.

Regular exercise and healthy eating improve physical fitness, control weight and help prevent diabetes mellitus and cardiovascular disease. Good and good night-time rest, stress management and moderation in alcohol consumption can help improve general conditions.

8. Palatoschisis (cleft palate)

Palatoschisis is a congenital malformation (present since birth), characterized by the presence of a slit in the palate. This defect is the result of incorrect welding of embryonic sketches designed to form the palate, which normally closes around the end of the first trimester of gestation.

Palatoschisis (cleft palate)The possible causes of palatoschisis are many. Often, genetic and environmental factors such as alteration of specific genes, exposure to ionizing radiation, the intake of particular drugs, the inadequate supply of folic acid, the habit of smoking and the abuse of genes are implicated, as well as alcohol during the first weeks of pregnancy.

The symptoms of palatoschisis are:

Difficulty in speech, dysphagia, hypoacusia, dental malocclusion, micrognasia, acid regurgitation, growth delay, nasal voice, vomiting.

The palatoschisis usually appears as a more or less open opening of the front of the hard palate. In the most severe cases, the fissure can also reach the palatine vault, the soft palate and the nose. The cleft palate can be accompanied by labioschis. In this case, it is referred to labiopalatoschisis or cheilognatopalatoschisis.

The slit present in the palate involves full contact between the mouth and the nasal cavities. This interferes with the power supply (in particular, the normal suction mechanism is prevented), the use of speech, hearing, and tooth development. Palatoschisis increases the risk of middle ear infections, as mucus or saliva can invade the auditory canal. This malformation can also facilitate food intake in the respiratory tract, exposing the child to a high risk of bronchopulmonary infections (e.g. pneumonia ab ingestis).

The treatment involves several approaches, including the use of prosthetic devices and plastic surgery. Surgical repair of pancreatic is usually performed over time. The goals of the treatment consist in ensuring normal feeding, phoning and maxillo-facial development.

9. GERD (Gastroesophageal reflux)

Gastroesophageal reflux is the rise of the stomach acid content in the esophagus (normally prevented by a muscular ring separating the two organs). Gastroesophageal reflux episodes are very common and accompany symptoms such as heartburn, acidity and regurgitation of gastric contents, sometimes to the mouth. In some cases this situation is complicated, evolving into the so-called gastroesophageal reflux disease (GERD), the main symptom of which is retrosternal burning.

GERD symptoms are:

Lowering of the voice, afony, anorexia, bitter mouth, burning in the mouth, tongue burning, retrosternal burning, stomach burns, bad digestion, contagious stomach cramps, yellow diarrhea, dysphagia, dysgeusia, dyspnoea, chest pain, stomach pain, sore throat, wheezing, acid regurgitation, growth retardation, salivary blood, metallic taste in the mouth, stomach pain, stomach pain, flatulence, hiccups, drowsiness, muscle spasms, stinging, night sweating, coughs, tracheitis, teeth wear, vomiting.

The rise of the gastric juice causes inflammation of the esophagus (esophagitis). Repeated acid insults may cause, in addition to the above mentioned symptoms, small lesions (up to the formation of true perforations – ulcers), narrowing (stenosis) of the esophageal lumen and, in some cases, metaplasia and neoplasms. It is important to talk to your doctor if the above mentioned symptoms occur with particular frequency, especially when associated with particularly dark and catastrophic stools.

10. Scleroderma

Scleroderma is a chronic inflammatory disease of the connective tissue. It is characterized by an abnormal thickening of the skin, with the involvement of other organs (especially the lungs, the heart and the digestive system). Pathophysiological mechanisms at the base of scleroderma include alterations in blood vessels (vascular damage) and hyperactivation of fibroblasts, with hyperproduction and deposition of collagen in tissues (diffuse fibrosis).

However, the exact causes are still unknown. Probably, immunological, genetic and environmental factors, such as exposure to toxic substances (organic solvents, silica, vinyl chloride, bleomycin, etc.) are implicated. Scleroderma is more frequent in women and generally affects subjects between the ages of 20 and 50. It is rare in children.

SclerodermaSystemic sclerosis varies by gravity and course.

There exist, in fact, such as:

  • Limited cutaneous form or CREST syndrome (acronym for Calcinosis, Raynaud phenomenon, changes in Esophageal motility, Sclerodactyla and Telangiectasia). It is characterized by gradual onset, with the involvement of the skin and slow progression before the onset of a visceral disease.
  • Diffused form. Rapidly progressive and often fatal, with generalized skin thickening and early involvement of internal organs. Scleroderma may overlap with other autoimmune rheumatic diseases (e.g. mixed connects).
Scleroderma symptoms include:

Alopecia, anorexia, arrhythmia, asthenia, dry mouth, swollen arms, calcinosis, cardiomegaly, decreased sweating, skin discoloration, dysphagia, dyspnoea, chest pain, spleen pain, joint pain, muscle aches, edema, eosinophilia, hand tingling, hypertension, hypomimia, macrocytosis, dry skin, weight loss, pneumothorax, rheumatism, joint rigidity, acid regurgitation, sclerodactygia, ocular dryness, raynaud syndrome, telangiectasia, cough, cutaneous ulcers. Among the most common symptoms of scleroderma there include: hardening and thickening of the skin, Raynaud’s phenomenon, diffuse articular pains, dysphagia, pyrosis (heartburn) and contracted fingers.

Disease often begins at the level of the hands, especially of the fingers (sclerodactyly), to extend to other areas of the body. The skin becomes tense and shiny, hypopigmented or hyperpigmented. It also has hair loss in the affected areas, adherence to the underlying tissues and gradual disappearance of the wrinkles. Frequent ulcerations on the knuckles and the distal extremities of the fingers (fingertips). In addition, subcutaneous calcifications may develop, typically, above the joints or bone projections. On the fingers, on the chest, on the face, on the lips and on the tongue appear teleangectasia (small vessels that become visible on the skin), while the nails are affected by capillary anomalies. As regards joints, polyartralgias are frequent, the progressive limitation in the movements and contractures of the fingers, wrists and elbows.

Occasionally, early manifestations may consist of respiratory symptoms (e.g., dyspnoea) or gastrointestinal disorders (e.g. acid reflux, difficulty swallowing food, slow intestinal motility with digestive problems, malabsorption, and diverticula). The involvement of lungs, heart and kidneys is responsible for most deaths. Pulmonary fibrosis may affect gaseous exchanges and evolve toward respiratory failure. Both pulmonary hypertension and heart failure may develop. Cardiac arrhythmias and pericarditis may also be present. Disease can also result in renal involvement, causing mild chronic kidney failure or severe acute renal failure.

Diagnosis is clinically relevant, but serum autoantibodies and other laboratory tests make it easier to confirm. The treatment is directed to the control of the symptoms and complications of the disease.

11. Zollinger-Ellison syndrome

Zollinger-Ellison syndrome is a serious pathological condition characterized by increased secretion of gastric acid, peptic ulceration and marked hypergastrinemia. These phenomena are secondary to the presence of a gastrin secreting tumor (gastrinoma) located in the duodenal wall, pancreas, abdominal lymph nodes or, rarely, in ectopic sites (heart, ovary and liver). In about 75% of cases, Zollinger-Ellison syndrome is sporadic but may also be associated with multiple endocrine neoplasia 1 (MEN1), which depends on specific genetic mutations transmitted by dominant autosomal mode. Usually, Zollinger-Ellison syndrome is diagnosed between 30 and 50 years of age.

The typical aspect of Zollinger-Ellison syndrome is the presence of numerous recurrent and / or conventional gastric and duodenal ulcers.

Other symptoms include:

Anorexia, retrosternal burns, stomach burns, bad digestion, diarrhea, yellow diarrhea, abdominal pain, upper abdominal pain, hematemesis, gastrointestinal bleeding, hypokalaemia, mucorrhoea, nausea, weight loss, gastrointestinal perforation, acid regurgitation, steatorrea, vomiting (or hematoma), intestinal malabsorption and weight loss.

The symptoms that occur most frequently are upper abdominal pain, diarrhea, and gastro-esophageal reflux. Gastric hypersecretion often causes persistent burns of the stomach and can complicate peptic ulcer with hemorrhage and gastrointestinal perforation.

Initially, the diagnosis of Zollinger-Ellison syndrome is based on the clinical picture. Confirmation is obtained by measuring fasting gastrinemia (FSG) levels, which are almost always high, and by detecting a gastric pH below 2. To locate gastrinoma, also imaging (abdominal ultrasound Or endoscopic, computerized axial tomography and scintigraphy of the somatostatin receptor). The treatment involves short and long term control of gastric acid hypersecretion with proton pump inhibitors and histamine receptor H2 receptor antagonists.

Where possible, localized gastrinoma must be surgically removed. In the case of metastatic tumors, however, various approaches such as chemotherapy, embolization of hepatic neoplastic masses and more aggressive surgery may be tempted. In the absence of liver metastases, the prognosis is good, while the survival rate is reduced in the presence of multiple or poorly responsive tumors.

12. Fetal-alcohol syndrome

Fetal-alcohol syndrome is considered the most serious consequence of alcohol consumption during pregnancy. In fact, a teratogenic effect is attributed to ethanol, which is able to influence embryonic and fetal development. Alcohol is able to cross the placental barrier, so it reaches the fetus after a few minutes, maintaining a blood concentration slightly lower than that of the mother.

The fetus, having no enzymes suitable for metabolizing alcohol, is subject to the harmful effects of ethanol and its metabolites (such as acetaldehyde). The most serious consequences are at the level of the central nervous system and the tissues being formed. The magnitude of damage reported by the fetus is related to the frequency and amount of alcohol consumed. Exposure during the first trimester of pregnancy is more dangerous.

fetal-alcohol syndrome

The symptoms of fetal-alcohol syndrome:

Spontaneous abortion, eyestrain, aggression, gestational delay, blepharophyte, impulsive behavior, seizures, depression, difficulty concentrating, difficulty in speaking, learning difficulties, hip dysplasia, mood disorders, gastroschis, insomnia, myocardial infarction, hypoacusia, ipospadia, jaundice, macrocephaly, thinning, dental malocclusion, meteorism, microcephaly, microcaphnia, micrognathy, fetal death, nervousness, nystagmus, misaligned eyes, tremors, vomiting.

Fetal-alcohol syndrome is characterized by three groups of symptoms: morphological anomalies, pre- and / or post-natal growth defects and neuropsychological disorders. The child with fetal-alcohol syndrome may exhibit highly variable morphological abnormalities, affecting predominantly the face. Typical skull-facial dysphorphisms include: small and distant eyes, short and flat nose, jaw and mandibular hypoplasia, short eyebrows and thin upper lip. Eyebrows can also be seen in the back, palatoschis, strabismus and eyelid ptosis.

The delay in growth is manifested with values ​​lower than the average for height, body weight and cranial circumference. Fetal-alcohol syndrome may also involve heart dysfunction, urogenital tract alterations, joint and vertebral abnormalities (e.g., hip dysplasia and scoliosis), gastrointestinal problems and other malformations.

The child with fetal-alcohol syndrome also manifests central nervous system dysfunction with behavioral disorders and cognitive and motor development deficits. Cognitive alterations are very variable: some are noticeable early, others manifest only when more complex processes are required. Sleep disturbances, improper sucking, uncontrolled crying, hearing and speech disorders can occur. With age progression, irritability, restlessness, hyperactivity, attention deficit, learning delay, low school performance, and poor social adaptation can be evident.

The diagnosis involves the assessment of the exposure to alcohol. Fetal-alcohol syndrome is irreversible, but can be avoided with absolute abstinence from alcohol during pregnancy.

13. Esophageal spasm

Esophageal spasm is a disorder of motility affecting the esophagus. In this pathological condition, normal peristalsis of the esophagus is replaced by vigorous, painful and non-propulsive muscular contractions. Sometimes these spasms are associated with alterations in tone and coordination of the lower esophageal sphincter (muscle valve located between the esophagus and the stomach). The causes that cause esophageal spasm are not yet known.

The symptoms of esophageal syndrome are:

Retrosternal burns, stomach burns, dysphagia, chest pain, upper abdominal pain, haemorrhage, nausea, throat nodule, obesity, acid regurgitation, choking, vomiting.

Esophageal spasm typically manifests with oppressive retrosternal pain, with sudden onset, which lasts for a few minutes. This painful feeling can be aggravated by the ingestion of very hot or cold fluids and during exercise. Moreover, it may awaken the patient during sleep. The pain can be so intense that it can be mistakenly mistaken with a heart problem (sometimes it is indistinguishable from angina pectoris). In case of esophageal spasm, dysphagia (difficulty in swallowing solid and liquid foods) and regurgitation of un-digested food may also occur. Over many years, esophageal spasm may evolve to achalasia.

The diagnosis is based on endoscopic examination and esophageal manometry (a tube is introduced through the nose that measures the pressure of the esophagus and the regularity of its peristalsis). Treatment of esophageal spasms involves the intake of specific drugs such as muscle relaxants, which can relax the muscles involved in swallowing. In some cases, injections of botulinum toxin in the lower esophageal sphincter, balloon dilatation or surgical myotomy are indicated.

Conclusion

An adequate lifestyle can help alleviate the problem. It is better to avoid too heavy meals, foods that favor acid secretion in the stomach, to sleep immediately after eating. However, a heartburn generally indicates an already quite compromised situation, and sometimes even the drugs normally used to reduce gastric acid seem to serve to fight it. In these cases, it may be necessary to intervene surgically to repair the damaged valve.

avoid too heavy mealsHeartburn is a serious problem requiring consultation with a physician as soon as possible. You can contact a healthcare center if you are worried about your inconvenience or have trouble even though you have tried to treat yourself and if you feel that the inconvenience is disturbing everyday life.

You should contact a healthcare center if you are: Are over 45 years old and have not had heartburn and sore throats earlier Have a big trouble with the heartburn Have difficulty swallowing or that the food sticks when swallowing, especially if the inconvenience is new Have heartburn and lose weight Previous treatment has been received but the inconvenience does not decrease. You should contact your health immediately if you have heartburn and a lot of pain in your stomach or chest, or if the stool is black.