Human head lice are tiny, wingless ectoparasites that choose humans exclusively for their real estate needs. That means your child can get lice, but your dog cannot. Like all parasites, these human-centered bugs need a host to survive. Some parasites infect the blood or GI tract, but lice prefer to hang out in the yard rather than inside the house. The “ecto” part of being a parasite means your head lice companions only live on the outside of your body. In the case of head lice, it is the hair on your head. Lice infestation is called pediculosis.

Three types of lice infect humans. In addition to head lice, there are body lice and pubic lice. Each type of lice has evolved to live in its perspective environment. Lice on your head will not infect your body. Lice on your body will stick to your clothes, and pubic lice stay in the pubic region, although in rare cases, pubic lice may find their way to other course hair. Head lice, the most common of the three types, is rarely a cause for concern and will be the primary type covered in this writing. 

Types of Lice

All lice are parasitic and need a human host to survive. None of the three types can fly or jump and therefore require direct contact to infest another person. Head, body, and pubic lice share the same life cycle: egg (or nit), nymph, and adult. Head lice and body lice are the same genus but different species. Think same household but not the same person. They are kind of like siblings. Pubic lice, colloquially called crabs, are from a separate family entirely. They are more like a neighbor. All three types of lice are treatable. 

Pubic lice (Pthirus pubis)

Pubic lice spread through sexual activity and are considered a sexually transmitted infection. Hygiene habits do not affect your chances of contracting pubic lice. Those with good hygiene are just as much at risk of getting it as those with poor hygiene. Pubic lice do not transmit other illnesses, but intense itching can lead to excessive scratching and damaged skin that, in rare cases, may become infected.

Body lice (Pediculus humanus corporis) 

Body lice, not to be confused with bed bugs, spread when noninfested items such as blankets or clothing come into contact with infested belongings. These tiny pests prefer to spend their time on clothing, climbing onto their human host only when ready to take a blood meal. They are the only type of lice that can transmit other diseases. Lice-borne illnesses often follow body lice outbreaks. Unlike head lice, crowded and unhygienic conditions attract this type of lice.¹ In the United States, individuals who reside in homeless shelters or other cramped living conditions are at the most significant risk of contracting body lice. 

Head lice (Pediculus humanus capitis)

Head lice are the most common type of lice and live out their entire lives in human hair. There are six to twelve million cases of head lice every year in the United States, with most of those cases in children between the ages of three and eleven.² Poor hygiene has no effect on you or your child’s chances of becoming infested. Head lice do not care if you bathe regularly or not at all. It spreads from direct head-to-head contact and, less commonly, from sharing hats, brushes, coats, or scarves.ⁱⁱ

Symptoms of Head Lice

Head lice are itchy and embarrassing but not dangerous. Although uncomfortable, there is no reason to panic if your child has head lice. Intense itching is usually as bad as it gets. When lice feed, they inject saliva before dining on your blood. The saliva initiates an allergic reaction, and itching ensues.³ In rare situations, all that scratching can break your skin and results in a secondary infection.

Some lice infestations, especially if it is your first, are asymptomatic or cause only mild itching. Your body’s allergic reaction to the bites may not be as strong. However, the simple act of these unwelcome guests and all six of their legs crawling around can still leave you scratching your head, and not because you’re thinking. 

If your child is complaining of an itchy scalp or rubbing their head frequently, take a close look at their hair. You might uncover some visual cues that head lice have found their way onto your kid. Dandruff or other hair product residue can be mistaken for lice eggs, but eggs remain close to the scalp and will not wash out. 

Although there are over-the-counter medications for ridding yourself of head lice, consulting a doctor is a good choice for accurate diagnosis and treatment if you suspect lice. A trained physician can examine pictures or videos and evaluate symptoms to determine if your suspicions are correct. They can recommend the best course of treatment based on your child’s age and the severity of infestation. 

Lifecycle of Headlice

According to the CDC, head lice go through three phases during their lifetime.⁴ The initial stage is an egg, followed by the nymph, and then finally an adult. The entire lifecycle exists only in human hair, which can be long or short. Hair only needs to be long enough to support the eggs, which require about a fourth inch of length.  

Nit (Egg)

The youngest form of lice is the egg, also known as a nit. Nits are hard to see and can easily be mistaken for dandruff. An adult female will lay her nits at the base of the hair, where it will stay warm, around a fourth of an inch from the scalp. The female louse affixes her nit to the shaft of the hair, ensuring it is safe and secure for the next six to nine days until it hatches. Nits are oval-shaped and 0.8 mm long. Once hatched, nit casings remain attached to the hair but are more obvious to spot due to a color change. 

Nymph

Nymph is the next phase of the head lice lifecycle. Upon hatching, nymphs have all the same features as their adult counterparts but are much smaller, starting about the size of a pinhead. Nymphs go through three stages, shedding their skin each time before becoming an adult about seven days after hatching. 

Adult

Once fully grown, an adult louse will be about the size of a sesame seed and similar in color. Females are larger than males, and both sexes will appear darker on individuals with darker hair. They have six legs with claws on each to grasp the hair and move about their environment. 

Females can lay roughly six nits per day and live an average of 30 days. That means female lice can lay up to 180 nits in their lifetime. Adults need to feed multiple times per day and do not live long if they are not in their preferred habitat. If not safely roaming about your hair, lice will die within two days without a blood meal. 

How is Lice Transmitted? 

Lice can only move by crawling. They travel most efficiently using their clawed legs to grip hair and maneuver around. They cannot fly and do not jump, nor live long off the human head. Close and consistent contact is usually required for lice to spread from child to child. In most cases, direct head-to-head contact is necessary. Less typically, sharing hats, clothing, or brushes may spread lice. 

Most lice that find their way to your clothes are too weak to hold onto your hair, indicating they are sick or elderly and unlikely to infect others.⁵ Activities like hugging and cuddling allow healthy lice to crawl from one head to the other, which is a far more efficient mode of transmission than from shared clothing. 

Some studies have shown that girls are more likely to get head lice than boys. Although their long hair is a common conclusion for this, a more likely scenario is that girls engage in closer physical contact than boys.⁶ Additionally, lice happily exist in short hair. Lice usually stay close to the scalp where it is warm and their food supply is nearby. They do not need long hair for that. 

Diagnosing Head Lice Infestation

Head lice misdiagnosis. Anyone without experience can easily mistake dandruff or other dried hair products for lice. The best way to determine if someone is infested is to look for lice moving within the hair. You should see them crawling around before assuming your child has an infestation. However, seeing active lice can be challenging, especially in milder cases. They move fast to avoid light. If you pull out the flashlight to inspect your child’s itchy head, you might not see anything if all the lice scatter into the shadows. 

Sometimes using a magnifying glass along with a flashlight can increase your chances of seeing these tiny ectoparasites. Although lice are big enough to be seen by the naked eye, about the size of a sesame seed, a magnifying glass can be a helpful tool. Some physicians may use a Wood’s light, which illuminates the lice when used in a dark room.⁷ Most doctors can diagnose infestations without any unique light sources. 

You can also check for nits. Even though nits without active lice do not indicate a current infection, it gives you some information to bring to your doctor. Unlike dandruff or hair product buildup, nits are secured to the hair shaft no more than one-fourth inch from the scalp. Nits without live lice indicate an old and no longer active infestation. These do not require treatment.

Contact a doctor if you suspect your child has lice. Take pictures and videos of anything you see and document your child’s symptoms. You have several treatment options that will change depending on your child’s age. Your doctor will be able to diagnose lice, develop a care plan, and provide any necessary prescriptions. 

How to Treat Head Lice

You do not need to worry about catching other illnesses from your unwelcome residents, but you do need to evict them. Fortunately, there are several effective treatment options, and many of them only require one application. All household members should be screened for head lice. Anyone who has an active infestation will need treatment. Those who are not infested do not need prophylaxis. Although shaving your child’s head is an effective way to eradicate lice, it is unnecessary. The embarrassment of a shaved head, particularly in girls, far exceeds any benefit from such an extreme reaction. 

Blankets, Linens, and Stuffed Animals Exposed to Head Lice

Before initiating treatment, wash all bed linens, clothes, and stuffed animals that have come into contact with the infected individual. There is no need to do anything beyond setting your washer and dryer to the hot setting. Lice and their nits are killed when exposed to temperatures of 128.3 degrees Fahrenheit for a minimum of five minutes.⁸ Items that cannot be laundered can be sealed in a plastic bag for two weeks or soaked in hot water for 10 minutes. 

For furniture, rugs, or carpet, a quick vacuum will suffice. Remember, lice do not spread easily without direct head-to-head contact. It is unnecessary to use fumigant sprays because lice are not that resilient once they have lost the protection of your hair. Fumigating your house would be a massive overreaction to something that is more of a nuisance than anything else. 

Ovicidal Versus Non-Ovicidal Medications

After tossing a load of laundry in and soaking hairbrushes in hot water, you can start treating the individual with head lice. There are several over-the-counter and prescription pediculicides (medicines that kill lice). Pediculicides come in two varieties: ovicidal and non or weak ovicidal. An ovicidal will kill nits, while the non or weak ovicidal will only kill the nymphs and adults. 

Non or weak ovicidal pediculicides require a second application nine to ten days after the first to kill any lice hatched after the initial treatment. Ovicidal pediculicides usually require just one use because they kill active lice and their nits. Your doctor will help you determine the best medication for your situation. 

Over-the-Counter Lice Treatment

Pyrethrin is a type of head lice medication extracted from a species of flowers from the chrysanthemum family. Pyrethrin is combined with piperonyl butoxide to make the medicine more lethal to lice. Permethrin lotion 1% is similar to pyrethrin; however, it is manufactured in a lab rather than extracted from a flower. Both types of medications are non or weak ovicidal, and FDA approved for children two and older.

Prescription Lice Treatment

Benzyl alcohol lotion, 5%, is a non-ovicidal formula approved for children as young as six months of age. Because of its non-ovicidal status, second treatments are often necessary.

Ivermectin lotion, 0.5%, is also non-ovicidal, but it seems to prevent newly hatched nymphs from surviving. Therefore second treatments are rarely needed. Ivermectin lotion, 0.5%, is approved for children six months and older. 

Malathion lotion, 0.5%, is a partial ovicidal and requires a second treatment only if active lice are spotted after seven to nine days. This medication is approved for children six years and older. 

Spinosad 0.9% topical suspension is an effective ovicidal that does not require retreatment when used correctly. Spinosad 0.9% topical suspension is approved for children as young as six months old. 

Nit Comb

A nit comb is a small comb with thinly spaced teeth designed to pull lice eggs (nits) and lice out of hair. Using a nit comb can be helpful when utilized along with lice shampoo, especially with non or weak ovicidal shampoos. Nit combs as the only method of lice removal is usually ineffective. 

How do You Know if Head Lice Medication Worked? 

Whether the medication you chose was purchased at your local grocery store or prescribed by your doctor, follow the instructions. Each product will have clear directions provided with the package. Contact your doctor for clarification if you do not understand the package insert. Be aware that longer hair may require a larger dose, not a stronger prescription, to ensure all hair is covered. 

Check your child’s hair around eight to twelve hours after completing head lice treatment. You should see mostly dead lice with the possibility of a few slow-moving ones. If you do not see any dead lice and they are still actively enjoying life on your child’s head, you may need a different medication. Do not treat again. Your lice may be resistant to the medicine you used. Consult your healthcare provider to determine your best option moving forward. 

Retreatment is necessary seven to nine days after the first round when using non or weak ovicidal shampoos. Other medications may require retreatment only if live lice are still present after one week. The instructions for your lice shampoo will tell you whether you will need more than one application. Each medication has different requirements. If you are unclear about how yours works, your doctor is available to help. 

No Nit Policy

A no nit policy is a policy in which children are removed promptly from class if infected with lice and not allowed to return until no nits are present in the child’s hair. This policy is likely ineffective at preventing the spread of lice and is not supported by the American Academy of Pediatrics or the National Association of School Nurses.⁹ Here is why: 

•        Many visible nits are too far from the scalp to be viable

•        Nits are attached to the shaft of the hair and do not come off and infest other children

•        Other hair residues can easily be mistaken for lice or nits

•        Nits are often identified by school officials and not healthcare professionals increasing the chances of misdiagnosis

No nit policies are based on a misunderstanding of lice and how they are transmitted. Lice are not dangerous, do not spread disease, and require relatively close and consistent contact to get from your child to another. Children identified at school as having lice should be allowed to finish the day and return after treatment has started. 

Virtual Appointments for Head Lice Diagnosis and Treatment

If you think you have lice, don’t be alarmed. Lice infestations are not a big deal. It is itchy, creepy, and no one wants it. But it is not dangerous. Lice will not transmit disease and are harder to spread than you think. It is easy to treat and clears up quickly. Maybe not quick enough if it is your head they have found, but you can usually get most of these wingless parasites killed within a day. 

If someone in your household has lice check everyone else for it, but you can skip your furry family members. Pets cannot get lice. Any member without an infestation can forgo the medicated shampoo. The house does not need to be turned upside down, looking for every last louse that might have made its way to the couch. Lice are not happy unless they are inhabiting human hair, and if they can’t hold on to your hair, they are probably too weak to set up a party in someone else’s. 

We know your time is limited and that you can’t spend it worrying about a few bugs that have taken over your kid’s hair. Our skilled doctors can quickly diagnose and treat your lice with a quick and easy virtual appointment. You don’t have to wait until Monday to schedule a visit or drag your lice to a doctor’s office. Instead, take care of this harmless pest in the comfort of your own home and contact us today.

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^[1] Powers J, Badri T. Pediculosis Corporis. Nih.gov. Published March 19, 2019. https://www.ncbi.nlm.nih.gov/books/NBK482148/

^[2] CDC – Lice – Head Lice – General Information – Frequently Asked Questions (FAQs). Center for Disease Control and Prevention. Published September 17, 2020. Accessed March 28, 2022. https://www.cdc.gov/parasites/lice/head/gen_info/faqs.html

^[3] Prevention C-C for DC and. CDC – Lice – Head Lice – Disease. http://www.cdc.gov. Published September 11, 2019. Accessed March 28, 2022. https://www.cdc.gov/parasites/lice/head/disease.html

^[4] CDC – Lice – Head Lice – Biology. Published 2019. Accessed March 28, 2022. https://www.cdc.gov/parasites/lice/head/biology.html

^[5] Nash B. Treating head lice. BMJ. 2003;326(7401):1256-1257. doi:10.1136/bmj.326.7401.1256

^[6] CDC – Lice – Head Lice – Epidemiology & Risk Factors. Published 2020. Accessed March 28, 2022. https://www.cdc.gov/parasites/lice/head/epi.html

^[7] Al Aboud DM, Gossman W. Woods Light (Woods Lamp). PubMed. Published September 30, 2021. Accessed April 15, 2022. https://www.ncbi.nlm.nih.gov/books/NBK537193/

^[8]  CDC – Lice – Head Lice – Treatment. CDC. Published 2019. Accessed April 11, 2022. https://www.cdc.gov/parasites/lice/head/treatment.html

^[9] Prevention C-C for DC and. CDC – Lice – Head Lice – Schools. http://www.cdc.gov. Published April 17, 2019. Accessed March 28, 2022. https://www.cdc.gov/parasites/lice/head/schools.html

Although the first influenza virus was not isolated until the 1930s^[1], there is evidence that influenza coexisted with humans long before we knew what it was. Historians have documentation of a likely influenza outbreak as early as 1510, but researchers believe it has been hanging around with humans since the 9th century.^[2] Perhaps the most infamous influenza outbreak was the 1918 pandemic, sometimes referred to as the Spanish flu. However, “Spanish flu” is a misnomer resulting from Spain’s frequent press coverage of the deadly illness, which gave the erroneous impression Spain suffered more from the pandemic than other countries.^[3]

Now influenza is worldwide, with outbreaks in the United States occurring every winter. Influenza’s presence during colder months is not because it prefers snow sports over sunbathing but because of human proximity. It is easier for the virus to get from person to person when everyone is indoors trying to stay warm. The closer you are to someone who hurls the virus at you through a sneeze, the more likely you will become infected. 

Once infected, most people mistake influenza for a bad cold, but some will become quite ill beyond a runny nose, headache, and fever. For many, the influenza virus is nothing more than a minor nuisance, but this single-stranded RNA virus causes hundreds of thousands of hospitalizations each year and thousands of deaths every flu season.^[4] If you don’t care about the flu, you ought to. As common as it is, you will likely become ill with influenza or care for someone with it sooner or later. 

Influenza Symptoms 

The influenza virus can be mild to severe, with the really young and really old being most at risk of severe disease and associated complications. Not everyone who becomes infected with the virus will have the same symptoms. Influenza causes upper respiratory infections, usually involving the nose and throat, but sometimes infects the lungs. 

Symptoms of influenza are: 

•        Fever

•        Cough

•        Sore throat

•        Runny nose and nasal congestion

•        Muscles and body aches

•        Fatigue

•        Headache

It is common to have influenza without a fever, and many individuals will only have a couple of the listed symptoms. However, some unfortunate people will exhibit all of the symptoms. In some cases, you may experience vomiting or diarrhea, but these uncommon manifestations tend to occur only in children. If your child experiences diarrhea and vomiting due to influenza infection, pay attention to signs of dehydration. Dehydration is already a risk of influenza due to possible fluid intake reduction and fevers contributing to water loss.

On average, initial symptoms present two days after exposure but range from one to four days. Flu symptoms last around five to seven days but can be shorter if you have had the flu shot or longer if you have complications. You are at risk of complications if you have certain underlying conditions like asthma, diabetes, kidney disease, cancer, or HIV/AIDS. Due to well-known health disparities, like lower vaccination rates, racial and ethnic minorities are at a greater risk of hospitalizations, ICU admissions, and death associated with influenza.^[5]

Complications of Influenza

Most people who contract influenza will recover without issues. Children under two and adults over 65 are at greater risk of experiencing severe flu disease. Women who are pregnant, those with a high BMI, and anyone with a compromised immune system has an increased risk of influenza-associated complications. 

Minor influenza complications include sinus or ear infections and dehydration. Although dehydration is generally not serious, it can become dangerous if untreated. It is essential to maintain fluid intake if you are sick with influenza and seek treatment if you exhibit symptoms of dehydration. Sinus and ear infections can be uncomfortable but are usually not dangerous and are easy to treat. 

The most common types of serious influenza-associated complications involve the pulmonary system.^[6] Primary viral pneumonia occurs when influenza infects the lungs, and secondary bacterial pneumonia occurs when your lungs become infected with bacteria. Influenza can also exacerbate chronic lung conditions. 

In some instances, very rare but serious neurological conditions like Reye’s syndrome and Guillain-Barre syndrome can transpire with influenza infections.^[7] Additionally, acute myocarditis, or inflammation of the heart, is a well-known complication associated with the influenza virus. Although myocarditis can be deadly, it is difficult to determine how many people who contract the flu also experience this heart condition because it is often asymptomatic. 

Cold Versus Flu

People with mild cases of influenza often mistake it for a simple cold. The only way to truly know if you have influenza is through laboratory testing. However, several characteristic differences between these two common illnesses provide clues to which one you have.

The onset of a cold tends to be gradual, while flu symptoms will take over suddenly. Fevers are rare with a cold but common with influenza, although not everyone with the flu will get a fever. Body aches tend to be mild with a cold but common and sometimes intense with the flu. Chills with or without fever are rare if you have a cold but can be expected with flu viruses. You may feel fatigued or weak with a cold, but fatigue and weakness occur much more frequently with influenza. 

Upper respiratory symptoms like sneezing, runny nose, congestion, and sore throat are all standard with a cold but only occur some of the time in individuals with influenza. You may have a mild cough that accompanies your cold, but a cough with the flu can be rather severe. Lastly, it is uncommon to have a headache with your cold but common among those who contract the flu. 

Causes of Influenza

There are four types of influenza: influenzas A, B, C, and D. Influenza A and B are the types responsible for seasonal epidemics or flu season. Influenza C infections are limited to minor upper respiratory infections in children, while D prefers to infect cattle and not humans. Influenza A and B circulate during flu season and infect five to twenty percent of the United States population during these annual epidemics.^[8]

Influenza A

Influenza A is the predominant type and causes most cases of flu. A wide variety of birds can become infected with it, ensuring worldwide prevalence. Because of the large reservoir in wild birds, influenza A also has ample opportunity for different subtypes to coinfect a single bird and reassort into new subtypes. 

Influenza A has two proteins on its surface, hemagglutinin (H) and neuraminidase (N). There are 18 H subtypes (H1 through H18) and 11 different N subtypes (N1 through N11). Each H and N subtype can reassort into new H and N combinations. Reassortment occurs when two different influenza viruses simultaneously infect a single host and share their genetic data. So far, 130 distinct reassortments have been identified, with most occurring in wild birds.^[9]

Currently circulating human subtypes are H1N1 and H3N2. Subtypes can be broken down further into groups and subgroups (also called clades and subclades) based on their gene sequences. Small changes in these sequences occur over time as the virus replicates until your immune system no longer recognizes it. At this point, the virus has effectively evaded immunity, which is bad for humans but good for the virus from an evolutionary standpoint.  

Although influenza A and B both cause epidemics, influenza A is the only known type of flu virus that causes pandemics. An epidemic happens when an infectious disease spreads throughout a community during a particular time. A pandemic is an epidemic that spreads beyond a specific region and into other countries or continents. Pandemics happen when a new virus or bacteria emerges that can spread efficiently and to which humans have little or no immunity. 

Some well-known and well-documented influenza pandemics caused by type A influenza are:^[10]

•        H1N1: 1918, causing 50 million deaths globally and 675,000 in the US 

•        H2N2: 1957, causing 1.1 million deaths globally and 116,000 in the US

•        H3N2: 1968, causing 1 million deaths globally and 100,000 in the US

•        H1N1: 2009, causing 151,700 to 575,400 deaths globally and 12,469 deaths in the US^[11]

Influenza B

Influenza B is not broken down into subtypes but into lineages and then further divided into groups and subgroups (or clades and subclades). There are two influenza B lineages: Victoria and Yamagata. Type B evolves slower than type A and does not cause pandemics but is still responsible for seasonal epidemics. Influenza B infects just humans and seals,^[12] which is a much smaller reservoir than the wide variety of birds that carry influenza A. The inability of type B to cause pandemics may be partly due to the limited reservoirs available to the influenza B virus, therefore creating fewer opportunities for mutating into new or novel strains. 

How Influenza Spreads

Influenza is a highly infectious virus with a reproductive number, R0 (pronounced R naught), between one and two.^[13] This means that for every one person infected, they infect one or two others. R0 is the average number of cases caused per one infected individual and is a way to estimate the contagiousness of an infectious disease. 

The flu spreads when droplets from an infected person exit through the mouth or nose and find their way to a healthy individual. If the viral-laden droplets make it into an uninfected person’s nose, mouth, or eyes, they may become sick with influenza. People carrying the flu virus can infect others up to six feet away.^[14]

Less commonly, flu can spread through fomites (surfaces) such as doorknobs or utensils. If a child with the flu sneezes into their hand and then touches a toy, they may deposit viral particles onto the surface. If a healthy parent later picks up that toy and then touches their nose, mouth, or eyes, they can potentially innoculate themselves with the flu virus and cause an infection. 

Once infected with influenza, you are most contagious during the first few days after symptoms commence but can infect others one day before becoming sick and up to seven days after. Asymptomatic infections, or infections that do not present with symptoms, occur in about half of influenza cases and can still spread the disease.^[15] Asymptomatic and pre-symptomatic transmission should be considered when evaluating influenza prevention strategies. 

Diagnosing Influenza

If you have influenza symptoms like a headache, fever, and cough during influenza season, there is a good chance you have contracted influenza. However, flu can present outside of influenza season, and other respiratory viruses can mimic the flu. Your doctor cannot say for certain if you have influenza based on symptoms alone. A definitive flu diagnosis requires diagnostic testing. 

In most cases, resting at home is sufficient to recover from flu-like illnesses, and clinical tests are unnecessary. If your doctor needs to know if you are infected with the influenza virus, there are several tests they can perform. Some flu tests offer quick results but may miss positive samples, while others may take longer to receive a result but are unlikely to give a false negative. 

Rapid influenza diagnostic tests are the most widely used method to detect influenza infections, and just like the name suggests, they provide prompt results, usually within fifteen minutes. These relatively low-cost tests are quick and easy to use, making them simple enough for a nurse to perform right in the clinician’s office. The drawback is that rapid tests are generally less sensitive than ones sent to a lab and conducted by trained laboratory scientists. 

Less sensitive tests are more likely to miss true positive results, which means a sick patient may be told they are negative for influenza when they in fact do have the disease. Doctors are aware of the sensitivity and consider it when diagnosing and treating their patients. Your doctor may choose to initiate treatment, especially if you are high-risk, even if a rapid test yields a negative result. Your doctor can also send your sample to the lab for more sensitive testing. 

RT-PCR (reverse transcription-polymerase chain reaction) tests are sensitive enough to detect influenza in most positive samples and specific enough to determine negative results in most samples where the influenza virus is absent.^[16] These molecular tests tend to be more expensive and take longer due to the necessity of sending them out to a lab with PCR testing capabilities. 

Treating Influenza Infections

For healthy individuals who do not fall into a high-risk category treating symptoms at home is usually adequate. Continue to drink plenty of fluids and eat enough to satiate hunger. Although over-the-counter medications and other symptom-reducing methods won’t shorten the duration of your illness, they may make you more comfortable. Ibuprofen and acetaminophen can help with headaches, fevers, and sore throats. Talk to a doctor before administering any medication to children or if you are taking something for the first time. Adults and children can continue normal activity levels if they feel well enough but should avoid people to prevent spreading the virus. 

There is no cure for the flu virus, and it cannot be treated with antibiotics. However, antivirals may be indicated for some patients with underlying conditions. Antivirals are most effective when initiated within 48 hours of symptom onset. You should contact a doctor if you have flu-like symptoms and are immunocompromised or considered high-risk. It is also important to speak with a doctor if your symptoms are not improving or are unusually severe. Seek immediate medical help if you are lethargic, losing consciousness, or having trouble breathing. Infants under three months should see a doctor straight away if they have a fever of 100.4 or higher. 

Preventing Influenza Transmission

Obtaining an annual flu shot is the best way to protect yourself and others from contracting influenza. In addition to your flu shot, practicing appropriate health and hygiene habits can decrease your chances of becoming sick this flu season. The flu virus changes every year, rendering your immunity from the last flu season, whether induced by a vaccine or naturally acquired from infection, unable to fight off this year’s strain. 

Although most individuals with influenza recover just fine, certain demographics are at risk of serious complications or death. Protecting yourself from contracting the flu means you are also protecting those at serious risk of influenza complications. The most effective and simplest way to protect yourself and others is to get your flu shot every year. 

The Annual Flu Shot

The best prevention for influenza is the annual flu shot, which protects against both A and B types. Scientists and public health officials study influenza patterns and strains to predict which ones will cause the next seasonal flu outbreak. Because the flu virus changes frequently, a new flu shot is developed each year to ensure efficacy. 

Getting your flu shot before flu season is in full swing gives you the most out of your flu shot. Vaccination before the end of October gives your immune system plenty of time to build up antibodies against the flu before the virus spreads throughout the community. However, flu activity can last into May, so a flu shot later in the season will still benefit you. 

Everyone over six months should get an annual flu shot, with rare exceptions. Talk to a doctor if you are unsure if the flu shot is right for you or your child. If you live with or care for someone in which the flu shot is contraindicated, prioritize your flu shot to diminish your chances of bringing the virus home to your loved one. 

People over 65 years of age may benefit from a type of flu shot with increased potency. Older individuals do not always elicit as robust of an immune response as their younger counterparts. Scientists have designed flu shots specific for the geriatric population to ensure a safe and effective vaccine. Talk to a doctor to determine if the higher potency flu shot is right for you. 

Healthy Habits to Avoid Getting the Flu

The flu virus can transmit when you touch contaminated surfaces and then touch your face. Wash your hands often with soap and water during flu season. If soap is unavailable, use an alcohol-based sanitizer. Refrain from touching your eyes, nose, or mouth with unwashed hands, and avoid close contact with anyone who has flu-like symptoms. Frequently clean high-touch surfaces such as doorknobs, children’s toys, utensils, or countertops to reduce fomite transmission. 

More commonly, flu spreads through droplets discharged from infected individuals into the air. If you have flu symptoms, stay home. If you must leave your house, wear a mask and always cough or sneeze into your elbow or a tissue. Although the probability of getting the flu, spreading it, or becoming severely ill from it significantly decreases after a flu shot, you can still catch and share it with others. 

Don’t underestimate maintaining your overall health. Engaging in healthy habits like staying active, prioritizing adequate sleep, and eating right may improve your ability to fight off cold and flu viruses. If you are a smoker, consider quitting. Consume alcohol in moderation and avoid second-hand smoke. 

Contact our Qualified Physicians if You Have Questions About Influenza 

Influenza is found across the globe and has the potential to infect every one of us. Humans have lived with it for centuries and will continue to live with it for centuries more. Although scientists and public health officials believe another deadly influenza pandemic is likely, unlike in 1918, we now have better treatments, effective vaccines, and a concrete understanding of transmission. Seasonal influenza outbreaks and future pandemics should be taken seriously but not feared. 

With the correct information and access to knowledgeable doctors, you have the capacity to make good choices for your family, slow influenza transmission, and reduce the chances of severe illness. From the basics of hand washing to the science of vaccines, annual influenza outbreaks are manageable. Remember to take care of your health, get your flu shot, and contact one of our doctors to learn more about the influenza virus and how you can protect yourself this cold and flu season.

References

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^[1] CDC. Influenza Historic Timeline. Centers For Disease Control and Prevention. Published 2019. Accessed May 2, 2022. https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm

^[2] Morens DM, North M, Taubenberger JK. Eyewitness accounts of the 1510 influenza pandemic in Europe. The Lancet. 2010;376(9756):1894-1895. doi:10.1016/s0140-6736(10)62204-0

^[3] CDC. Partner Key Messages on the 1918 Influenza Pandemic Commemoration | Pandemic Influenza (Flu) | CDC. http://www.cdc.gov. Published November 29, 2018. https://www.cdc.gov/flu/pandemic-resources/1918-commemoration/key-messages.htm

^[4] Centers for Disease Control and Prevention. Disease burden of influenza. Centers for Disease Control and Prevention. Published 2019. Accessed May 2, 2022. https://www.cdc.gov/flu/about/burden/index.html

^[5] O’Halloran AC, Holstein R, Cummings C, et al. Rates of Influenza-Associated Hospitalization, Intensive Care Unit Admission, and In-Hospital Death by Race and Ethnicity in the United

^[6] Rothberg MB, Haessler SD, Brown RB. Complications of Viral Influenza. The American Journal of Medicine. 2008;121(4):258-264. doi:10.1016/j.amjmed.2007.10.040

^[7] Rothberg MB, Haessler SD, Brown RB. Complications of Viral Influenza. The American Journal of Medicine. 2008;121(4):258-264. doi:10.1016/j.amjmed.2007.10.040

^[8] Hale D. Nfluenza 101. Home Healthcare Nurse. 2014;32(9):525-530. doi:10.1097/nhh.0000000000000137

^[9] CDC. Types of Influenza Viruses. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/flu/about/viruses/types.htm

^[10] CDC. Influenza Historic Timeline. Centers For Disease Control and Prevention. Published 2019. https://www.cdc.gov/flu/pandemic-resources/pandemic-timeline-1930-and-beyond.htm

^[11] CDC. 2009 H1N1 Pandemic (H1N1pdm09 virus). Centers for Disease Control and Prevention. Published June 11, 2019. https://www.cdc.gov/flu/pandemic-resources/2009-h1n1-pandemic.html

^[12] Valesano AL, Fitzsimmons WJ, McCrone JT, et al. Influenza B Viruses Exhibit Lower Within-Host Diversity than Influenza A Viruses in Human Hosts. Journal of Virology. 2020;94(5):e01710-19. doi:10.1128/JVI.01710-19

^[13] Biggerstaff M, Cauchemez S, Reed C, Gambhir M, Finelli L. Estimates of the reproduction number for seasonal, pandemic, and zoonotic influenza: a systematic review of the literature. BMC Infectious Diseases. 2014;14(1). doi:10.1186/1471-2334-14-480

^[14] CDC. How Flu Spreads. Centers for Disease Control and Prevention. Published 2019. https://www.cdc.gov/flu/about/disease/spread.htm

^[15] Cohen C, Kleynhans J, Moyes J, et al. Asymptomatic transmission and high community burden of seasonal influenza in an urban and a rural community in South Africa, 2017–18 (PHIRST): a population cohort study. The Lancet Global Health. 2021;9(6):e863-e874. doi:10.1016/s2214-109x(21)00141-8

^[16] Information on Rapid Molecular Assays, RT-PCR, and other Molecular Assays for Diagnosis of Influenza Virus Infection. Published 2019. https://www.cdc.gov/flu/professionals/diagnosis/molecular-assays.htm

Vomiting is the involuntary expulsion of your stomach contents out of your body through the mouth. Throwing up is usually partnered with nausea, but not all nausea will result in vomiting. Rarely does vomiting present without nausea. By itself, it is not a disease but rather a symptom of an illness, syndrome, or other condition. Throwing up is an uncomfortable process for anyone to go through. Fortunately, most cases are self-limiting and occur infrequently. 

Vomit, throw up, hurl, puke, heave. No matter what you call it, the fact remains, it’s a terrible but usually harmless ordeal. However, if you are throwing up, one day of puking seems to last an eternity. Most people will bear through a puke session at some point in their life. There are many reasons humans, and even animals, vomit. The process of forcefully losing your last meal out the wrong end of your gastrointestinal tract can feel as though your body has betrayed you. Your body, however, has its reasons, and we will cover some of them here.

Seek medical attention if vomiting follows a head injury, you have a high fever, stiff neck, severe abdominal pain, difficulty breathing, altered mental state, lethargy, bleeding (blood in vomit), or worsening symptoms. If you have questions about the severity of your symptoms or any other concerns, knowledgeable doctors are available and happy to assist you.

Viral Gastroenteritis (Stomach Bug)

Gastroenteritis is inflammation in your stomach and intestines. If a virus is the cause of your intestinal inflammation, it is called viral gastroenteritis or, informally, a stomach bug. If you or someone you care for has viral gastroenteritis, you will likely notice watery (non-bloody) diarrhea, nausea, vomiting, stomach cramps, mild muscle aches, and low-grade fever. The most common viruses that cause vomiting are adenovirus, norovirus, and rotavirus. 

Adenovirus

Adenovirus is responsible for several infections, including the common cold and pink eye. The kind of infection you get from adenovirus will depend on the type of adenovirus you were exposed to. Gastrointestinal upset is one of the more miserable illnesses it causes. Although anyone can fall ill from adenovirus, infections are more common in children than adults. 

Norovirus 

Norovirus is a highly infectious virus that frequently causes gastroenteritis. It can take just a few norovirus particles to make a person sick. Once infected, you can shed billions of these particles.^[1]  Norovirus comes in various strains that can infect people of all ages multiple times throughout their lives. 

Rotavirus

Rotavirus can be severe enough in children to require hospitalization due to dehydration. Infants and children are most likely to get rotavirus. However, adults can contract this illness, but it tends to be milder. Children are eligible for a two or three-dose rotavirus vaccine starting at two months of age. The rotavirus vaccine is effective at preventing severe disease. 

How to Treat a Stomach Bug

Lots of rest and supportive care while letting the virus run its course is usually sufficient for treating a stomach bug. It is crucial to replenish fluid loss due to vomiting or diarrhea. When your stomach settles and your appetite returns, start with small amounts of bland food. 

If you suspect you are suffering from viral gastroenteritis but are unsure how to manage it best, schedule a visit with a doctor. Your physician can provide appropriate information that may help your recovery and support you in seeking further care, if necessary.

Migraines

Migraines are intense headaches with symptoms severe enough to be debilitating. You will likely experience more than just a headache if you have a migraine. Migraines often come with dizziness, nausea, vomiting, weakness, and photophobia (light sensitivity). They can last hours to days and occur as frequently as once per week or more in extreme cases. Migraines don’t discriminate between age, race, gender, or economic status. People of all backgrounds are affected by these unbearable headaches. 

Migraines can present in four stages. You may experience a prodrome stage where you notice early warning signs of an impending migraine, followed by the aura stage, then the headache, and lastly, a postdrome period. Not all migraine sufferers will move through each phase. 

Prodrome

During the prodrome stage, you might notice subtle warning signs indicating a migraine is on its way. You may feel tired, anxious, or irritable. Picking up on these early signals can be helpful to treat your headache preemptively. Some patients find a migraine journal worthwhile to discover if they have a prodrome phase and what it looks like for them. Identifying prodrome symptoms can allow for early treatment in hopes of thwarting an approaching headache. 

Aura

The neurological symptoms during an aura phase are usually visual, such as vision loss or seeing bright flashes of light. Some auditory or hearing disturbances may also occur during this time. The aura stage directly precedes the headache. 

Headache

A severe headache, usually on one side and often throbbing, is the hallmark of migraines. The pain associated with migraines can last hours or days and is intense enough that you are unlikely to continue normal activities during this time. It is common for nausea and vomiting to accompany migraines. Additionally, you may become unable to tolerate light, sounds, or certain smells. 

Postdrome 

During the last stage of a migraine, you may feel exhausted or depressed. You may also have residual nausea, dizziness, and photophobia. Some patients call this a migraine hangover and report that it can last up to a day after the headache. Not everyone will have a prodrome period.  

Treatment

The goal is to prevent migraines from occurring or stop them once they start. Pain-relieving medications attempt to end the headache after it begins, while preventative medications aim to avert future attacks. A wide range of drugs are available to manage these migraines and related symptoms—everything from botulinum toxin injections to blood pressure medications. Even antidepressants have shown to be a valuable tool for migraine frequency reduction. Patients can also take antinausea meds to reduce the unbearable nausea that regularly comes with migraines.

Journaling your symptoms and activities in the days leading to migraines may add valuable information to your treatment plan. You may be able to identify catalysts that initiate your headaches. Once identified, trigger avoidance can result in an overall reduction of migraines. Journaling won’t work for everyone because not all migraines have triggers. 

Although the cause of migraines is not fully understood, facial nerves appear to harbor some responsibility. Doctors believe some of these nerves become compressed by surrounding structures. Releasing specific nerves shows efficacy for migraine treatment, particularly for patients who don’t respond to more conventional therapies. In one meta-analysis that reviewed studies from 2000 to 2020, up to 93% of patients who suffered frontal migraines reported satisfactory results.^[2] A frontal migraine is a headache that causes pain in the forehead or temples. 

Anxiety

Anxiety is an often overlooked cause of vomiting and nausea but affects a large portion of the population. Anxiety is a psychological response to stress that can lead to substantial physical symptoms. If you have anxiety, you might feel restless, tense, or have a sense of impending doom. Your heart rate can increase, you may begin rapid breathing (hyperventilation), sweat, tremble, and feel weak. Your symptoms may also involve the GI tract and cause nausea, vomiting, or diarrhea.  

When you endure intense anxiety, your body thinks it either needs to flee the situation or fight the danger. When fight or flight signals are received, your body’s nonessential functions, like digestion, shut down—the altered state of the GI tract can result in nausea. If the nausea is bad enough, you may vomit. 

It is normal to have anxiety in certain situations. If you are in danger or even just nervous about a first date, you might notice a rapid heartbeat or feel a bit nauseous. It is your body’s way of ensuring an appropriate response to a pending or current risky event. However, some people can suffer from excessive anxiety. If you have an anxiety disorder, your physical and emotional responses to situations are more intense than a typical reaction. 

Because of the physical symptoms of anxiety, doctors or patients might mistake it for another condition. Fortunately, anxiety is treatable through a multipronged approach. Therapy, lifestyle changes, and medication can all work together to alleviate your symptoms. Scheduling an appointment with a general practitioner is a sufficient starting point to determine if your nausea or vomiting could be due to anxiety.  

Cyclic Vomiting Syndrome

Cyclic vomiting syndrome is a condition in which the patient will encounter episodes of vomiting with periods of normalcy, or decreased symptoms, in between attacks. The vomiting can last hours or days. Vomiting incidents can occur regularly or appear at random. Doctors diagnose cyclic vomiting syndrome more often in children, up to 2,000 per 100,000, but data shows this syndrome may affect adults with the same frequency as children.^[3] Researchers believe it is a variant of migraines, and children diagnosed with it may grow into adults with migraines. 

Episodic vomiting in the absence of a cause is the primary feature of cyclic vomiting syndrome. If you are diagnosed with this syndrome, you may have abdominal pain, diarrhea, headache, and increased sensitivity to light or sound, in addition to nausea and vomiting. During periods of normalcy, you may also begin to feel anxious in anticipation of the next occurrence. In some patients, this can lead to depression and other mental health concerns. 

Treatment focuses on controlling symptoms and preventing future attacks. Antinausea meds and even some of the same medications used to treat migraines treat cyclic vomiting syndrome. Evidence-based guidelines sponsored by the American Neurogastroenterology and Motility Society (ANMS) and the Cyclic Vomiting Syndrome Association (CVSA) recommend tricyclic antidepressants as the first line of defense for prophylactic treatment in adults with cyclic vomiting syndrome. ^[4]

Alcohol Consumption

When consumed in moderation, most people will not have an issue with alcohol. However, if you consume a large amount in a short period, you can become sick and throw up. The intake of alcohol can be intentional through alcoholic beverages or from accidental ingestion of household products that contain alcohol. Vomiting is your body’s attempt at removing excess toxins from the alcohol. In most cases, and in the absence of accidental ingestion, you can let it run its course. Call poison control if you have consumed any household product not intended for consumption.

Why does alcohol cause vomiting? 

Alcohol is a toxin. When you drink it, your body gets to work right away to metabolize the alcohol using enzymes from your liver. Your liver breaks it down into acetaldehyde and then into acetate, which then converts into water and carbon dioxide that your body can remove.^[5]  Acetaldehyde is highly toxic. When breaking down alcohol, if acetaldehyde becomes too concentrated in your liver, your body cannot cope and reacts by inducing vomiting to remove the excess toxins. If you feel your drinking negatively impacts your health, you might benefit from meeting with a doctor to discuss your drinking habits.

Alcohol Poisoning Versus Excess Alcohol Consumption

Alcohol poisoning is different from having one too many drinks and vomiting a few times. Alcohol poisoning is a medical emergency that occurs when a person drinks, intentional or unintentional, a toxic amount of alcohol over a short duration. With alcohol poisoning, your body becomes overwhelmed by the process of breaking down alcohol, and your body’s compensatory actions become insufficient to clear the toxins safely. Symptoms of alcohol poisoning are:

• Vomiting
• Confusion
• Slow heart rate
• Irregular breathing 
• Seizures
• Being unconscious or unresponsive

Alcohol poisoning can also impair your gag reflex, making you more likely to choke on your vomit. If you suspect you or someone you are with has alcohol poisoning seek medical assistance immediately. 

Motion Sickness

Motion sickness occurs when movement results in physical illness. You may find that amusement park rides don’t agree with you, or you are always reaching for the brown vomit bag on airplanes. Even something as familiar as a car ride might send you into a hurling session. Motion sickness happens because your brain receives conflicting signals from your senses. If your brain cannot process the inconsistent information, you get sick. 

The Senses Involved in Motion Sickness

You have three senses responsible for telling your brain where your body is positioned in relation to everything else around you. These senses are your eyes, the inner ear system called vestibular apparatus, and receptors throughout your body called proprioceptors. Proprioceptors are present in your skin, muscles, and joints. 

If these three systems do not agree with where your body is or how your body is moving, your brain becomes confused, causing you to become sick. When driving in a car, your inner ear senses movement, but your proprioceptors are still. Your inner ear tells your brain you are moving, but your proprioceptors tell your brain you are not. Your eyes may agree with your inner ear or your proprioceptors, depending on where you are looking. 

What are the symptoms of motion sickness? 

Symptoms of motion sickness can mimic other illnesses but are distinguishable from alternative causes of vomiting because the symptoms present when your body is in motion and relent when the movement ceases. You may feel dizzy, nauseated, or irritable if you have motion sickness. You may also notice a headache or increased saliva, and you could throw up. People might mention that your skin looks pale or sweaty. 

How do I treat motion sickness? 

There are over-the-counter medications that can treat motion sickness. You can also try to relieve the disconnect between your body and your brain. If you find yourself fighting motion sickness whenever you get in a car, try to sit up front or look out a window. Looking out a window while moving allows your inner ear system and visual cues to be on the same page. Both tell your brain you are in motion. If the activity that causes your sickness is unnecessary to everyday life, avoidance can be an easy fix. Motion sickness should relent once the movement stops. 

Talk With a Doctor to Learn More About the Causes of Vomiting and How to Treat Them

Vomiting can present for many reasons. Stomach viruses are one of the more common causes. Fortunately, viruses are usually transient and clear on their own. Although migraines, or the potentially related cyclic vomiting syndrome, can be debilitating, they are not dangerous and are treatable. It may take some trial and error to develop something that works, but many who suffer from these conditions effectively reduce their symptoms with the proper treatment. Other reasons for vomiting, like excess alcohol consumption or motion sickness, can often be avoided. 

Throwing up is a distressing experience regardless of the cause. There is not much that feels as discordant as the forceful ejection of your stomach contents. Unfortunately, almost everyone will experience it in some capacity or another during their life. Schedule an appointment with a doctor if you are throwing up and unsure how to best treat your symptoms. Usually, all that is needed is a little rest and fluid compensation. If you need more extensive care, our doctors can prescribe medications or, if necessary, point you in the direction of additional treatment.  

References

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^[1] Centers for Disease Control and Prevention. (2021, March 5). About norovirus. Centers for Disease Control and Prevention. Retrieved February 18, 2022, from https://www.cdc.gov/norovirus/about/index.html 

^[2]  Lucia Mangialardi, M., Baldelli, I., Salgarello, M., & Raposio, E. (2020). Decompression surgery for frontal migraine headache. Plastic and Reconstructive Surgery – Global Open, 8(10). https://doi.org/10.1097/gox.0000000000003084 

^[3]  U.S. National Library of Medicine. (2020, September 8). Cyclic vomiting syndrome: Medlineplus Genetics. MedlinePlus. Retrieved February 15, 2022, from https://medlineplus.gov/genetics/condition/cyclic-vomiting-syndrome/#frequency 

^[4] Venkatesan, T., Levinthal, D. J., Tarbell, S. E., Jaradeh, S. S., Hasler, W. L., Issenman, R. M., Adams, K. A., Sarosiek, I., Stave, C. D., Sharaf, R. N., Sultan, S., & Li, B. U. (2019). Guidelines on management of cyclic vomiting syndrome in adults by the American neurogastroenterology and motility society and the Cyclic Vomiting Syndrome Association. Neurogastroenterology & Motility, 31(S2). https://doi.org/10.1111/nmo.13604 

^[5] U.S. Department of Health and Human Services. (2007, July). Alcohol metabolism: An update. National Institute on Alcohol Abuse and Alcoholism. Retrieved February 19, 2022, from https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm 

Most people, young and old, will experience some form of acid reflux in their lifetime. In most cases, it remains nothing more than an occasional nuisance. Acid reflux occurs when food and acid inside the stomach flow in the wrong direction. Also known as heartburn, it may be uncomfortable, but it is rarely a cause for concern. However, in some cases, acid reflux can be more than a minor irritation after over-indulging in a large meal. Acid reflux can progress into persistent discomfort that negatively impacts your life and requires treatment.

If you experience frequent acid reflux, you may have a condition called Gastroesophageal Reflux Disease, or GERD. You might have GERD if you experience symptoms of acid reflux at least twice per week.¹ In some cases, more severe symptoms less than twice per week will warrant treatment. GERD is diagnosed in approximately 20% of adults, making it one of the most common gastrointestinal disorders in the United States.² It is seen in patients of all ages, from infancy into the geriatric population, and can be mild to severe. 

What are the symptoms of GERD?

Symptoms of GERD vary between individuals. Someone with GERD may complain of one or two symptoms, while others may suffer from a majority of them. Because signs of GERD may be present in other conditions, it is essential to consult your doctor for a correct diagnosis. If you frequently encounter any of the following symptoms or often take over-the-counter medications for them, you should make an appointment with a doctor. 

•        Difficulty swallowing

•        Nausea or vomiting

•        Feeling as though there is a lump in your throat

•        Regurgitation of food or stomach acids

•        Frequent burping accompanied by a burning sensation

•        Chronic cough or laryngitis

•        New or worsening asthma symptoms

•        Chest pain

Obtain immediate medical attention if you have chest pain. It may indicate a heart attack. 

What causes GERD? 

Your esophagus is a hollow tube that connects your mouth to your stomach. It is closed off at the top, and the bottom by muscles called sphincters that act as one-way valves. After swallowing food, your muscles take over in a process called peristalsis. Peristalsis is the involuntary contraction of muscles that create a wave-like motion to move contents, such as food, in the right direction. During peristalsis of your esophagus, the sphincter muscles relax, allowing food to pass through the esophagus and into the stomach, but not the other way. 

In some people, the lower esophageal sphincter (LES) that separates the bottom of the esophagus from the stomach becomes weakened or intermittently relaxed. When this muscle relaxes, it no longer acts as a one-way valve, and acidic stomach contents flow up into the esophagus, causing acid reflux symptoms. Additionally, sometimes the pressure inside the stomach is greater than the pressure on the other side of the LES. When this occurs, gastric contents are driven into the esophagus. 

Although it is not known why some people develop GERD while others do not, several risk factors have been identified. ³

•        Alcohol use

•        Pregnancy

•        Obesity

•        Smoking

•        Hiatal hernia

•        Certain medications

•        Pregnancy

Some people will not have any of the risk factors listed above but encounter acid reflux severe enough to obtain a GERD diagnosis. Schedule an appointment with a physician if you have concerns about your risk factors.

Are there any complications? 

GERD is relatively easy to diagnose and treat, with most patients reporting an improvement in symptoms soon after treatment is initiated. If left untreated, the persistent backflow of stomach acid can affect your quality of life and lead to complications.⁴ It is important if you experience recurrent symptoms of acid reflux to schedule an appointment with a healthcare provider.

Esophageal Stricture

Esophageal stricture, or narrowing of the esophagus, results from scarring caused by persistent injury to the esophagus. Long-term GERD is the most common cause of esophageal stricture. Patients with esophageal stricture may not have any symptoms or could experience extreme discomfort depending on the severity of narrowing. 

If patients have symptoms, they may feel as though food is stuck in their throat, chest, or upper abdomen. They can also experience painful swallowing, regurgitation, and unintentional weight loss. Esophageal stricture can become so severe that it is difficult for the patient to consume liquids. It is commonly treated by dilating the esophagus as well as treating the underlying cause, which is often GERD.  

Esophagitis

Esophagitis is inflammation of the esophagus. Continuous exposure to acidic gastric contents irritates the esophagus lining, resulting in inflammation. When left untreated, esophagitis can lead to esophageal ulcers. Symptoms of esophagitis are similar to esophageal stricture. If esophagitis progresses to esophageal ulcers, patients may vomit blood in addition to the symptoms of esophagitis. Treating GERD will usually resolve symptoms. 

Barrett’s Esophagus

Barrett’s esophagus is a condition in which the tissue lining the esophagus is replaced by tissue similar to that which lines the intestine. In a small number of patients, this can lead to a type of esophageal cancer called esophageal adenocarcinoma. 

Barrett’s esophagus doesn’t cause symptoms, but patients with this condition often have GERD and the associated symptoms. Although not all patients with Barrett’s esophagus have GERD, long-standing GERD is the principal risk factor. The primary treatment is to control the acid reflux. In some cases, your doctor may recommend procedures to remove the abnormal tissue. 

How do I get a diagnosis?

A doctor can easily diagnose GERD by reviewing your symptoms and medical history. If you are experiencing heartburn more than twice per week, intense heartburn less than twice per week, or have any concerns about the severity or frequency of your symptoms, you should schedule a doctor’s appointment. Diagnosing GERD rarely requires further medical testing or procedures beyond evaluating symptoms. If your symptoms do not improve with treatment or your doctor suspects you have a complication of GERD, you may need diagnostic testing. 

Upper gastrointestinal (GI) endoscopy

During an upper gastrointestinal (GI) endoscopy, your doctor will insert a long flexible line with a camera attached to the end through your mouth and into your stomach. Depending on the level of sedation, you may not be awake during the procedure. Images from the camera are delivered to a screen for your doctor to see. 

The doctor can look at the internal structures from your throat down into your stomach. They can see if you have any esophageal damage or other complications of GERD. They can also take tissue samples, dilate a narrow area, or treat bleeding. After an upper GI endoscopy, you can return home. 

Esophageal pH monitoring

Esophageal pH monitoring measures how often stomach acid enters your esophagus and for how long it stays there. During the procedure, your doctor inserts a thin tube through your nose and into your esophagus. You will be given a small monitor, about the size of a cell phone, attached to the tube. 

The monitor will continuously measure the pH of your esophagus and record the data for 24 hours. You will have a journal to document when you have acid reflux symptoms, eat, or lie down. At the end of the 24-hour period, your doctor will remove the tube and collect the equipment and journal for evaluation.  

Manometry

Manometry is a procedure where your doctor threads a long, thin tube through your nose, down your esophagus, and into your stomach. The tube is sensitive to pressure and provides crucial information to your doctor about the muscles in your esophagus. Some patients feel discomfort during the tube’s insertion, which lasts about a minute. After data is collected, your doctor removes the line, and you are free to go home. A manometry takes around 40 minutes to complete, and you will be asked not to eat for several hours before the procedure. 

X-rays

Upper gastrointestinal (GI) tract x-ray is a non-invasive diagnostic test used to gather information about your upper GI tract. You will be asked to drink a chalky substance that creates contrast during the x-ray. This substance is called barium and is safe to drink while under the guidance of a doctor. Barium coats the inside of your throat, esophagus, stomach, and upper GI tract giving your provider a better x-ray image. The x-rays will require your stomach to be empty, so you will need to fast for several hours before your appointment. 

What are the treatment options for GERD?

Once you are diagnosed with GERD, your doctor will develop a treatment plan for you. GERD may improve with lifestyle changes, medications, or a combination of the two. In rare cases, surgery may be necessary. 

Lifestyle Modifications

Patients may see improvement in symptoms of GERD by decreasing their risk factors. In one study of 332 overweight adults who participated in a weight loss program, 81% reported improvement in their symptoms while 65% no longer had symptoms by the study’s end.⁵ Weight loss has many health benefits and should be part of your treatment plan if you are overweight and suffering from GERD. Acid-reducing medications can help manage symptoms while you’re supported during a proper weight loss plan. 

Many patients and their doctors report that smoking, alcohol, and certain foods aggravate GERD. If you or your doctor suspect diet could be exacerbating your symptoms, you might consider maintaining a food journal to try and identify triggers, if any. With a food journal, you will document all food and drink consumption alongside your symptoms and the time they occurred. You and your doctor can review your data for patterns. Smaller meals more often can also be beneficial. 

If your symptoms appear primarily at night, you may have nocturnal gastroesophageal reflux. In one study, 13% of respondents from a phone interview reported acid reflux symptoms only during the night.⁶ Reducing food intake several hours before sleeping and adjusting sleep positions may benefit patients with this kind of reflux. Elevating the head and torso enlists gravity’s help and could improve nocturnal gastroesophageal reflux symptoms. 

Medications

Stomach acid is vital to aid in digestion and keep bacteria under control. However, some people have to regulate their stomach acid to manage their GERD. There are three types of medications used to prevent gastric acid and treat reflux symptoms. They are PPIs, H2RAs (H2 blockers), or antacids. Each drug has a different profile and offers distinct benefits. 

The proper medication for you will depend on the duration and severity of your symptoms and requires a review of your health history. You should meet with a doctor before starting any medication for GERD to ensure your symptoms are caused by acid reflux disease. Your doctor can help you determine the best course of action for your situation.  

The most common class of medications used to treat GERD are proton pump inhibitors or PPIs.⁷ They improve esophageal healing with fewer relapses of symptoms compared to other medicines. As the name implies, proton pump inhibitors inhibit specialized stomach cells from pumping acid into the stomach, decreasing overall acidity. The reduction in acid improves reflux symptoms and promotes esophageal healing. Scientists designed PPIs to work as a preventative medication and require daily use for maximum benefits. They do not work as well when taken on demand for acute reflux. 

Medications like H2 blockers and antacids work better for acute treatment. H2 Receptor Antagonist, or H2 blockers, reduce the amount of acid in your stomach by interrupting a chemical signal that tells the acid-producing cells in your stomach to create more acid. Like PPIs, doctors also prescribe H2 blockers to treat symptoms and complications of GERD. 

Lastly, antacids are an effective option to relieve symptoms of heartburn that occur occasionally. Antacids work by neutralizing stomach acid. If you find yourself taking over-the-counter antacids often, you may need a stronger medication like a PPI or H2 blocker. 

Surgery

Your doctor may recommend surgery if lifestyle changes and medications do not reduce your symptoms to satisfactory levels.⁸ In some cases, your doctor may also support surgical intervention for GERD if you want to discontinue long-term GERD medication use. 

Fundoplication is the most common surgery used to manage GERD. It irreversibly modifies the structures of the stomach and esophagus to prevent gastric contents from entering the esophagus. During the surgery, your doctor folds the upper part of your stomach around the esophagus and sews it into place. The surgery is effective at reducing acid reflux and offers durable symptom relief. 

Can you prevent GERD? 

Prevention for GERD primarily focuses on the same lifestyle changes used to treat GERD. Remember, the esophageal sphincters act as one-way valves. Many ways to prevent GERD are based on reducing pressure to the lower esophageal sphincter (LES). The LES muscle can become overwhelmed by pressure, especially in patients prone to reflux. Relieving that pressure reduces your chances of experiencing chronic heartburn.

Maintain a Healthy Weight

Maintaining a healthy weight by making good food choices and staying active will decrease your chances of having GERD. The added weight of obesity puts pressure on your stomach, which can push stomach acid back up into the esophagus. 

Alter Your Eating Habits

Alter your eating habits to include several smaller meals instead of three big ones. Large meals fill your stomach enough to apply upward pressure against the LES muscle. The additional pressure can be enough that the LES can no longer prevent gastric contents from entering the esophagus. 

Don’t Eat Before Bed

Plan your dinner earlier to avoid bedtime with a full stomach. Skipping bedtime snacks means less food in your stomach at bedtime, decreasing the chances of food finding its way into the esophagus after lying down. Less food also puts less pressure against the LES, which helps diminish the likelihood of experiencing reflux in the night. 

Avoid Tight Clothing

Just like a full stomach and extra body weight, tight clothing applies pressure to the LES, increasing the chances of retrograde flow of stomach contents. Choosing clothes with loose waistbands and avoiding sinching your belt too tight may reduce your chances of acid reflux.  

Smoking

Smoking has been shown to contribute to acid reflux by promoting the LES’s relaxation and decreasing saliva production.⁹ Once the LES relaxes and reflux occurs, saliva can help clear stomach acid from the esophagus by flushing it back into the stomach. Saliva also contributes to neutralizing acidic gastric contents. 

What if your baby has GERD?

As with adults, GERD is one of the most diagnosed gastrointestinal conditions in the pediatric population. However, there are fundamental differences between how GERD presents in adults and how it presents in children. Infants have the most difference in symptoms. As infants age into toddlers and teens, symptoms present closer and closer to that of their adult counterparts. 

If your infant has GERD, they may arch their back, choke, gag, vomit, or have problems with swallowing. Your infant could also wheeze or develop a frequent cough. Additionally, they may refuse to eat or exhibit poor weight gain. Some infants spit up often without discomfort or cause for concern, but an infant with GERD may exhibit irritability accompanied by regurgitation. If your infant has any of these symptoms, a pediatrician should evaluate them to rule out other potential health concerns before treating for GERD. 

Most infants will not require medication for GERD. Symptoms usually clear on their own as the infant grows into toddlerhood. For most pediatric patients, conservative treatment is indicated and should be the first line of defense against your child’s reflux symptoms.¹⁰ Your doctor may recommend that you:

•        Feed your child in an upright position

•        Avoid laying your infant down for 20 to 30 minutes after eating

•        Burp your infant often

•        Adjust the infant’s diet, or your diet if you are breastfeeding

Medication may be necessary for infants with a severe presentation of GERD. Infants refusing to eat, have poor weight gain, or show evidence of esophagitis may need a temporary course of acid-reducing medication. 

Schedule a Doctor’s Appointment Today

Although acid reflux is common, it is not normal and needs attention if you have frequent or severe heartburn. Delaying treatment can increase your chances of encountering a complication of GERD. Contacting a doctor is the first step to obtaining relief and promoting healing of your esophagus. Most of the time your doctor can make a quick diagnosis after evaluating your symptoms and medical history. After a diagnosis, you can take immediate action to improve your reflux. Many patients report a reduction in their heartburn within the first few days after visiting their doctor. 

Some lifestyle changes that improve reflux are within your control, but GERD requires a diagnosis and treatment plan to prevent complications and improve healing outcomes. Chronic acid reflux symptoms can be distressing and interfere with your daily activities. The right doctor can help you take a proactive approach to improve your symptoms while supporting you through pharmaceutical treatment if necessary. You don’t have to live with chronic acid reflux. Meet with a doctor to find the treatment plan that works for you.  

References

1. Mayo Foundation for Medical Education and Research. (2020, May 22). Gastroesophageal reflux disease (GERD). Mayo Clinic. Retrieved January 23, 2022, from https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940
2. Antunes, C. (2021, July 18). Gastroesophageal reflux disease. StatPearls [Internet]. Retrieved January 23, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK441938/ 
3. U.S. National Library of Medicine. (n.d.). Gastroesophageal reflux disease: Medlineplus medical encyclopedia. MedlinePlus. Retrieved January 25, 2022, from https://medlineplus.gov/ency/article/000265.htm
4. U.S. Department of Health and Human Services. (n.d.). Definition & Facts for Ger & Gerd. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved January 23, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts
5. Singh, M., Lee, J., Gupta, N., Gaddam, S., Smith, B. K., Wani, S. B., Sullivan, D. K., Rastogi, A., Bansal, A., Donnelly, J. E., & Sharma, P. (2013). Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial. Obesity, 21(2), 284–290. https://doi.org/10.1002/oby.20279
6. Lee, K. J. (2011). Nocturnal gastroesophageal reflux: Assessment and clinical implications. Journal of Neurogastroenterology and Motility, 17(2), 105–107. https://doi.org/10.5056/jnm.2011.17.2.105 
7. Carlsson, R., Galmiche, J.-P., Dent, J., Lundell, L., & Frison, L. (1997). Prognostic factors influencing relapse of oesophagitis during maintenance therapy with antisecretory drugs: A meta-analysis of long-term Omeprazole Trials. Alimentary Pharmacology and Therapeutics, 11(3), 473–482. https://doi.org/10.1046/j.1365-2036.1997.00167.x
8. U.S. Department of Health and Human Services. (n.d.). Treatment for ger & gerd. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved January 29, 2022, from https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment 
9. Pandolfino, J. E., & Kahrilas, P. J. (2000). Smoking and gastro-oesophageal reflux disease. European Journal of Gastroenterology & Hepatology, 12(8), 837–842. https://doi.org/10.1097/00042737-200012080-00002 
10. Lightdale, J. R., Gremse, D. A., Heitlinger, L. A., Cabana, M., Gilger, M. A., Gugig, R., & Hill, I. D. (2013). Gastroesophageal reflux: Management guidance for the pediatrician. Pediatrics, 131(5). https://doi.org/10.1542/peds.2013-0421