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Digestive System
Diseases and
Disorders
Key Terms
Achlorhydria (p. 219)
Adhesions (p. 226)
Asymptomatic (p. 218)
Colorectal (p. 231)
Defecate (p. 210)
Dental plaque (p. 213)
Enterotoxin (p. 228)
Exacerbation (p. 222)
Feces (p. 209)
Gastroenteritis (p. 222)
Gingivitis (p. 214)
Hematemesis (p. 209)
Hematochezia (p. 209)
Ileus (p. 226)
Intrinsic factor (p. 209)
Intussusception (p. 226)
Malaise (p. 224)
Melena (p. 209)
Motility (p. 209)
Occult blood (p. 212)
Ova and parasite (O&P)
(p. 212)
Paralytic obstruction
(p. 226)
Perforation (p. 209)
Peristalsis (p. 209)
Peritonitis (p. 210)
Polyp (p. 231)
Remission (p. 222)
Salmonella (p. 228)
Septicemia (p. 210)
Stool (p. 209)
Strep throat (p. 216)
Vermiform (p. 225)
Virulent (p. 216)
Volvulus (p. 226)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define the terminology common to the upper and
lower digestive system and the disorders of the
system.
2. Discuss the basic anatomy and physiology of the
digestive system.
3. Identify the important signs and symptoms
associated with common digestive system disorders.
5. Identify the common disorders of the digestive
system.
6. Describe the typical course and management of
the common digestive system disorders.
7. Describe the effects of aging on the digestive
system and the common disorders associated with
aging of the system.
4. Describe the common diagnostics used to determine
type and cause of digestive system disorders.
Overview
T
he digestive system provides nutrients for the body through the processes of ingestion, digestion, and
absorption and eliminates waste products from the system. Diseases or disorders of the digestive system
are some of the most common medical problems. Because there are many differences in eating patterns,
lifestyle behaviors, and inherited traits, digestive system problems vary considerably among individuals.
207
208 Chapter 11
Some digestive system problems are caused by poor nutritional habits, whereas others might be due to struc
tural problems or a particular disease process. ■
Consider This...
The average American eats approximately
50 tons of food and drinks 13,000 gallons
of fluids in a lifetime.
Anatomy and Physiology
The digestive system has been described as a long tube
running through the body. It has two main purposes:
(1) to change the food we eat into simpler substances
so they can be absorbed into the blood and carried to
all cells of the body and (2) to eliminate waste products
from the body. The two major parts of the digestive sys
tem are the alimentary canal and the accessory organs,
including the tongue, teeth, salivary glands, gallbladder,
pancreas, and liver.
The alimentary canal (Figure 11-1) is a contin
uous tube running from the mouth to the anus. The
term gastrointestinal (GI) tract technically refers only
to the stomach and intestines but is often used as a syn
onym for the alimentary canal. The alimentary canal
is approximately 30 feet, or 9 meters, in length, but
most of it is coiled up in the abdomen and surrounded
by the peritoneum. The peritoneum is a large, serous
membrane covering the organs in the abdomen and
lining the walls of the abdominal cavity. It secretes
fluid to prevent friction between organs in the abdo
men as they move during the process of digestion. The
alimentary canal starts at the mouth, where ingested
food begins to be broken down to supply the body
with needed nourishment. The teeth begin the process
by breaking the food into smaller parts. The tongue,
the organ of taste, assists the process by helping move
the food in the mouth. The salivary glands, located out
side the mouth with ducts leading from the glands to
the mouth, secrete about 1,500 milliliters of saliva per
day. The saliva continues the process of breaking down
food and moistening it to make it easier to swallow. At
the back of the mouth lies the pharynx, the channel for
food to pass from the mouth to the esophagus.
Liver
Appendix
Small
intestine
Parotid gland
Pharynx
Esophagus
Diaphragm
Stomach
Pancreas
Large intestine
Rectum
Anus
Figure 11-1 The digestive system.
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Digestive System Diseases and Disorders 209
Consider This...
If saliva can’t dissolve the food, it can’t be
tasted. In order for the taste buds to taste
something, it must be dissolved by saliva.
The esophagus is a tube (about 9 inches in length)
that extends from the pharynx to the stomach. The
walls of the esophagus are very muscular. Movement
of these muscles is called peristaltic contraction. These
contractions, the process called peristalsis, move the
food from the pharynx to the stomach.
The stomach is a sac-type receptacle that lies just
under the diaphragm in the upper abdomen. The
esophagus connects to the stomach at the cardiac ori
fice (opening). A thick ring of smooth muscle called
the cardiac, or gastroesophageal, sphincter surrounds
this opening. The upper portion of the stomach, at the
cardiac orifice end, is called the fundus, and the mid
dle portion of the stomach is called the body. Food is
broken down in the stomach by a process of chemical
changes from the action of pepsin—an enzyme—and
hydrochloric acid secreted by cells in the stomach. Food
is mixed with these chemicals by the contractions of
the stomach. The lining of the stomach also secretes a
substance called the intrinsic factor, which is necessary
for the absorption of vitamin B
12
. At the lower portion
of the stomach, called the pyloric region, the stomach is
connected to the first part of the small intestine, called
the duodenum. The opening at this end of the stom
ach is the pyloric orifice, which is surrounded by the
pyloric sphincter. Sphincter muscles control the cardiac
and pyloric openings.
The stomach of the average-sized adult will
produce approximately 2 liters of hydro
chloric acid per day.
The small intestine extends from the pyloric orifice
to the ileocecal valve at the beginning of the large intes
tine. It is divided into three sections. The first section,
the duodenum, is about 10 inches, or 25 centimeters,
in length, the shortest of the three sections. The duode
num receives bile from the liver and pancreatic juices
from the pancreas, which aid in the digestive process.
Consider This...
The duodenum connects the stomach to the jeju
num (jay-JUNE-um), the second section of the small
intestine, on the left side of the upper abdomen. The
jejunum extends from the duodenum to the ileum. It
is about 7.5 feet, or 2 meters, in length and is coiled
throughout the abdomen. The ileum is the third section
of the small intestine, attaching to the jejunum at its
beginning and ending at the ileocecal (il-ee-oh-SEE-cal)
valve, the beginning of the large intestine.
The major function of the small intestine is diges
tion and absorption of food and fluids. Material is
moved through the small intestine by muscular action
(peristalsis). Most of digestion takes place in the small
intestine. Fingerlike projections called villi, containing
lymph vessels and blood capillaries, are located on the
inside surface of the intestine. Additional extensions
called microvilli cover the villi, forming a velvety surface
that greatly increases the surface area of the small intes
tine. As a result of this increased surface area, nutrient
absorption is greatly increased. Nutrients pass into the
vascular capillaries for delivery to the body cells.
The large intestine connects to the small intestine
at the ileocecal valve in the lower-right portion of the
abdomen. The first section of the colon is called the
cecum. The appendix is attached to the cecum near
the ileocecal valve. The large intestine, also called the
colon, is about 5 feet, or 1.5 meters, long. Each section
of the colon is named according to its anatomical posi
tion. The colon begins in the lower-right quadrant of
the abdomen (cecum), rises to the mid-level (ascend
ing colon), crosses the abdomen at the umbilicus
level (transverse colon), and descends on the left side
(descending colon) into the pelvic cavity, where it is
called the sigmoid colon. The sigmoid colon forms an
S-shaped tube that extends into the lower pelvic region,
ending at the rectum and anus. The process of digestion
and absorption continues in the large intestine, but the
most important function of the large intestine is the
absorption of water and electrolytes and the elimination
of feces, the material not absorbed by the intestines.
Common Signs and Symptoms
Diseases of this system usually result in signs and symp
toms related to hemorrhage, perforation, and altered
motility (movement) in the system. Hemorrhage can
be mild or severe and can originate at any site along the
system. Terms identifying bleeding are hematemesis
(HEM-ah-TEM-eh-sis; hemat = blood, emesis = vom
iting), hematochezia (HEM-at-toe-KEE-zee-ah, bright
red blood in the feces), and melena (meh-LEE-nah,
dark, tarry stool) due to the presence of blood.
210 Chapter 11
Perforation in any area of the tract can be life threat
ening due to the contaminating contents of the tract and
the ease of spread in the abdominal cavity. Perforation
in the stomach or intestines allows spillage of contents
into the abdominal cavity, causing peritonitis (PER-
ih-toe-NIGH-tis; an inflammation of the peritoneum),
of which pain is a common symptom. Spilled gastric
contents are high in gastric acid and are corrosive to
abdominal organs, and intestinal contents have a nor
mally high bacterial count. Spilling intestinal contents
into the abdominal cavity causes infection, which can
lead to septicemia (SEP-tih-SEE-me-ah; septic = dirty,
emia = blood or bacteria in the bloodstream). Causes of
perforation can include peptic ulcer, injury from gun
shot or stab wounds, and untreated appendicitis.
Alteration in motility, or movement of food along
the tract, commonly leads to a variety of signs and
symptoms, including nausea, vomiting, diarrhea, or
constipation. Diarrhea is a disorder characterized by
frequent, watery stools. Irritability of the intestinal lin
ing causes hyperactivity of muscle contractions (peri
stalsis), causing a rushing of the watery contents in the
small intestine through the large intestine. This rushing
denies the large intestine the time needed to reabsorb
the water. The primary concern with diarrhea, espe
cially in young children and older people, is loss of flu
ids, leading to dehydration. Causes of diarrhea include
a sudden increase in stress or nervous condition, bac
terial or viral infection, or food poisoning.
Constipation is the opposite of diarrhea. The stool
in the colon remains for an extended period of time,
too much water is reabsorbed, and the stool becomes
hard, dry, and difficult to pass. Constipation is com
monly caused by poor dietary and elimination habits.
Avoiding the urge to defecate (have a bowel move
ment) increases the amount of time the stool remains
in the colon and, thus, increases constipation.
Diagnostic Tests
Diagnostic tests for the digestive system commonly
include radiologic (X-ray) examinations and endo
scopic (looking into the cavity with a lighted scope)
examinations. An upper GI series, also called a bar
ium swallow, allows visualization of the esophagus,
stomach, and upper portion of the small intestine.
In preparation for such an examination, the individ
ual must be N.P.O. (non per os—nothing by mouth)
for a minimum of eight hours. Prior to the exam
ination, the individual drinks a barium solution,
which coats the inside of the upper tract, allowing
Liver
Appendix
Small
intestine
Parotid gland
Pharynx
Esophagus
Diaphragm
Stomach
Pancreas
Large intestine
Rectum
Anus
Figure 11-2 Upper GI series; yellow area is visualized.
visualization by X-ray. The physician can view a series, or
several X-rays, to detect problems of the upper tract
(Figure 11-2).
A lower GI series, also called a barium enema, pro
vides visualization of the large intestine. In preparation
for this radiologic examination, the individual is given
an enema or laxatives the day before the examination to
rid the colon of fecal material, and the diet is restricted
to clear liquids. On the day of the examination, an
enema of barium solution is administered to coat the
lower tract and allow X-ray visualization of the large
intestine (Figure 11-3).
Endoscopic examination allows the physician to
look directly into the digestive organs through a lighted
scope (Figure 11-4). The name of each procedure is
identified by naming the organ being scoped: stom
ach (gastroscopy), colon (colonoscopy), sigmoid colon
(sigmoidoscopy), and entire upper GI area (esophago
gastroduodenoscopy, EGD). During an endoscopic
examination, a physician might obtain a biopsy (small
piece of tissue for examination) to determine the pres
ence of a neoplasm or other disease processes. During
this examination, they may also remove a polyp, called
a polypectomy.
Video capsule endoscopy has recently been added
as a diagnostic test. In this test, a capsule containing
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Digestive System Diseases and Disorders 211
Figure 11-3 Lower GI series; yellow area is visualized.
a miniature video camera is swallowed and travels
through the small intestine. As it travels along, it
sends video images of the lining to a receiver worn
on a belt at the waist. The images can then be down
loaded and viewed on computer. The value of this
test is the ease of viewing even very small or mild
abnormalities. A disadvantage of this camera is that
it cannot be used in patients with obstruction in the
intestine because it might get stuck in the obstruction.
Several laboratory tests can be performed to
assist in diagnosis of digestive system diseases. One of
these is the breath test for bacterial growth. A lactose
Healthy Highlight
Good Elimination
Habits
T
o avoid constipation, defecation should be allowed to occur when reflexes are the
strongest, usually early in the morning following breakfast, although elimination hab
its differ from individual to individual. Some people might have bowel movements after
every meal; others will have a bowel movement daily or every two or three days. Other
good elimination habits include a diet high in fiber (fruits, vegetables, grains, and cere
als), daily exercise, and adequate intake of fluids. Laxatives and enemas should be avoided
because these artificially stimulate the bowel and can alter its normal elimination pattern.
Regular use of laxatives produces dependence on them for bowel elimination.
212 Chapter 11
Figure 11-4 Esophagogastroduodenoscopy.
intolerance test may be performed on an individual
who complains of bloating, gas, or other discomfort
after ingesting milk or milk/cream-based products.
Another laboratory test is an occult stool test,
which tests stool for occult blood (blood hidden in the
stool). A positive occult stool test can be indicative of
colon cancer.
An ova and parasite (O&P) is an examination of
a stool specimen for the presence of adult parasites or
their eggs (ova). Parasites identified by an O&P might
include roundworms, tapeworms, pinworms, or hook
worms and protozoa such as Giardia lamblia. Stool or
fecal cultures can be used to determine bacterial infec
tions in the colon.
A genetic study can be done to determine the
genetic propensity for some types of cancer of the
gastrointestinal system. A positive test for the specific
gene does not mean the individual will develop cancer
but it does alert the physician, and the individual, to
be watchful for early signs and symptoms. Along the
same lines, a negative test does not mean the individual
cannot develop cancer in the system, it just means the
individual does not have the genetic trait for it.
Common Drugs for Gastrointestinal Disorders
Category Examples of Medications
Antacids and Others
Drugs used to reduce
stomach acidity and
gastroesophageal reflux
Phosphate binders Aluminum hydroxide, calcium carbonate, magnesium
carbonate, magnesium hydroxide, or sodium
bicarbonate
H2 receptor antagonists Famotidine, nizatidine
Proton pump inhibitors Esomeprazole, lansoprazole, rabeprazole, or
omeprazole
Promotility agent Metoclopramide
Antibiotics
Drugs used to prevent or
stop bacterial infections
Ampicillin, amoxicillin, ciprofloxacin, doxycycline,
erythromycin, penicillin, or tetracycline
Anti-inflamm atories
Drugs used to reduce
inflammation
Steroids Amcinonide, balsalazide, beclomethasone,
hydrocortisone, mesalamine, or olsalazine
Nonsteroidal Apirin or ibuprofen
Antidiarrheals
Drugs used to treat
diarrhea
Bismuth subsalicylate, eluxadoline, loperamide,
octreotide, or rifaximin
(continued )
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Digestive System Diseases and Disorders 213
Common Drugs for Gastrointestinal Disorders (continued)
Category Examples of Medications
Antinauseants
Drugs used to reduce or
eliminate nausea/vomiting
Aprepitant, hydroxyzine, netupitant, ondansetron,
or palonosetron
Antineoplastics
Drugs used to treat cancer
Alkylating agents Carboplatin, chlorambucil, cisplatin,
cyclophosphamide, lomustine, or oxaliplatin
Antimetabolites 5-Flourauracil, mercaptopurine, or methotrexate
Antitumor antibiotics Mitomycin or streptozocin
Hormones/antihormones
Other substances
Estrogens, androgens, flutamide, or tamoxifen
Bevacizumab, capecitabine, carboplatin, cetuximab,
cisplatin, etoposide l-asparaginase, paclitaxel,
ramucirumab, or vincristine
Laxatives and Opioid Antagonists
Drugs used to treat
constipation
Docusate, bisacodyl, lubiprostone, methylcellulose,
naloxegol, or senna
Common Diseases of the
Digestive System
Diseases of the Mouth
The primary function of the mouth is to begin the
breakdown of food into smaller particles. Diseases of
the mouth include those related to inflammation and
tumors.
Consider This...
The life span of a taste bud is about
10 days, and before it dies, it is replaced
with a new taste bud.
Dental Caries
■ Description. Dental caries is an infectious disease
that damages the teeth; it primarily affects children and
young adults.
■ Etiology. Microorganisms in the mouth attack the
teeth, producing dental cavities. The cause of caries is
twofold, requiring bacteria along with a diet high in
carbohydrates (sugars). Left untreated, the disease can
lead to infection, pain, and tooth loss.
■ Symptoms. The bacteria stick to the tooth surface in
a tough, sticky material called dental plaque. Acids pro
duced by the bacteria erode the tooth surface.
■ Diagnosis. Diagnosis involves inspecting the teeth for
plaque, followed by X-rays revealing cavities.
■ Treatment. Treatment can range from simple dental
fillings to oral surgery, depending on the extent of the
caries.
■ Prevention. Prevention is based on frequently remov
ing dental plaque by brushing and flossing the teeth. A
decrease in carbohydrate (sugar) intake is also helpful.
The use of fluoride in drinking water and toothpaste
also reduces the incidence of caries.
Consider This...
Enamel is the hardest substance in the
human body.
214 Chapter 11
Healthy Highlight
What Does the
Tongue Tell You?
Essential Oils for
Relief of Nausea
and Vomiting
T
he tongue can tell a great deal about the health of a person. The tongue helps in
chewing and swallowing. About 15% of the population has some disorder in which
the tongue is directly involved. It is important for individuals to be aware of the tongue
and any changes that might be observed.
Color changes such as white patches may indicate an infection, a suppressed immune
system, or a precancerous condition. White patches can appear when the individual has a
yeast infection and is called oral thrush. Another type of white patches (called leukopla
kia) on the tongue often develop when the tongue has been irritated. This may occur from
smoking and can be a precancerous sign. A “hairy tongue” (black tongue) is common
to persons who drink large amounts of coffee or tea or use tobacco. A pale tongue may
indicate anemia, but a reddened tongue may indicate inflammation or infection such as
scarlet fever or Kawasaki disease. It could also indicate other dietary insufficiencies such
as a lack of folic acid or vitamin B
12
.
Growths and ulcerations such as cold sores, ulcers (canker sores), benign lesions, or
oral cancer are common. The tongue can also be enlarged in some case of hypothyroidism
or in allergic reactions. In fact, a thick or enlarged tongue might be one of the first signs
of an anaphylactic reaction, which is a medical emergency.
Pain in the tongue usually indicates sores or ulcers that need to be reviewed for the
underlying cause. Pain may also occur in women during menopause and can be treated
with some lozenge medications.
Some problems of the tongue will disappear without treatment, but others need
medical intervention. The tongue can tell the physician some important factors about the
patient’s health. Individuals should report any abnormalities to their health care provider.
Source: Allan (2019)
Complementary and Alternative Therapy
N
ausea and vomiting are symptoms of many different disorders and treatments.
Post-chemotherapy is one of the most common times an individual has both
nausea and vomiting, but they are also common symptoms in several gastrointestinal
disorders. Some essential oils have been studied for their use in treating nausea and
vomiting. Several studies have concluded that they can be an effective treatment.
Ginger has been used for centuries to control nausea and is often recommended for
travelers on ocean cruses. Lemon and peppermint have also been effective to reduce
minor nausea and vomiting. The dose to relieve symptoms may vary from one indi
vidual to another.
Source: Cooksley (2020)
Periodontal Disease
■ Description. Periodontal disease affects the support
ing structures of the teeth such as the gums. It is a dis
ease that affects adults and incidence increases with
aging. Most adults have some degree of periodontal
disease, the main reason for tooth loss in an adult.
■ Etiology. Dental plaque, poor oral hygiene, and
inadequate diet are common factors leading to this
disease.
■ Symptoms. Dental plaque sticks on the tooth at the
gum line, often leading to gingivitis (inflammation of
the gums with painful bleeding) (Figure 11-5).
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Digestive System Diseases and Disorders 215
Figure 11-5 Gingivitis (inflamed gingiva).
■ Diagnosis. A dentist can make a diagnosis by inspect
ing the gums and measuring the pocket depth of the
teeth. Redness, puffiness, and bleeding along with a
pocket depth of 3 millimeters indicate disease.
■ Treatment. Treatment involves removing the plaque
and treating the inflammation.
■ Prevention. Prevention is based on frequent brushing
and flossing of the teeth with special attention given to
the gum line, regular dental care to remove plaque, and
an adequate diet.
Consider This...
Individuals with gum disease are twice as
likely to have a stroke or heart attack as
those without gum disease.
Figure 11-6 Cancer of the lip.
■ Treatment. Radiation therapy and surgical excision
are usually quite effective in treating this cancer.
■ Prevention. Decreasing exposure to sunlight by
using SPF sunscreen, wearing hats to shade the face,
and eliminating the use of tobacco products aid in
prevention.
Diseases of the Throat and Esophagus
There are many diseases of the throat and esophagus,
ranging from mild to severe and acute to chronic.
Infections and inflammatory conditions are some of
the most common. Pharyngitis is often categorized as
a respiratory problem because the pharynx can be con
sidered part of the respiratory system as well as part of
the digestive system.
Cancer of the Mouth
■ Description. Tumors of the mouth can occur on the
lip, cheek, gum, palate, or tongue. A common oral can
cer is squamous cell carcinoma of the lip.
■ Etiology. This tumor usually occurs on the lower lip
of men and is related to exposure to sunlight, chewing
tobacco, and smoking pipes or cigars (Figure 11-6).
■ Symptoms. The common symptom is a small,
pale-colored, painless lump on the tongue, lip, or other
mouth area.
■ Diagnosis. A tissue biopsy of the lump is the most
definitive diagnostic test.
Consider This...
Another word for the esophagus is “gullet”
from the Latin word gula meaning throat.
Pharyngitis
■ Description. Pharyngitis is commonly called a sore
throat.
■ Etiology. Viral or bacterial microorganisms are com
mon causes of pharyngitis.
216 Chapter 11
Healthy Highlight
Get Rid of
Halitosis
H
alitosis (bad breath) is often caused by food particles in the mouth or from a
health problem.
To prevent or reduce bad breath:
1. Clean your teeth after you eat. Brushing is best, but if this is not an option, then
swishing mouth wash or even water alone helps rid the mouth of food particles.
2. Floss your teeth at least once a day. Flossing removes decaying food from
between your teeth.
3. Clean the back of your tongue. Either brush your tongue or scrape it with a
tongue scraper.
4. Drink water or chew gum. Water and saliva help wash away dead cells and
food particles.
5. If you wear dentures, clean them daily. Dentures can also harbor decaying
food particles.
6. Limit foods and beverages that may cause bad breath. This includes garlic,
onion, coffee, and alcohol. These are easily absorbed through the lungs and
then exhaled.
7. See your doctor or dentist. If these simple measures do not help, then the halito
sis may be related to a health problem such as a sinus infection or abscessed tooth.
■ Symptoms. The most frequent and earliest symp
tom of pharyngitis is a sore throat. Visual examination
reveals redness in the area. A common type of pharyn
gitis is an inflammation of the tonsils called tonsillitis,
in which the tonsils form crypts of pus, which give the
tonsils a whitish appearance. (See Figure 9-8 for a pic
ture of pharyngitis.)
An acute type of pharyngitis is called strep throat,
caused by virulent (VIR-u-lent; infectious, difficult to
kill) bacteria, Streptococci. These bacteria can spread
into the bloodstream and produce other diseases such
as scarlet fever, rheumatic fever, glomerulonephritis,
and endocarditis.
■ Diagnosis. Diagnosis is made by examination and
throat culture.
■ Treatment. Treatment of strep throat includes iden
tification of the organism through laboratory cultures,
followed by antibiotic treatment and follow-up culture
to check effectiveness of antibiotic treatment. Antibiotic
treatment is quite effective if taken as prescribed.
■ Prevention. Frequent and thorough handwashing is
one of the best preventive methods, along with avoiding
contact with people who are sick. Using a new tooth
brush after an infection prevents reinfection.
Reflux Esophagitis
■ Description. Reflux esophagitis, more recently called
gastroesophageal reflux disease (GERD), is an inflam
mation of tissue at the lower end of the esophagus.
■ Etiology. GERD is caused by a reflux (backflow) of
stomach acids through the cardiac sphincter upward
into the esophagus.
■ Symptoms. The most common symptom of reflux
esophagitis is heartburn, a burning sensation in the
mid-chest or epigastric (epi = above, gastric = stom
ach) area. Long-term reflux can lead to bleeding, ulcer
ation, and scarring of the esophagus, which can cause
stricture and difficulty swallowing (Figure 11-7).
■ Diagnosis. Diagnosis is usually made by barium swal
low X-ray (upper GI series). If further diagnostic testing
is needed, an EGD with biopsy can be performed.
■ Treatment. Treatment is directed at reducing reflux
and can include recommendations to avoid large
meals, spicy foods, caffeine, and tight clothing. Medi
cations such as stool softeners, laxatives, and antacids
might be helpful. Several drugs specifically for reflux
problems are also available, some over the counter and
others requiring a prescription. Activities that increase
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