GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 270

decrease their nicotine usage. Alcohol and caffeine also must be avoided. A mild tranquil-
izer may help highly stressed individuals.
Symptoms normally improve within a few days, but full healing takes six to eight
weeks. Physical activity may continue during treatment, but strenuous exertion, particu-
larly if emotionally stressful, is best avoided for at least a week after the institution of ap-
propriatetherapy.Persistent symptomsinspiteoftheinstitution oftreatment meritthecare
of a physician.
Individualswithactiveulcersshouldnottakepartinextendedexpeditionsuntiltheulcer
has healed.
Gastroesophageal Reflux Disease (GERD)
GERD is caused by the reflux of acidic gastric contents into the esophagus. It is gener-
allyassociatedwithrelaxationofthelowerendoftheesophagusorahiatalhernia,aprotru-
sion of the stomach into the chest through the opening in the diaphragm through which the
esophagus passes. The symptoms of GERD include cramping pain or burning in the mid-
line of the lower chest (heartburn), a sense of fullness after eating, excessive belching, and
regurgitating small amounts of food or sour stomach contents. Occasionally the chest pain
is so severe it may be difficult to distinguish from the pain associated with a heart attack.
Some individuals have trouble swallowing. Sour stomach contents may reach the back of
the throat. Symptoms usually get worse with eating, whereas ulcer symptoms are usually
improved for an hour or so after food consumption. The symptoms of GERD become less
noticeable with time and the passage of food from the stomach, also the opposite of ulcer
symptoms.
Medications that may provide symptomatic relief include antacids, H 2 blockers, and
proton pump inhibitors (PPIs) such as omeprazole (Prilosec®) or esomeprazole (Nexi-
um®). Eating small meals four to six times a day may be helpful. Symptoms that are not
readily relieved bymedications shouldpromptconsultation withaphysician toruleoutthe
presence of ulcers or even a malignant tumor.
Individuals with this condition should avoid fatty foods, caffeine, and chocolate; should
not eat for several hours before going to bed so their stomachs are empty; and should try
to sleep with head and shoulders elevated so that gravity can help prevent reflux. GERD is
rarely severe enough to prevent individuals from partaking in wilderness activities.
Gastrointestinal Hemorrhage
One of the most serious problems that can occur in the wilderness is hemorrhage from
thestomachorintestines.Evenwithexperttreatment,about10percentofelderlyindividu-
als hospitalized with this condition die. (Death rates in young, otherwise healthy adults are
lower.) Since blood transfusions and other forms of intensive medical and surgical care are