Gastroesophageal Reflux Disease (GERD); Treatment.
GERD is treated in a stepwise approach. By working closely with your health care professional, finding the right course of action can lead to an improved quality of life. For mild cases, those with infrequent symptoms, you may only need to change your diet and avoid certain activities and over-the-counter medications. For more persistent symptoms, such as daily heartburn or symptoms that occur at night, you may need a prescription medication. Anti-reflux surgery can be a reasonable alternative to a lifetime of medication and discomfort, especially if the condition is caught when you're relatively young.
Surgery may also be considered when medications don't work.
The cornerstone for all GERD treatments begins with lifestyle changes. The key to these changes requires understanding what triggers and activities are contributing to your symptoms.
If you are having symptoms of GERD, the following can help:
Avoid foods and drinks that trigger relaxations of the lower esophageal sphincter.
Lose weight if you are overweight. Obesity may contribute to GERD because the extra weight increases the pressure on your stomach and the lower esophageal sphincter, allowing reflux.
Avoid lying down after eating a meal or snack for at least two to three hours. Go for a walk after a meal. Not only will this help prevent GERD symptoms, but it also burns extra calories.
Avoid common food triggers such as fatty or fried foods, like fried chicken, cream sauces, mayonnaise or ice cream. Other problem foods to avoid include mints, chocolate, alcohol, coffee, tea, sodas, citrus fruits and tomatoes. These foods relax the lower esophageal sphincter muscle, allowing stomach contents to wash back up, or their acidity can irritate the lining of the esophagus.
Stop smoking. Smoking damages the digestive system and, some studies find, relaxes the lower esophageal sphincter. Smoking may also reduce the amount of bicarbonate in saliva, thus reducing its ability to protect the esophagus from stomach acid. However, some nicotine replacement therapies (nicotine patch, nicotine gum) can cause indigestion, stomach pain and vomiting. Discuss possible side effects of these products with your health care professional before using them.
Avoid tight clothing around your abdomen, such as girdles, tight jeans and elastic waist bands, which can increase pressure on your stomach and lower esophageal sphincter.
Elevate the head of your bed six to eight inches or sleep on a wedge pillow to help gravity move the acid reflux back into the stomach.
Don't bend over after eating. Instead, bend at your knees if you have to pick something up, and avoid exercises that require you to bend at your waist. Additionally, avoid exercising after a heavy meal.
Check your medications. Certain medications may make your symptoms worse. These include theophylline, hormones such as progesterone, calcium channel blockers, alpha blockers and beta blockers, and anticholinergic drugs, which can be present in medications used to treat Parkinson's, asthma and certain over-the-counter cold preparations. If you think a medication you're taking might be contributing to your symptoms, check with your health care professional about alternatives.
Your health care professional may want to treat your GERD with medications. You may have to take these drugs for the rest of your life or just for a short period of time.
Be patient; finding the right medication and dosing schedules may take time. If symptoms persist while taking medication or if they return after you stop taking them, consult your health care professional. If symptoms of GERD occur during pregnancy, consult with your obstetrician before taking any medications.
Here's an overview of the most common medications used in the treatment of GERD:
These products can help with mild and infrequent symptoms. They work by neutralizing stomach acid. Antacids are typically fast acting and can be taken as needed. Because they also short acting, they don't prevent heartburn and are less useful for frequent symptoms. Typical antacid medications include the following:
Most antacids contain either calcium carbonate (Tums, Rolaids, Mylanta, Maalox) or magnesium hydroxide (Phillips Milk of Magnesia). Sodium bicarbonate (baking soda) can also relieve indigestion.
Antacids can interfere with how well your body absorbs other medications, so if you are taking any medications, check with your health care professional before you start using antacids.
Ideally, you should take the antacid at least two to four hours after you take other medications to reduce the chance it won't be fully absorbed. People with high blood pressure should avoid antacids with high amounts of sodium, such as Gaviscon.
Finally, antacids are not a good option to heal erosive esophagitis, which should be treated with other medications.
These drugs work by decreasing the amount of acid your stomach produces and are available in both prescription and over-the-counter (OTC) doses. Typically, the prescription form is a larger dose and may benefit some people who can't find relief with over-the-counter preparations. Combining an acid reducer and lifestyle changes often helps.
There are two types of acid reducers: "H2-blockers" and proton pump inhibitors. Typical H2-blockers include the following:
nizatidine (also known as Axid, Axid AR)
famotidine (also known as Pepcid, Pepcid AC)
cimetidine (also known as Tagamet, Tagamet HB)
ranitidine (also known as Zantac, Zantac GELdose)
Proton pump inhibitors are also acid reducers but are much more powerful than the H2-blockers. Proton pump inhibitors (PPIs) are the most commonly prescribed class of medications for treating heartburn and acid reflux disease. One PPI, Prilosec, is also available in an over-the-counter formulation.
These drugs work by blocking acid production in the cells lining the stomach and can reduce the amount of stomach acid as much as 95 percent. They don't work as quickly as antacids, but they can prevent reflux symptoms for many hours.
These drugs are also used to treat esophageal inflammation (esophagitis) and esophageal erosions. Studies find that the majority of patients with esophagitis who use them heal after six to eight weeks. Typical medications include the following:
lansoprazole (also known as Prevacid)
omeprazole (also known as Prilosec)
rabeprazole (also known as AcipHex)
pantoprazole (also known as Protonix)
esomeprazole (also known as Nexium)
omeprazole + sodium bicarbonate (Zegerid)
People with liver conditions should consult their physicians before taking these drugs.
These drugs work by tightening the lower esophageal sphincter, which helps prevent acid from washing back up into the esophagus. They also slightly increase the contractions of the esophagus and the stomach to help empty the stomach faster. Prokinetic agents include metoclopramide (also known as Reglan), bethanechol (Duvoid) and tegaserod (Zelnorm). These medications can be useful as additional therapy in some people with GERD but shouldn't be used alone.
This drug coats the lining of the esophagus and helps protect the lining from stomach acid. It may be used in pregnant women, those who cannot tolerate acid reducers or in combination with other drugs. Very little of this drug is actually absorbed into the body. You should take any other medications at least one hour prior to sucralfate because it may interfere with the absorption of other drugs. Prolonged use may interfere with absorption of essential vitamins (K, A, D and E). If you are taking a blood-thinning medication such as Coumadin, use this medication with caution.
Surgery is considered an alternative to medical therapy for GERD. The best candidates for surgery are young patients (because they would otherwise require long-term treatment) with typical GERD symptoms (heartburn and regurgitation) who respond to medical therapy but who are seeking alternatives to taking daily medications. Those with unusual symptoms or symptoms that don't respond to medication should only consider surgery if there is no doubt about the diagnosis of GERD, and there is a clearly documented link between symptoms and reflux based on testing.
Fundoplication is the most common surgery used. This surgery reinforces the lower esophageal sphincter by wrapping the top of the stomach around the lower esophageal sphincter. One advantage is that a hiatal hernia can be corrected at the same time. Surgery is not always successful, and many patients still require some form of medication. There can also be significant complications during or immediately after surgery, including bleeding, bowel obstruction, infection, muscle spasms after eating food, pain and even death. Other long-term complications include difficulty swallowing (if the "wrap" is too tight) as well as bloating (due to the inability to belch air).
New techniques using endoscopy are being developed and in some cases, used, but the safety and effectiveness of these alternatives are still under investigation.
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Keywords: gastroesophageal reflux disease, gerd, symptoms, gerd symptoms, symptoms of gerd, acid reflux, smoking, over-the-counter, antacids, calcium carbonate, acid reducers, side effects, proton pump inhibitors, sucralfate
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|Publication:||NWHRC Health Center - Gastroesophageal Reflux Disease|
|Date:||Mar 13, 2007|
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