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The best treatment options for GERD.

Gastroesophageal reflux disease (GERD) affects between 25 and 35 percent of the U.S. population, and it's thought that up to 15 million Americans experience its main symptom--heartburn--each day. It's particularly common among older adults, and occurs because the lower esophageal sphincter, a muscular valve that separates the esophagus from the stomach, becomes too relaxed or weak and allows stomach acid to flow up into the esophagus. Laxity in the diaphragm (the sheet of muscle that separates the thoracic and abdominal cavities) can also contribute to GERD, as can a hiatal hernia, a condition in which part of the stomach pushes through the opening of the diaphragm where the esophagus joins the stomach.

The condition can have a debilitating effect on sleep, work, and general quality of life, but mild GERD can usually be managed through lifestyle and dietary changes. These include quitting smoking, avoiding spicy and fried foods as well as chocolate, wearing loose-fitting clothing, and not eating within two hours of bedtime. If these don't work, elevating the head of your bed may help.

Medication for GERD If GERD cannot be managed with lifestyle changes, there are several effective treatment options. Initially, try taking an antacid like Turns, or a nonprescription histamine-2 receptor antagonist (H2RA), like Tagamet. For more severe cases, prescription-strength H2RAs, acid suppressants such as proton pump inhibitors (PPIs, which include Prilosec, Nexium, and Prevacid), and drugs that strengthen the lower esophageal sphincter, may be used. "In moderate to severe GERD, PPIs have been shown to be effective," says Sita Chokhavatia, MBBS, an associate professor of medicine in Mount Sinai's Division of Gastroenterology.

But PPIs don't come without risks. Research has suggested that omeprazole (Prilosec) may decrease the efficacy of the blood thinner clopidogrel (Plavix). Additionally, a possible small increased risk of fractures of the hip, wrist, and spine has been reported in some studies of people who received PPIs. The greatest increased risk for these fractures was seen in those who took high doses of these medications or used them for a year or longer. If you're taking a PPI and are concerned about its potential side effects, ask your doctor about alternative treatments.

When is surgery an option? A laparascopic (keyhole surgery) procedure called a fundoplication can be used to treat GERD, and a study published in the May 18 issue of the Journal of the American Medical Association suggests that it may be just as effective as treatment with esomeprazole (Nexium). During the surgery, the gastric fundus (upper part) of the stomach is wrapped around the lower end of the esophagus and stitched in place, in order to minimize acid reflux.

However, the procedure isn't appropriate for everyone. "Surgery is best suited for younger patients who have complete or partial relief of typical GERD symptoms while taking a PPI or other medication, but who may not want to be on long-term medical therapy," sayes Dr. Chokhavatia. "However, people should be aware that some patients may need to go back on a PPI post surgery."

Dr. Chokhavatia also notes that surgery may not be ideal in obese patients or older patients with multiple comorbidities. Surgical complications can develop, including dysphagia (difficulty swallowing) and recurrent reflux if the wrap slips or loosens.

If you have GERD and are not responding adequately to medication, ask your doctor if surgery is an option. r61


* Try to avoid common GERD triggers, such as smoking, spicy, fried and fatty foods, garlic, onions, alcohol, chocolate, and caffeine.

* Don't bend over immediately after eating, and wait at least two hours before lying down.

* Take your medications as directed, and don't stop taking them without consulting your doctor.
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Title Annotation:DIGESTION
Publication:Focus on Healthy Aging
Date:Aug 1, 2011
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