GERD (Gastroesophageal Reflux Disease)
Treatment & Prevention Options
Treatment involves life style changes, medications and surgery.
Life Style Changes:
This is the simplest form of treatment that uses a combination of life
style changes and eating habits. The patient is advised to sleep with
his or her upper body in an elevated position by placing blocks under
the bed’s feet at the head of the bed or sleeping with upper body
on a wedge to avoid reflux of contents of stomach by restoring the effects
of gravity partially (2).
Doctors also advise patients to stop smoking, avoid alcohol and wear
loose fitting clothes (1).
Smaller and early evening meals reduce the
amount of reflux for two well known reasons. First, a
smaller meal leads to less distention of stomach. Second,
reflux is less likely since an early small meal will
empty the stomach quicker as compared to a large meal
(2).
Foods such as chocolate, peppermint, alcohol,
caffeinated drinks and fatty foods must be avoided since
they promote reflux and reduce pressure in the sphincter.
Spicy or acid containing foods such as citrus juices,
carbonated beverages and tomato juice aggravate the
symptoms of GERD and should be avoided (2).
Medications:
Antacids
The first dose of antacid is advised one hour after the meal to
avoid symptoms of reflux and neutralize acid. A second dose of
antacids are advised approximately two hours after the meal. Antacid
may be aluminum, magnesium, or calcium (usually calcium carbonate)
based. Calcium based antacids are not recommended since they stimulate
the release of the hormone gastrin in stomach and duodenum which
in turn is responsible for stimulation of acid secretion. The
over production of acid is counterproductive for the treatment
of GERD. Aluminum based antacids tend to cause constipation and
magnesium based antacids have a tendency to cause diarrhea.
Histamine antagonists:
A histamine antagonist blocks the histamine receptor (histamine
stimulates acid producing cells) Therefore, by blocking the histamine
receptors, the stimulation of acid producing cells can be prevented.
Histamine antagonists are called H2 antagonists since they block
histamine type 2 receptor. H2 antagonists are advised to be taken
30 minutes after the meals. Some of the H2 antagonists prescribed
are Cimetidine (Tagamet), Ranitidine (Zantac), Nizatidine (Axid)
and Famotidine (Pepcid).
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Proton pump inhibitors (PPI):
These medications shut off acid production more
effectively and for a longer period as compared to H2
antagonists. Some of the PPI’s approved for
treatment of GERD are Omeprazole (Prilosec), Lansoprazole
(Prevacid), Rabeprazole (Aciphex), Pantoprazole
(Protonix) and Esomeprazole (Nexium).
Pro-motility Drugs:
These drugs stimulate the muscles of gastrointestinal
tract i.e., muscles of the esophagus, stomach, small
intestine, and colon. The drugs also increase the
pressure in LES and strengthen the peristaltic movements
of esophagus thus reducing reflux of acid. These drugs
are taken 30 minutes after a meal. Metoclopramide
(Reglan) is a pro-motility drug approved for GERD.
Foam Barriers:
These drugs comprise an antacid and a foaming agent. The
tablet disintegrates as it reaches the stomach and the
foam floats on the liquid contents of the stomach not
permitting the reflux of liquid. Simultaneously, the
antacid neutralizes the acid. A combination of aluminum
hydroxide gel, magnesium trisilicate and alginate
(Gaviscon) is a best example of foam barrier.
Surgery:
Surgery becomes inevitable when drugs prove to be
ineffective in treatment of GERD. Surgery is recommended
only when following complications are found in a patient:
- Large hiatal hernia
- Severe esophagitis
- Recurrent narrowing (stricture) of the esophagus
- Barrett's esophagus, especially with progressive
precancerous or cancerous changes
- Severe pulmonary problems, such as bronchitis or
pneumonia, due to acid reflux (10).
The surgery process to prevent reflux is called Nissen
Fundoplication or reflux surgery or
anti-reflux surgery (2 & 10). In this surgery “...any
hiatal hernia sac is pulled below the diaphragm and
stitched there” (2). The opening of diaphragm
through which the esophagus passes is also tightened. “The
upper part of the stomach next to the opening of the
esophagus into the
stomach is wrapped around the lower esophagus to
make an artificial lower esophageal sphincter”
(2). The surgery can be conducted by a technique called
laparoscopy or laparotomy.
Other similar surgical procedures are Toupet
fundoplication, Hill repair and the Belsey Mark IV
operation (10).
Prevention Methods
Following preventive methods can be adopted to
effectively lessen heartburn. These include:
- Weight control
- Smaller meals
- Loosen the belt and avoiding tight clothing. Avoid heartburn triggers
such as fatty or fried foods, alcohol, chocolate, peppermint, garlic,
onion, caffeine and nicotine
- Avoid stooping or bending
- Avoid lying down immediately after a meal
- Raising the head of bed
- Avoid smoking and alcohol (11).
Article by Kona Vishnu, MS
Medical Writer,
OmniMedicalSearch.com
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