GERD Treatment & Prevention Options (Gastroesophageal Reflux Disease)

Conditions & Diseases: Digestive Diseases

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).

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

Bibliography

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