Gastroesophageal reflux disease - Treatment - Encyclopedia II

The rubric "lifestyle modifications" is the term physicians use when recommending non-pharmaceutical treatments for GERD.

Certain foods and lifestyle tend to promote gastroesophageal reflux:

• Coffee, alcohol, calcium supplements, and excessive amounts of Vitamin C supplements are stimulants of gastric acid secretion. Taking these before bedtime especially can promote evening reflux. Calcium containing antacids such as TUMS (Calcium carbonate) are in this group[2]
• Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help, as well. Fat also delays emptying of the stomach.
• Having more but smaller meals also reduces the risk of GERD, as it means there is less food in the stomach at any one time.
• avoid eating for 2 hours before bedtime
• elevate the head of the bed on 6-inch blocks. (Pillows under the head and shoulders have been shown to be ineffective.)
• avoid sodas that contain caffeine
• avoid chocolate and peppermint
• avoid spicy foods
• avoid acidic foods like oranges and tomatoes
• avoid cruciferous vegetables: onions, cabbage, cauliflower, broccoli, Brussels sprouts
• milk and milk-based products contain calcium and fat, so should be avoided before bedtime.

Avoiding food for 2 hours before bedtime and not lying down after a meal are the most important of the lifestyle modifications. Elevation to the head of the bed is the next-easiest to implement. If one implements pharmacologic therapy in combination with food avoidance before bedtime and elevation of the head of the bed over 95% of patients will have complete relief. Additional conservative measures can be considered if there is incomplete relief. Another approach is to advise all conservative measures to maximize response.

A number of drugs are registered for the treatment of GERD, and they are among the most-often-prescribed forms of medication in most Western countries. They can be used in combination with other drugs, although some antacids can impede the function of other medications:

• Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase the pH). Alginic acid may coat the mucosa as well as increase the pH and decrease reflux.
• Gastric H₂ receptor blockers such as ranitidine or famotidine can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients.
• Proton pump inhibitors such as omeprazole are the most effective in reducing gastric acid secretion, as they stop the secretion of acid at the source of acid production, i.e. the proton pump. To maximize effectiveness of this medication the drug should be taken a half hour before meals.
• Prokinetics strengthen the LES and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing Long QT syndrome.

The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.

An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the Stretta Procedure, uses electrodes to create tiny cuts on the LES and apply radio frequency energy. When the healed, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

Another treatment which involved injection of a solution that is injected during endoscopy into the lower esophageal wall was available for approximatly one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.

Adapted from the Wikipedia article "Treatment", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki/Main_Page