Gastroesophageal Reflux Disease (GERD or Acid Reflux)

Treatment for Gastro Reflux Disease

 

The treatment options for gastroesophageal reflux disease (GERD) fall into three broad categories: conservative, medications, and surgical.

 

1. Conservative methods include changing lifestyle and eating behaviors that contribute to acid reflux.

2. Medication therapy uses both over-the-counter and prescription medications to reduce the production of acid in the stomach, protect the esophagus from acid damage, and help keep pressure at the esophageal junction low.

3. Surgical intervention is necessary when other methods of controlling GERD fail.

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Conservative Therapy for Acid Reflux

 

Lifestyle and diet change are the first steps in reducing the frequency and severity of heartburn and GERD-related symptoms. These changes focus on food choices, modifying intake, and taking steps to reduce pressure within the stomach.

Control alcohol and tobacco use: Tobacco and alcohol irritate the esophagus and act on the lower esophageal sphincter (LES) to reduce its ability to stay closed.

Reduce trigger foods: Foods that stimulate acid production or relax the LES are called “trigger foods.” Eliminating these foods from your diet can alleviate many symptoms of GERD.

Adjust medications: Prescription and non-prescription medications change acidity, LES pressure, and stomach emptying. Review medications with your doctor to ensure they are not making your GERD worse.

Get active: Activity helps gastric emptying and assists with weight control. Reducing your weight by as little as 10 pounds can have a dramatic effect on stomach pressure and prevent reflux through the LES.

Stay upright: Reclining increases the pressure of stomach contents on the LES and promotes reflux, especially when your stomach is full. Staying upright for a minimum of 2 hours after eating can reduce symptoms.

Adjust sleeping position: Raising the head of your bed about 6 inches using blocks under the front legs can decrease pressure on the LES while you sleep, reducing nighttime heartburn.

Loosen clothing: Tight-fitting clothes such as pants, belts, and back support belts increase abdominal pressure and make it more difficult for the LES to do its job. In many cases, weight gain is responsible for tight-fitting clothing, so weight loss can help tremendously.

Medications for Reflux

Both over-the-counter and prescription medication have been the mainstay of GERD treatment for many years. Medications are designed to reduce symptoms by reducing stomach pressure, decreasing stomach acid production, and protecting the esophagus from acid damage. Because GERD is a progressive disease, however, medication doses will adjust upward as a reflux disease worsens.

 

Types of Medications

• Antacids: Reducing stomach acidity with over-the-counter antacids is the most frequent remedy for infrequent and mild heartburn.

• H2 Blockers: Histamine turns on acid production at a cellular level in the stomach. Histamine blockers are frequently used to stop acid production as part of stomach ulcer treatment. Reducing stomach acid production also reduces the severity of acid reflux symptoms.

• Proton Pump Inhibitors (PPIs): More powerful than H2 blockers, PPIs reduce acid production in the stomach by up to 80%. They have quickly become the most important class of drugs used in GERD treatment and are usually part of a lifelong drug therapy regimen to control chronic acid reflux. There could be potential side effects to long term use.

• Coating Agents: These types of prescription drugs protect damaged tissue in the stomach and esophagus from exposure to acid, reduce pain, and allow damaged tissues to heal.

• Motility-promoting drugs: Improving the rate at which stomach contents empty into the intestines with motility drugs can reduce stomach pressure and prevent reflux through the LES.

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Surgical Treatment for Reflux Disease

 

Minimally invasive surgery has increased the popularity of surgery as a long-term solution for chronic GERD. Surgical intervention focuses on strengthening the lower esophageal sphincter, correcting hiatal hernias, and in some cases, helping obese patients reduce their weight.

Surgical repair of the LES is considered when:

 

• Conservative and medication-based therapies are ineffective at controlling GERD symptoms

• Complications are developing from GERD, despite medication treatment

• Atypical symptoms such as asthma, sinus problems and chronic cough are uncontrolled

• GERD medication side effects are not tolerated by the patient

• Lifelong therapy with medications is cost prohibitive or too disruptive to the patient’s lifestyle

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