Gerd and Acid Reflux Treatment

Gastroesophageal reflux disease is treated according to its severity.
Mild symptoms — Initial treatments for mild acid reflux include dietary changes and using non-prescription medications, including antacids or histamine antagonists.
Lifestyle changes — Changes to the diet or lifestyle have been recommended for many years, although their effectiveness has not been extensively evaluated in well-designed clinical trials. A review of the literature concluded that weight loss and elevating the head of your bed may be helpful, but other dietary changes were not found helpful in all patients. Thus, these recommendations may be helpful in some, but not all people with mild symptoms of acid reflux.
For people with mild acid reflux, these treatments can be tried before seeking medical attention. However, anyone with more serious symptoms should speak to their healthcare provider before using any treatment.
Weight loss – Losing weight may help people who are overweight to reduce acid reflux. In addition, weight loss has a number of other health benefits, including a decreased risk of type 2 diabetes and heart disease.
Raise the head of the bed six to eight inches – Although most people only have heartburn for the two- to three-hour period after meals, some wake up at night with heartburn. People with nighttime heartburn can elevate the head of their bed, which raises the head and shoulders higher than the stomach, allowing gravity to prevent acid from refluxing. Taking honey at bedtime will also help smooth digestive system.

Raising the head of the bed can be done with blocks of wood under the legs of the bed or a foam wedge under the mattress. Several manufacturers have developed commercial products for this purpose. However, it is not helpful to use additional pillows; this can cause an unnatural bend in the body that increases pressure on the stomach, worsening acid reflux.
Avoid acid reflux inducing foods – Some foods also cause relaxation of the lower esophageal sphincter, promoting acid reflux. Excessive caffeine, chocolate, alcohol, peppermint, and fatty foods may cause bothersome acid reflux in some people.
Quit smoking – Saliva helps to neutralize refluxed acid, and smoking reduces the amount of saliva in the mouth and throat. Smoking also lowers the pressure in the lower esophageal sphincter and provokes coughing, causing frequent episodes of acid reflux in the esophagus. Quitting smoking can reduce or eliminate symptoms of mild reflux.
Avoid large and late meals – Lying down with a full stomach may increase the risk of acid reflux. By eating three or more hours before bedtime, reflux may be reduced. In addition, eating smaller meals may prevent the stomach from becoming overdistended, which can cause acid reflux.
Avoid tight fitting clothing – At a minimum, tight fitting clothing can increase discomfort, but it may also increase pressure in the abdomen, forcing stomach contents into the esophagus.
Chew gum or use oral lozenges – Chewing gum or using lozenges can increase saliva production, which may help to clear stomach acid that has entered the esophagus.
Antacids — Antacids are commonly used for short-term relief of acid reflux. However, the stomach acid is only neutralized very briefly after each dose, so they are not very effective. Examples of antacids include Tums®, Maalox®, and Mylanta®.
Histamine antagonists — The histamine antagonists reduce production of acid in the stomach. However, they are somewhat less effective than proton pump inhibitors.
Examples of histamine antagonists available in the United States include ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®). These medications are usually taken by mouth once or twice per day. Cimetidine, ranitidine, and famotidine are available in prescription and non-prescription strengths.
Moderate to severe symptoms — Patients with moderate to severe symptoms of acid reflux, complications of gastroesophageal reflux disease, or mild acid reflux symptoms that have not responded to the lifestyle modifications and the medications described above usually require treatment with prescription medications. Most patients are treated with a proton pump inhibitor.
Proton pump inhibitors — PPIs include omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®), dexlansoprazole (Kapidex™), pantoprazole (Protonix®), and rabeprazole (AcipHex®), which are stronger and more effective than the H2 antagonists.
Once the optimal dose and type of PPI is found, you will probably be kept on the PPI for approximately eight weeks. Depending upon your symptoms after eight weeks, the medication dose may be decreased or discontinued. If symptoms return within three months, long-term treatment is usually recommended. If symptoms do not return within three months, treatment may be needed only intermittently. The goal of treatment for GERD is to take the lowest possible dose of medication that controls symptoms and prevents complications.
Proton pump inhibitors are safe, although they may be expensive, especially if taken for a long period of time. Long-term risks of PPIs may include an increased risk of gut infections, such as Clostridium (C. diff), or reduced absorption of minerals and nutrients. In general, these risks are small. However, even a small risk emphasizes the need to take the lowest possible dose for the shortest possible time.
If symptoms are not controlled — If your symptoms of gastroesophageal reflux disease are not adequately controlled with one PPI, one or more of the following may be recommended:
An alternate PPI may be prescribed or the dose of the PPI may be increased
The PPI may be given twice per day instead of once
Further testing may be recommended to confirm the diagnosis and/or determine if another problem is causing symptoms
Surgical treatment may be considered
Surgical treatment — Prior to the development of the potent acid-reducing medications described above, surgery was used for severe cases of GERD that did not resolve with medical treatment. Because of the effectiveness of medical therapy, the role of surgery has become more complex. In general, anti-reflux surgery involves repairing the hiatus hernia and strengthening the lower esophageal sphincter.
The most common surgical treatment is the laparoscopic Nissen fundoplication. This procedure involves wrapping the upper part of the stomach around the lower end of the esophagus.
Although the outcome of surgery is usually good, complications can occur. Examples include persistent difficulty swallowing (occurring in about 5 percent of patients), a sense of bloating and gas (known as “gas-bloat syndrome”), breakdown of the repair (1 to 2 percent of patients per year), or diarrhea due to inadvertent injury to the nerves leading to the stomach and intestines.

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