Treatment of GERD

Life style changes
Several changes in lifestyle, related to individuals’ habits are recommended.

As mentioned before, reflux is more troublesome at night when the individual is lying down. Relief can be provided by elevating the patient’s upper body at night. This can be done by putting blocks under the bed’s feet on the head side. Also, reflux has been observed to occur less frequently when the patient lies on his left side rather than on the right.

Alterations in eating habits are also recommended. Certain foods aggravate reflux. These should be religiously avoided. Chocolate, alcohol, caffeinated drinks, peppermint, fatty foods, spicy foods, citrus juices, carbonated drinks and tomato juice fall in this category. Smoking should be completely stopped.

Reflux is more after meals when the stomach is distended with food. Hence, smaller and earlier evening meals are recommended. A smaller meal distends the stomach less and an earlier evening meal would mean that by bedtime, it has been digested and the stomach is empty. Therefore, reflux will be less bothersome when the patient lies down.

Antacids
Antacids are the chief form of treatments for patients of GERD. They neutralize the acid in the stomach, thus leaving no acid to reflux. However, their effect is brief as they empty out of the stomach quickly and subsequently, acid accumulates once again. An antacid, if taken one hour before a meal and then again taken approximately two hours after it, is most effective in reducing reflux.

Histamine antagonists
As mentioned above, antacids are effective for a very short duration. Hence, histamine antagonists were developed as a more long lasting remedy for treatment of acid-related diseases, including GERD. The chemical Histamine produces acid in the stomach. Histamine antagonists prevent histamine from doing its work.

Histamine produces acid, particularly after a meal. Therefore, histamine antagonists are best taken 30 minutes before a meal so that they at the peak of efficiency when most of the acid is being produced.

Proton pump inhibitors
A proton pump inhibitor or PPI was another type of drug developed for acid-related diseases such as GERD. Like the histamine antagonists, a PPI also blocks off the production of acid in the stomach. Moreover, it does so for a longer duration than the histamine antagonist. Also, unlike the histamine antagonist, the PPI protects the esophagus from acid, allowing for esophageal inflammation to heal. PPI’s are used when histamine antagonists are found to be inadequate.

Pro-motility drugs
Pro-motility drugs stimulate the muscles of the gastro intestinal tract. These include the esophagus, stomach, small intestine and/or colon. They heighten the pressure in the LES and boost the wave-like contractions of the esophagus. Both these effects reduce acid reflux.

Surgery
Surgery is very effective in relieving the symptoms of GERD and is resorted to when other means have proved to be inadequate. The surgical procedure that is undertaken to prevent reflux is known as fundoplication.

Endoscopy
In recent times, endoscopic treatments have been applied to deal with GERD. In the first type of treatment, the LES area is stitched, which tightens the muscle. In the second type of treatment, radio frequency waves are applied just above the LES. They cause a scar to form below the esophageal lining. When this scar shrinks, it pulls the surrounding tissue, thus tightening the LES area. There is yet another type of endoscopic treatment in which material is injected into the esophageal wall, in the LES area. This raises the pressure on the LES, thus preventing reflux.

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