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Heartburn (GERD)

How Is GERD Treated?

Tuesday, April 10, 2012 - 10:23

Contributing Author: Guy Slowik FRCS

GERD can be treated with lifestyle changes, medication, or surgery. Many people with GERD improve a great deal by eliminating factors in their daily lives that contribute to reflux. Lifestyle changes often are used in combination with non-prescription or prescription drugs. In the rare cases, however, when those measures fail, surgery can provide relief.

Lifestyle changes

Medication

Surgery

Lifestyle Changes

GERD may occur less often or disappear after individuals make simple changes in daily life. Changes involve eliminating factors that cause reflux.

  • Some common foods and beverages increase the risk of reflux by relaxing the lower esophageal sphincter (LES). Reflux triggers include alcoholic beverages, chocolate, carbonated beverages, coffee, tea, soft drinks containing caffeine, spicy foods, and fatty foods.
  • Cigarettes contain chemicals that also relax the LES as they pass from the lungs into the blood.
  • Obesity increases abdominal pressure, forcing stomach contents past the LES. In some cases, GERD symptoms disappear completely after an overweight person looses 10-15 pounds.
  • Sleeping habits can trigger GERD. Lying down flat presses the stomach's contents against the LES. When a person goes to bed within two-three hours of heavy eating or drinking, a meal which includes GERD-triggering foods - spicy food, wine, coffee, and a chocolate desert, for instance - makes matters much worse.
  • Clothing that fits tightly around the abdomen squeezes the stomach. It can force food up against the LES. Problem clothing includes tight-fitting belts and slenderizing undergarments.

How-To Information:

Tips on Avoiding Heartburn and Other GERD Symptoms

  • Eat smaller meals. A full stomach puts extra pressure on the lower esophageal sphincter (LES), increasing the chances that food will reflux into the esophagus.
  • Loose weight if you are overweight. Obesity increases abdominal pressure, which can push stomach contents up into the esophagus.
  • Stop smoking. Chemicals in cigarette smoke weaken the LES .
  • Sleep with your head raised a few inches. Sleeping with the head higher than the stomach reduces the pressure at which partially digested food in the stomach presses on the LES. Try using an extra pillow. Place books, bricks, or blocks securely under the legs at the head of your bed. A foam wedge extending from buttocks to head provides the best form of elevation.
  • Avoid eating within two-three hours of bedtime. Lying down with a full stomach results in stomach contents pressing harder against the LES, increasing chances that food will reflux.
  • Avoid tight-fitting belts or garments around the waist. They squeeze the stomach, and may force food to reflux into the esophagus.
  • Avoid bending over or stooping after meals. Lift objects by keeping the upper part of your body straight and bending your knees.
  • Avoid foods and beverages that can trigger GERD. Some foods weaken the LES. They include: alcohol; coffee, tea, cola drinks, and other beverages containing caffeine; carbonated beverages; chocolate; citrus fruits and juices; tomatoes and tomato sauces; and spicy foods.

Medication

Medications can be used when lifestyle changes alone do not bring adequate relief. Many people with heartburn and GERD self-treat their symptoms with non-prescription drugs. Antacids and other products can ease the immediate symptoms. But they seldom bring complete relief. Several prescription drugs can be more effective. Doctors use three groups of medications to treat GERD.

  1. Prokinetic medications work by increasing the pressure of the lower esophageal sphincter (LES) . By causing the LES to contract with greater force, they reduce the chances that food will reflux into the esophagus. These medications include Propulsid(cisapride), Reglan (metoclopramide), and Bethanacol(urecholine). Propulsid is being removed from the market because of evidence that it can cause serious disturbances in heart rhythm. People taking Propulsid should contact their physician about an alternative medicine.
  2. Proton pump inhibitors suppress almost all acid production in the stomach. These medications include Prilosec (omeprazole),Prevacid (lansoprazole), Aciphex (rabeprazole), Protonix(pantoprazole), and Nexium (esomeprazole). Although they do not prevent GERD, these drugs allow inflammation and other damage in the esophagus to heal by reducing the acidity of refluxed stomach contents.
  3. Histamine blockers partially suppress the production of stomach acid by blocking the action of histamine on cells in the stomach lining. Histamine is a protein that signals stomach cells to make hydrochloric acid. These drugs help inflammation in the esophagus to heal by reducing the acid that causes it. Some are available as non-prescription medicines in a lower strength. Examples of non-prescription histamine blockers include Zantac (ranitidine),Tagamet (cimetidine), and Pepcid (famotidine).

Nice To Know:

Q. I've always used an antacid for heartburn. Is there anything more effective?

A. Antacids counteract, or neutralize, acid after the stomach produces it. They must be taken repeatedly as the stomach makes more acid. Several drugs do a much better job than antacids. Non-prescription strengths of TagametZantac, and Pepcid, for instance, block some acid production in the stomach. Several prescription drugs likePrilosec, Prevacid, Aciphex, and Nexium actually shut off almost all acid production. Other prescription drugs like Propulsid and Reglan attack the real cause of GERD by making the valve between the stomach and the esophagus contract with greater force; these drugs help most by improving or speeding up the emptying of the stomach. Your doctor will suggest the most appropriate medication.

Surgery

When severe symptoms of GERD persist after lifestyle changes and drug treatment, surgery may provide relief. In the past, surgical treatment of GERD required a large abdominal incision and meant a long period of recovery. The use of a laparoscope, a thin viewing tube, and the development of laparoscopic surgery methods, however, has made surgery for GERD easier on patients. Laparoscopic surgery, a minimally invasive procedure, is done through small incisions. Patients can leave the hospital quicker, and recover faster.

For further information about laparoscopy, go to Laparoscopy.

  • Laparoscopic anti-reflux surgery is the most common form of surgery for GERD. The operation is sometimes called Laparoscopic Nissen Fundoplication. It involves strengthening the lower esophageal sphincter (LES) by wrapping part of the upper stomach around the sphincter and lower esophagus. The flap of stomach fits around the esophagus much like a hot dog bun fits around a hot dog. It reinforces the LES, helping the sphincter to close more strongly.
  • In some cases, the conventional "open" surgery (called Nissen Fundoplication) which requires a larger abdominal incision, may be needed. It is used mainly when surgeons are not able to see abdominal structures through the laparoscope because of scar tissue from past operations or other complications.
  • If a hiatal hernia also is present, it usually will be repaired during anti-reflux surgery.

Nice To Know:

Q. Will I need surgery for a hiatal hernia? The doctor thinks a hiatal hernia is causing my stomach problems, He wants me to have a series of upper GI x-rays to be sure. Now I'm worried that if the x-rays show a hernia, I'll have to undergo an operation.

A. Hiatal hernias are very common. In most people they don't even cause symptoms. A hiatal hernia, however, may cause heartburn and other symptoms of GERD. Those symptoms usually can be treated with lifestyle changes or medications. Relatively few people with hiatal hernias need surgery. Even then, new laparoscopic surgery is a lot easier on patients because it involves less discomfort and a faster recovery.

 

Heartburn (GERD)