9 Mar 2015

Treatment of heartburn and Gastro esophageal reflux disease

Aims of treatment is adequate symptom control.
For most patients, the aim is acceptable symptom control.
General measures for managing gastro-oesophageal
reflux disease
Obese and overweight people are advised to lose weight, this will help in better symptom control.
Patients are advised to  raise the head end  of the bed on 15 cm wooden blocks.This has been found to be useful
Medications - Avoid non-steroidal anti-inflammatory drugs.
Avoid or reduce dose of nitrates, calcium channel antagonists, and anticholinergics.
Patients are advised to avoid or reduce smoking,large evening meals, food or drink within 3 hours of bedtime  should be avoided - Small frequent meals are better in these patients.
Fats or chocolate should be reduced or avoided.
Problem producing food and drinks are avoided especially citrus fruits, fruit juices, tea, coffee, peppermint, onions, garlic, cinnamon, cloves
Antacids and analgesics.
Short term relief is obtained with antacids. Many people on self medication are on this drugs. Antacids form a layer over the stomach content and help to reduce the reflux. Better when given with food.
Acid suppression therapy
H2 receptor Inhibitors  and the proton pump inhibitors are the two major groups.  Proton pump inhibitors are more rapid and effective in symptoms  relief and  healing oesophagitis.
The optimal daily dose  of proton pump inhibitors are given below
Omeprazole 20 mg.
Lansoprazole 30 mg
Pantoprazole 40 mg.
Rabeprazole 20 mg.
Motility modifying drugs
Metoclopramide and Domperidone are the agents, they are useful in symptom control but not useful in healing esophagitis. Metoclopramide is particularly useful GERD ,however, these drugs may be more useful in heart burn with nausea or early satiety.
Indicated only in those people require long term medical therapy. Conventional and Laparoscopic anti-refluxsurgery is useful.
Indications for surgical treatment
Patients poorly responding to medical treatment and patients with persisting reflux that is regurgitation of gastric contents without symptom of heartburn especially at night may get benefit from surgery.

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