A Simple Guide to Gastroesophageal reflux disease

A Simple Guide to Gastroesophageal reflux disease II
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What are the Complications of untreated Gastroesophageal reflux disease?
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GERD complications include

1.stricture formation,

2.Barrett's esophagus,

3.esophageal spasms,

4.esophageal ulcers,

5.esophageal cancer, especially in adults over 60 years old.


What is the treatment of Gastroesophageal reflux disease?
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Treatment is aimed at
A. prevention of reflux:
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1.weight loss for the Obese

2.Positional therapy

a.Sleeping on the left side has been shown to drastically reduce nighttime reflux episodes in patients

b.Elevating the head of the bed is also effective.

The head of the bed can be raised by wooden bed risers that support bed posts or legs.

Elevation must be at least 6 to 8 inches (15 to 20 cm) to be able to prevent the backflow of gastric fluids.

c.a bed wedge pillow will also help to raise the patient's body higher

3.Certain foods should be avoided to prevent gastroesophageal reflux:

a.Coffee,

b.alcohol,

c.Acidic foods, such as oranges,tomatoes and excess amounts of Vitamin C

d.Antacids based on calcium carbonate actually increase the acidity of the stomach.

e.Foods high in fats -delay stomach emptying

f.Carbonated soft drinks with or without sugar.

g.Chocolate and peppermint.

h.Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.

i.Milk and milk-based products containing calcium and fat,

j.Eating within 2 hours before bedtime.

k.Large meals- smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.

4.Smoking reduce lower esophageal sphincter competence, and should be avoided

5. Posture and GERD
Slouching causes a kink between the stomach and esophagus.

The esophageal muscles become twisted in a spasm.

Gas and acid get trapped in the spasm,causing irritation to the throat and the windpipe resulting in cough and asthmatic symptoms.

6.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.

B. Neutralizing the Gastric Acid Reflux
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1. Drug treatment

a.Proton pump inhibitors are the best drugs used in reducing gastric acid secretion. (eg Nexium, Losec)

b.Antacids taken before meals half hourly after symptoms begin can reduce gastric acidity (liquid antacid are more useful than tablets)

c.Alginic acid (Gaviscon) protects the mucosa as well as increase pH and decrease reflux.

d.Gastric H2 receptor blockers such as ranitidine or famotidine decrease gastric secretion of acid.

e.Sucralfate (Carafate) is used to help heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two hours apart from meals and medications.

2. Surgical treatment
The standard surgical treatment, done laparoscopically, is the Nissen fundoplication.

The upper part of the stomach is wrapped around the Lower Esophageal Sphincter(LES) to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.

3.New treatments
Eight years ago some new endoscopic devices to treat chronic heartburn were approved:

a.The Endocinch apply stitches in the LES to help strengthen the muscle.

b.The Stretta Procedure uses electrodes to use radio frequency energy to strengthen the LES.

c.The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fix the fold using a suture-based implant.


What is the prognosis of Gastroesophageal reflux disease?
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It is a chronic disease so treatment is lifelong and recurrences are common.


How is Gastroesophageal reflux disease prevented?
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1.Prevent heartburn by limiting acidic foods, such as grapefruit, oranges, tomatoes, or vinegar

2.Spicy foods - Cut down on pepper or chilies.

3.Avoid lying down for two to three hours after meals.

When you are sitting up, gravity helps drain food and stomach acid into your stomach.

4.Eat lean meats and non-fatty foods.
Greasy foods (like French fries and cheeseburgers) can trigger heartburn.

5.Avoid GERD symptom triggers- chocolate, mint, citrus, tomatoes, pepper, vinegar, catsup, and mustard.

6.Avoid drinks that can trigger reflux, such as alcohol, drinks with caffeine, and carbonated drinks.

7.Eat smaller meals to avoid triggering GERD symptoms.

8.Avoid stress.

Learn to relax or meditate.

Adopt a healthy lifestyle with exercises to improve flow of food down the stomach.