Treatment for GER & GERD
The surgeon performs the operation at a hospital. You receive general anesthesia and can leave the hospital in 1 to 3 days. Most people return to their usual daily activities in 2 to 3 weeks. They can heal the esophageal lining in most people with GERD. Doctors often prescribe PPIs for long-term GERD treatment.
Gastroesophageal Reflux Disease (GERD)
When you lay on your right side, stomach acid covers the lower esophageal sphincter. This increases the risk of acid leaking through it and causing reflux. The esophagus enters the right side of the stomach. As a result, the lower esophageal sphincter sits above the level of stomach acid when you sleep on your left side ( 55 ). Additionally, an analysis of controlled studies concluded that elevating the head of the bed is an effective strategy to reduce acid reflux symptoms and heartburn at night ( 10 ).
If GERD is severe and unresponsive to medical treatment, a surgical intervention known as fundoplication may be needed. Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid. PPIs and H2 blockers decrease acid production and reduce the potential for damage caused by acid reflux. A recent study suggests that dietary choices may be as effective as using proton pump inhibitors (PPIs) in treating acid reflux.
Note that smoking also substantially reduces the clearance of acid from the esophagus. This effect continues for at least 6 hours after the last cigarette. As previously mentioned, swallows are important in eliminating acid in the esophagus. Swallowing causes a ring-like wave of contraction of the esophageal muscles, which narrows the lumen (inner cavity) of the esophagus.
Moreover, many people have hiatal hernias but do not have GERD. It is not known for certain how or why hiatal hernias develop. The most recently-described abnormality in patients with GERD is laxity of the LES. Specifically, similar distending pressures open the LES more in patients with GERD than in individuals without GERD. At least theoretically, this would allow easier opening of the LES and/or greater backward flow of acid into the esophagus when the LES is open.
- A number of anatomic and physiologic mechanisms normally prevent reflux from occurring, and derangement in any of these can promote esophageal acid exposure.
- Moreover, the effectiveness of drug treatment can be monitored with 24 hour pH testing.
- “Newly approved treatment for acid reflux disease available.” ScienceDaily.
- These cells are pre-cancerous and may, though usually, become cancerous.
There are problems with using pH testing for diagnosing GERD. Despite the fact that normal individuals and patients with GERD can be separated fairly well on the basis of pH studies, the separation is not perfect. Therefore, some patients with GERD will have normal amounts of acid reflux and some patients without GERD will have abnormal amounts of acid reflux.
Although there is an available drug that prevents relaxations (baclofen), it has side effects that are too frequent to be generally useful. Much attention is being directed at the development of drugs that prevent these relaxations without accompanying side effects. A third type of endoscopic treatment involves the injection of materials into the esophageal wall in the area of the LES. The injected material is intended to increase pressure in the LES and thereby prevent reflux. In one treatment the injected material was a polymer.
Foam barriers are tablets that are composed of an antacid and a foaming agent. As the tablet disintegrates and reaches the stomach, it turns into foam that floats on the top of the liquid contents of the stomach. The foam forms a physical barrier to the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes into contact with the foam. The tablets are best taken after meals (when the stomach is distended) and when lying down, both times when reflux is more likely to occur.
If you have ever burped and had an acid taste in your mouth, you have had reflux. Sometimes the LES relaxes at the wrong times. Often your child will just have a bad taste in his or her mouth.
When the LES relaxes too often or for too long, stomach acid flows back into the esophagus. This causes vomiting or heartburn. Long-term follow-up results from a multicenter, randomized trial showed that, relative to pharmacotherapy, fundoplication maintained better symptomatic relief in the management of gastroesophageal reflux disease without evidence of long-term postsurgical adverse symptoms.