STAGE III: INITIATION AND TITRATION OF SCHEDULED PHARMACOLOGIC THERAPY
After food and liquid enter the stomach, the LES tightens and closes the opening. If these muscles relax irregularly or weaken over time, stomach acid can back up into your esophagus.
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, OTC treatments to reduce the acidity of the stomach contents are available. 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.
Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective.
Therefore, smaller and earlier evening meals may reduce the amount of reflux for two reasons. First, the smaller meal results in lesser distention of the stomach. Second, by bedtime, a smaller and earlier meal is more likely to have emptied from the stomach than is a larger one. As a result, reflux is less likely to occur when patients with GERD lie down to sleep.
Moreover, normal individuals and patients with GERD can be distinguished moderately well from each other by the amount of time that the esophagus contains acid. Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers.
Common Causes of Acid Reflux Disease
Clearly, we have much to learn about the relationship between acid reflux and esophageal damage, and about the processes (mechanisms) responsible for heartburn. This issue is of more than passing interest.
The first is to perform 24-hour pH testing to determine whether the PPI is ineffective or if a disease other than GERD is likely to be present. If the PPI is ineffective, a higher dose of PPI may be tried. The second option is to go ahead without 24 hour pH testing and to increase the dose of PPI.
Nicotine stimulates stomach acid and affects the function of the lower esophageal sphincter. More serious reflux symptoms, such as bleeding from the esophagus or swallowing problems, might warrant further investigation. Individuals who don’t find relief with medications might also benefit from testing. Heartburn or acid indigestion is the most common symptom of GERD. Heartburn, or acid indigestion, is the most common symptom of GERD.
GERD is caused by the reflux of gastric contents into the esophagus. Normally, reflux is prevented by the lower esophageal sphincter (LES), a ring of muscle located at the junction of the esophagus and the stomach.
The contraction, referred to as peristalsis, begins in the upper esophagus and travels to the lower esophagus. It pushes food, saliva, and whatever else is in the esophagus into the stomach.