Gastroesophageal Reflux Disease
Common symptoms of gastroesophageal reflux disease are heartburn and/or acid regurgitation. Heartburn
burning sensation felt behind the breast bone that occurs when stomach contents irritate the normal
lining of the esophagus. Acid regurgitation is the sensation of stomach fluid coming up through the chest which may reach the mouth. Less common symptoms that may also be associated with gastroesophageal reflux include unexplained chest pain, wheezing, sore throat and cough, among others. How is Gastroesophageal Reflux Disease treated?
Reflux symptoms sometimes disappear if dietary or lifestyle excesses that cause the symptoms are reduced or eliminated. Avoiding these items may reduce your discomfort:
fatty or spicy foods
eating within three hours of bedtime
excess alcohol consumption
excess weight gain
Propping up the head of the bed at night may be helpful.
Should symptoms persist, over-the-counter antacids may decrease discomfort. Antacids, however, only work for a short time and for this reason, they have a limited role in treating reflux disease. Histamine H2 receptor antagonists (cimetidine, ranitidine, and famotidine) decrease acid production in the stomach.These medications work well for treating mild reflux symptoms and are quite safe, with few side effects.They are available over the counter at a reduced dose, or at a higher dose when given by prescription by your doctor.
Proton pump inhibitors (omeprazole, lansoprazole, pantoprazole, esomeprazole, and rabeprazole) are all highly effective in treating reflux symptoms. These medications act by blocking the final step of acid production in the stomach and are typically taken once or twice daily prior to meals. For reflux symptoms
that occur frequently, proton pump inhibitors are the most effective medical treatment.
Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of reflux disease. The only available drug in the market is metoclopramide, which has little benefit in the treatment of reflux disease and has many side effects, some of which can be
Surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for
treating reflux disease is known as fundoplication. In this procedure, a hiatal hernia, if present, is eliminated and part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. The operation is typically done via a laparoscope, an instrument
that avoids a full incision of the stomach. Due to the complexity of this surgery, it is important to seek a skilled surgeon who has experience in performing this procedure and can discuss the risks and benefits of the procedure.