Treatment of GERD
Treatment of GERD can be separated into three types:
Changing of lifestyle
There are a number of foods and habits that increase the frequency of gastroesophageal reflux. Below we will provide a number of tips concerning your lifestyle which will guard you against symptoms of GERD:
- For the time being pants and belts that are too tight should be avoided, as they increase the pressure within the abdomen which promotes the backward flow of stomach’s content.
- Sleeping with an elevated head will prevent the backward flow of gastric acid.
- Make sure that you get enough sleep. On average 7-8 hours of sleep per night is enough.
- Lifting heavy weights (especially after a meal) can also worsen the symptoms of GERD, since it increases the pressure within the abdomen.
- Stress is also a major factor that causes your stomach to produce more acid. Try to avoid stressful situations, and if you can’t, you should learn techniques of autosuggestion and meditation.
- Nevertheless it is important to perform a cardio workout every day to keep your weight in check. Visceral fat is a major factor that causes gastroesophageal reflux, as it pushes up the stomach, causing dysmotility of the lower esophageal sphincter.
The main medications used to treat gastroesophageal reflux are:
- Proton-pump inhibitors – is a group of pharmaceutical products that produce a substantial and long-lasting decrease in gastric acid production, by irreversibly blocking the hydrogen and potassium adenosine triphosphate enzyme system of the gastric parietal cells.
- H2 receptor blockers (H2 receptor antagonists) – are a class of drugs that block the effect of histamine on the gastric parietal cells (the H2 histamine receptors), which decreases the production of gastric acid by these cells.
- Antacids – are substances that neutralize the stomach’s acidity, without influencing its production. Currently calcium-, aluminum-, and magnesium-based antacids are available. It is interesting to know that in the past people used to drink baking soda to get rid of the heartburn by decreasing the acidity in their stomach. Though it did help for a short while, gasses that were produced stimulated the walls of the stomach, causing it to produce even more acid, worsening the condition.
Proton-pump inhibitors (omeprazole, pantoprazole, etc.) appear to be the most powerful treatment with H2 receptor blockers (it advisable to take newest generations of this drug) being second. Antacids (Maalox, etc.) are not as good at treating GERD; however, they are perfect as a fast, symptomatic treatment if you’re suffering from terrible heartburn after a night of drinking with your friends
Surgical treatment is used as the last resort and is called Nissen fundoplication. This procedure involves wrapping the upper part of the stomach around the lower esophageal sphincter. This strengthens the sphincter (especially if the cause is hiatal hernia), preventing the content of the stomach from leaking into esophagus. This procedure is only recommended to patients that do not respond to drug therapy throughout the period of six months or when the patient is also suffering from asthma. Also, in short and long term, this operation better improves the quality of life of patients suffering from GERD, when compared to medical treatment.
Surgical treatment of complications of GERD includes the following procedures:
- Esophageal dilation – is a procedure that allows a doctor to stretch a narrowed part of the esophagus (strictures). Esophageal strictures most commonly appear as a result of scarring of the esophagus, which is caused by the irritation and ulceration of the mucous layer of the esophagus by the stomach acid.
- Removal of a part of the esophagus – this surgical operation is carried out due to repeated bleeding from ulcers in the esophagus, which do not heal on their own. It is also used when the patient is suffering from Barret’s esophagus (since it’s been directly linked with cancer) or when the patient already has esophageal adenocarcinoma. This procedure is followed by esophagogastric anastomosis to allow for the food to pass from the remaining part of the esophagus into stomach.
Treatment of GERD during pregnancy
Usually during pregnancy, dietary changes and changes to lifestyle have very little effect. This is caused by the fact that the womb is pushing up against the stomach stimulating its walls (which leads to production of more gastric acid) and causing dysmotility of the lower esophageal sphincter.
Calcium-, aluminum-, and magnesium-based antacids are recommended as a way of treatment of GERD during pregnancy. H2 receptor blockers and proton-pump inhibitors are also safe to use during pregnancy.