Treatment

Lifestyle Changes

   Lifestyle changes can lessen the severity of GERD.  In this form of treatment, the patient must avoid the leading factors that cause symptoms to occur.  There are a number of ways to prevent heartburn and decrease the amount of occurrences.

   The first aspect that affects GERD is a patient's position post eating. Often times, after a patient eats a large meal, heartburn occurs. Heartburn could be prevented if this patient maintains a straight posture while eating. If the patient experiences heartburn when sleeping, it may be beneficial to raise the head of the bed so the esophagus is above the stomach.

   The time of day a patient eats can also affect the severity of symptoms. It is ideal to eat early in the evening to give food time to digest before going to sleep. Eating a main meal at noon and a lighter meal in the evening could be beneficial. Certain foods should be avoided before bending, lying down or lifting. These foods could negatively impact the sphincter’s ability to prevent reflux. These foods differ depending on the person, but common foods that trouble people with GERD include chocolate, fats and onions. Some common drinks could also cause symptoms such as tea, cola, citrus juice and tomato juice. These drinks stimulate stomach acid to be made and irritate the esophagus. Another strategy would be to avoid lifting objects or bending following a meal.

   Another factor that can cause acid reflux is being overweight. The extra fat puts pressure on the stomach and causes more acid to be produced. This pressure can build up and push acid up into the esophagus. Losing weight can cause people to feel better and lower the stomach pressure.  Emotional changes and stress are other factors that lead to heartburn. Certain hormones in pregnant woman weaken the LES and can promote reflux. Often, heartburn experienced by a pregnant woman will decrease after delivery.

Medications

Antacids:

   Antacids neutralize acid in the stomach so there is no acid present to cause symptoms. A neutralization reaction occurs when an acid and a base react to form carbon dioxide and water. Antacids only provide temporary relief. In less than an hour, the antacid leaves the stomach and acid continues to build up again.

H2 blockers:

   H2 blockers decrease how much acid is made in the stomach. A chemical in the body called histamine 2 sends signals to the stomach to make acid. This form of medication blocks these signals which reduces acid production. In approximately 50 % of patients, H2 blockers heal the esophagus and eliminate symptoms. Remission only occurs in 25% of patients. 

Promotility drugs:

   If a patient has non-erosive GERD or mild esophagitis, this type of drug may be beneficial. It helps GERD patients because it stimulates the muscles of the esophagus and stomach. Metoclopramide is a promotility drug used to treat GERD that speeds the emptying of the stomach while reducing reflux. 

Proton Pump Inhibitors:

   Proton pump inhibitors limit acid secretion in the stomach. This medication inhibits proton pumps in the stomach, limiting acid secretion in the stomach for up to 24 hours. This provides time for the esophagus to heal. Proton pump inhibitors have been proven to work in 80-90% of patients

Foam Barriers: 

     Foam barriers are another treatment for GERD. These tablets contain a foaming agent and an antacid. The tablet deteriorates and reaches the stomach, where it becomes foam that floats above the liquid in the stomach and forms a barrier. While this is happening, the antacid attached to the foam neutralizes any acid that touches the foam. Foam barriers are often used with other drugs to help treat GERD.

Surgery

   If the above treatments prove to be ineffective, surgery is another alternative.  When a surgical procedure is preformed, there is always a chance that something will go wrong.  Complications or side effects occur in 5-20% in patients. Side effects are usually short-term but sometimes will continue for a longer period. These side effects include difficulty vomiting or belching and trouble swallowing. Anti-reflux surgery might break down. In some individuals, symptoms may continue to occur even after surgery and medication may need to be continued.

   Fundoplication is the technical name for anti-reflux surgery. During fundoplication, a hiatal hernia sac is stretched below the diaphragm and stitched in this position. The diaphragm opening is also tightened around the esophagus. The upper part of the stomach near the esophagus is also tightened around the lower esophagus. This creates an artificial lower esophageal sphincter. 

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