How to manage ACID reflux

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents goes backwards from the stomach into the esophagus (the tube like structure from the mouth to the stomach). This action can irritate the esophagus.

Physiology

When you eat, food passes from the throat to the stomach through the esophagus (also called the food pipe or swallowing tube). Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.

If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux .This reflux may cause symptoms, or can even damage the esophagus.

The risk factors

hiatal hernia (a condition in which part of the stomach moves above the diaphragm which is the muscle that separates the chest and abdominal cavities)
pregnancy
scleroderma.


Other factor are obesity, cigarettes, and alcohol also increase the chance of GERD.
medications. Such drugs include:

• Anticholinergics (e.g., for motion sickness)
• Beta-blockers for high blood pressure or heart disease
• Bronchodilators for asthma
• Calcium channel blockers for high blood pressure
• Dopamine-active drugs for Parkinson's disease
• Progestin for abnormal menstrual bleeding or birth control
• Sedatives for insomnia or anxiety
• Tricyclic antidepressants

If you suspect that one of your medications may be causing heartburn, talk to your doctor. Never change or stop a medication you take regularly without talking to your doctor.


Symptoms of Gastroesophageal Reflux (GERD)

The most common symptom is heartburn. Heartburn most often occurs 30 to 60 minutes after meals. The heartburn is usually get worsened by eating, lying down, bending over or exercising.

other symptoms may include regurgitation of acidic materials, chest pain, swallowing difficulty, bloating, belching, nausea, amorning hoarseness, nd weight loss.

Atypical symptoms like asthma, chronic cough, chronic bronchitis, chronic sore throat . So if you have chronic cough or uncontrolled bronchial asthma ,GERD need to be ruled out . Some doctors might prefer to just add antiacid and other acid inhibitors and see the patient response ...

The diagnosis:

Medical history is most important, as physical examination and laboratory tests are often normal.

Further investigation may include upper endoscopy with biopsy
- barium studies if it is indicated in rare cases
pH monitoring is the gold standart test this test enable us to document abnormal acid exposure in the esophagus ,but not commonly done as the duagnosis mostly done by the medical history.

Possible Complications

• Barrett's esophagus (a change in the lining of the esophagus that can increase the risk of cancer)
• Dental problems
• Esophegial stricture causing diffeculty in swallowing

The treatment

Lifestyle changes, such as quitting smoking or losing weight, and taking over-the-counter (OTC) antacids.

dietary changes: eat smaller meals and avoid acidic foods (such as tomato products, citrus fruits, spices )
Avoid fatty foods, peppermint, chocolate and alcohol especially during the time of the exacerbation of GERD

- Most importantly, it is recommended to avoid eating three (3) hours prior to bedtime or even lying down.
-Avoid bending over or exercising just after eating.

-Sleep with your head raised about 6 inches. Do this by tilting your entire bed, or by using a wedge under your body, not just with normal pillows.

There are other prescription drugs can treat GERD. They work more slowly than antacids but give you better and longer relief. But consult you GP first before taking them especially if you are on other medications like the plavix a heart medication ...to avoid drug interactions

Proton pump inhibitors (PPIs) are the most potent acid inhibitors: omeprazole (Prilosec) esomeprazole (Nexium), and pantoprazole (Protonix)

H2 antagonists: famotidine (Pepsid), cimetidine (Tagamet), ranitidine (Zantac), and nizatidine (Axid)

Promotility agents: metoclopramide (Reglan).

Usually the patient is given a 2 week course PPI plus Pro-motility agent and life style modification advice then is no improvement endoscopy done


Anti-reflux operations

(Nissen fundoplication and others)

This may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn.

This surgery can be performed in two way open or laprosopically
open and laparoscopic. Laparoscopic surgery (done via a small incisions in the abdomen) is the procedure of choice due to the reduced post-surgical recovery time.After laparoscopic surgery patients usually spend 1 to 3 days in hospital but those who underwent open surgery spend 2 to 6 days in the hospital after the procedure.

Most patients go back to work 2 to 3 weeks after laparoscopic surgery and 4 to 6 weeks after open surgery.

Some patients may need another operation in the future to treat new reflux symptoms or swallowing problems that comes after the surgeries. This usually happen if new hiatal hernia develops ,stomach was wrapped around the esophagus too tightly, or the wrap loosens,

There is newer LASER and chemical ablation procedures mainly for Barret esophagus.