Gastro-Eosophageal Reflux Disease (GERD)
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- What is GERD?
- Symptoms of GERD
- Causes of GERD
- Prevention of GERD
- Risk factors for GERD
- Complications of GERD
- When to see a doctor about GERD
- Diagnosis of GERD
- Conventional treatment of GERD
- Alternative/complementary treatment of GERD
- Living with GERD
- Caring for someone with GERD
Conventional treatment of gastro-eosophageal reflux disease (GERD)
Conventional treatment of gastro-eosophageal reflux disease (GERD) involves treating the symptoms to reduce their effects and is based on a number of approaches used in conjunction.
Dietary modifications
It is well documented that some foods can make reflux symptoms worse, but not everyone will have the same reaction to these foods every time.
The best way to determine which foods cause exacerbation of symptoms, keep a dairy of symptoms and remove these foods from the diet (or strictly limit them) and re-introduce them, one food at a time later to see if they still cause symptoms.
Lifestyle modifications
The following lifestyle modifications are recommended to reduce severity and duration of symptoms:
- Add fibre to the diet - it is really important to add some fibre to the diet, especially soluble fibre in the form of oat bran, psyllium, as it helps the digestive system become more healthy by reducing the pressure in the digestive system. Fibre also helps to reduce constipation symptoms
- Avoid large meals or eating late at night - large meals cause a lot of pressure on the digestive system as it needs to break down, digest and absorb the food that has been eaten. Digestion involves producing stomach acids and the more foods that are eaten, the more stomach acids that need to be produced, which can cause reflux symptoms to get worse. Eating late at night is not advised, because the digestive system needs a few hours to properly digest food and eating late does not give adequate time for this to occur and this can increase reflux symptoms and discomfort and inability to get to sleep
- Avoiding lying down after meals - this can cause a great deal of reflux symptoms as it becomes very easy for the sphincter to allow stomach acids up the eosophagus as there is no gravity to prevent it
- Avoid wearing tight clothes - especially tight pants, tight tops and tight belts and this is because these tight clothes can constrict the gastro-eosophageal area, which may be inflamed and cause it to further become more inflamed and worsen symptoms
- Check medications - some medications are known to have side effects which cause reflux or make reflux symptoms worse. The most common medications to cause this are: heart medication, Parkinson's disease medication, aspirin, non-steroidal anti-inflammatory medications (NSAIDs). People taking these types of medications and who also have GERD should ask their doctor if there are alternatives that do not aggravate their symptoms
- Elevate pillows - this is useful when the reflux symptoms occur later at night and sleep is difficult. Elevating the pillows will elevate the head, the upper part of the torso and subsequently the eosophagus so that reflux symptoms are less likely to occur
- Maintain a healthy weight - being overweight can put more pressure on the whole digestive system and cause a worsening of symptoms from the excessive fat
- Reduce alcohol intake - all alcohol, but especially red wine can make reflux symptoms much worse as they have a very low pH (too acidic)
- Reduce caffeine intake - a known trigger for causing worsening of symptoms is caffeine (from coffee, chocolate, tea or even energy drinks) and intake should be reduced to prevent symptoms
- Stop smoking - it is essential to stop smoking as studies show that smoking makes reflux symptoms worse and smoking also increases the risk of cancer of the throat and eosophagus
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Medication
Gastro-eosophageal reflux disease (GERD) is treated by two different groups of medications:
- Over-the-counter medications - these medications can be purchased at a pharmacy and do not require a prescription from a doctor (although often a doctor may recommend them):
- Antacids - as the name suggests, these medications work by reducing the amount of acid in the stomach which prevents reflux symptoms. Antacids are available in liquid, lozenge and tablet form. Common examples are: Gaviscon, Mylanta, Rennie
- Histamine H2-receptor antagonists (H2RAs) - these medications decrease the production of acid in the stomach by suppressing the action of histamine on the parietal cells in the stomach (which normally produce the stomach acids). These medications should not be used long term as this can cause possible complications. Common examples are: Gaviscon Advance, Pepcidine, Zantac
- Prescribed medications - these are prescribed to heal the inflammation in the eosophagus and give relief from reflux symptoms. There are two classes of medications which are prescribed for this condition:
- Proton pump inhibitors (PPIs) - this class of medications work on the reducing the pump mechanism action that produces acid in the parietal cells in the stomach and this reduces the amount of acid produced and helps to reduce reflux symptoms. This medication is usually prescribed to be taken at a higher dose at first and then tapered down for maintenance. Common examples are: Losec, Pariet, Nexium, Zoton
- Prokinetics - this class of medications are used to help quicken the emptying of the stomach contents, so less acid is required and this helps to reduce incidence of reflux symptoms. These medications work on the nerves in the stomach, by promoting the signal to empty the stomach contents more quickly. This medication is normally taken longer term, but can be used as often or as little as required. Common examples are: Maxalon, Motilium
All medications can produce side effects and any concern about these should be discussed with a medical doctor. With the prescription medications for GERD, the PPI's cause few side effects and are well tolerated by most people, but the prokinetics can sometimes cause side effects.
Surgery
Surgery is not often recommended for gastro-eosophageal reflux disease (GERD) and the only people who are advised to have surgery are those with very severe symptoms that cannot be adequately controlled with medication and if these symptoms cause a major impact to quality of life. Other diagnostic tests need to be performed first before surgery can be done to ensure that this type of surgery is actually warranted.
The only surgical procedure recommended is:
- Nissen fundoplication - this procedure involves keyhole surgery that wraps some of the top of the stomach around the lower end of the eosophagus and is very effective to help prevent future reflux symptoms. Sometimes complications arise if the wrapping is too tight or if swallowing becomes difficult (but these are able to be remedied)
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