Gastroesophageal Reflux Disease (GERD)
What is GERD?
How is GERD treated?
Gastroesophageal reflux, or acid reflux, occurs when Mild GERD is treated with lifestyle changes and stomach contents reflux (back up) into the esopha- non-prescription medicines, including antacids or gus or mouth. It occurs commonly and briefly in a group of medicines known as histamine antago- healthy people and usually does not cause bother- Moderate to severe GERD and mild GERD unre- In contrast, people with gastroesophageal reflux sponsive to histamine antagonists/lifestyle changes disease (GERD) experience uncomfortable symp- may be treated with a different class of medicines, toms or injury to the esophagus as a result of the re- flux. The esophagus can be damaged by repetitive, prolonged exposure to the high acidity of stomach Lifestyle treatments for GERD
contents. Treatments for GERD are designed to Lifestyle changes that are the most helpful are: decrease the acidity of the stomach contents while limiting the amount and duration of the reflux.
For all people: maintaining weight in a healthy range (losing weight if overweight).
What are symptoms of GERD?
The most common symptom of GERD is heartburn, For people with night time heartburn or laryngeal which is a burning sensation in the center of the symptoms: elevating the head of the bed 6-8 inches chest, sometimes spreading to the throat. on blocks or with a wedge under the mattress (us- Other common symptoms are: pain in the upper abdomen, chest pain, a sensation of food getting stuck, regurgitation of food/fluid, an acid taste in ♦ Avoid large or late meals, especially within 3 ♦ Avoid acid reflux-inducing foods such as alco- Less common symptoms are: painful swallowing, hol, caffeine, chocolate, peppermint, and fatty persistent laryngitis or hoarseness, persistent sore throat, chronic cough and sense of a lump in the ♦ Limit onions, tomato, and citrus.
♦ Stop smoking and chew gum to increase saliva which neutralizes stomach acid (avoid sugarless You should seek medical help if there is difficulty gum with sorbitol, as this can increase gas).
or pain with swallowing, unexplained weight loss, ♦ Avoid tight fitting clothing which may increase chest pain, choking, or bleeding (i.e. vomiting blood the pressure on the abdomen and stomach.
Medications for GERD
How is GERD diagnosed?
Nonprescription medications used for mild acid re- GERD is diagnosed by a medical provider based on flux are antacids such as Tums, Maalox, or Mylanta the history of your symptoms and your response to (in liquid or pill form). These medicines neutralize treatment. Your provider will also rule out other stomach acid only very briefly after each dose and causes of symptoms such as chest pain. Endoscopy is a test in which a lighted tube is inserted into the esophagus and stomach to look for damage to the Histamine antagonists reduce the production of mucosal linings of those organs, and to take biopsy acid in the stomach. They work quickly and are samples of damaged areas. Endoscopy is usually effective for many. Examples of histamine antago- reserved for people who fail treatment with medica- nists are rantidine (Zantac), famotidine( Pepcid), tions or who have “alarm” symptoms (eg. weight cimetidine (Tagamet) and nizatidine (Axid). Most loss, dark tarry stools, bloody vomiting, difficulty or are available over the counter and also in prescrip- pain with swallowing), to insure there is not a more BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953
Moderate to severe symptoms of GERD or mild symptoms unresponsive to histamine antagonists and lifestyle changes may be treated with PPIs, very effective medicines for reducing the produc- tion of stomach acid. Examples are: omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix), rabepra- For optimum effectiveness, PPIs should be taken on an empty stomach before the first meal of the day. In some cases, under the direction of your provider, a second dose may need to be given be- fore the evening meal. PPIs take about 5 days to build up to their maximum effective level. For this reason, they should not be used on an “as needed” basis. Generally, they should not be used along Once the optimum dose has been found, the PPI is often continued for several weeks, at which time the medication may be stopped or decreased. If symptoms recur within 3 months, long term treat- ment may be needed. If symptoms do not recur within 3 months, intermittent treatment is usu- ally adequate. If the symptoms are not controlled, endoscopy is often recommended, and requires a Complications of untreated long term
Untreated GERD is uncomfortable. The delicate esophageal tissues can be damaged by repeated, prolonged exposure to the highly acidic refluxed stomach contents. Scar tissue (strictures) can develop from the acid exposure, narrowing the esophagus. Precancerous changes in the esophagus can also be complications of long term untreated GERD. Asthma (spasms in the airways triggered by reflux of acid), chronic laryngitis and chronic cough have also been reported as complications of Make an appointment with a provider if you have symptoms of GERD to discuss what treatment may BROWN UNIVERSITY HEALTH SERVICES | www.brown.edu/health | 401.863-3953

Source: http://w.pembrokecenter.org/Student_Services/Health_Services/library/documents/GERD12.pdf

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