Acid reflux tratment

Acid reflux tratment 

The major patho-physiologic event in acid reflux disease is the occurrence of transient lower esophageal sphincter relaxation. The relaxation is triggered by large meals, meals with high fat content, and lying down after eating. Acid reflux is exacerbated with certain food and drink such as chocolate and alcohol, and medications including bronchodilators, nitrates and calcium channel blockers. 

Endoscopic evidence of esophagitis may be present in only 38–68% of patients with significant reflux symptoms. Patients should receive advice on lifestyle modifications such as weight loss or dietary changes. A course of a standard dose a proton pump inhibitor for 4 weeks is effective in healing 95% of erosive esophagitis. Unfortunately, 80% of patients have been shown to develop recurrent esophagitis within 6 months if inadequate or no maintenance treatment is given. Symptomatic control for relapses may require use of intermittent courses of a proton pump inhibitor, antacids,  alginate-based raft forming preparations, or H2 antagonists. The new isomer of omeprazole, Nexium , is the only proton pump inhibitor at present that is licensed for use on an as-required basis. Continuous treatment with a proton pump inhibitor (usually at lower dose) or H2 antagonists may be beneficial for those with frequent, recurrent symptoms. 

Anti-reflux surgery is usually considered for patients who are symptomatic or have recurrent strictures despite all medical treatment, or intolerance to a proton pump inhibitor. It may also be performed if the patient wishes it, as long as they are fully informed of possible complications including dysphagia, bloating, difficulty in belching, and likely relapse of reflux symptoms. Preoperative esophageal manometry is usually performed together with a 24-h pH study: the former facilitates accurate placement of the pH electrode. These tests confirm the diagnosis of reflux and  help rule out achalasia. The prevalence of esophageal dysmotility in GERD is approximately 30%, and symptomatic relief from anti-reflux surgery is not as good in these patients. About 60% of surgically treated patients develop recurrent symptoms that require antisecretory medications when followed for 10 years after surgery. One of the predictors of successful surgery is a clinical response  to medical therapy. A 24-h pH study is also helpful in the definitive diagnosis of acid reflux in symptomatic patients whose endoscopy is unremarkable.