Dietary and Lifestyle Changes
By Michel Kafrouni, M.D.
Many patients succeed in relieving most if not all the symptoms of gastroesophageal reflux disease (GERD) by changing the way they eat, what they eat and when they eat. Several foods can decrease the pressure at the lower esophageal sphincter, which works as a gateway preventing the acid from getting to the esophagus. Spicy foods, fatty foods, alcohol, sodas, smoking cigarettes, chocolate, coffee and all caffeinated products, peppermints, tomato-based juices and products and citrus products are examples of those foods. Avoiding those foods will help control GERD.
Some day-to-day lifestyle modification should be initiated and continued throughout the course of treatment for reflux disease. These include avoiding tight clothes, elevating the head of the bed, avoiding large meals, fasting for three hours before going to bed, and losing 5 percent of one’s body weight.
Medical Treatment
By Michel Kafrouni, M.D.
Despite dietary and lifestnyle changes, some patients still require medications to control their reflux symptoms. The medications can be given for a short period of time to help with the acute symptoms and to give time for the lifestyle and habits to change. However, some patients require lifetime treatment.
Many medications have been used to control gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPI) are the mainstay of treatment. They are potent acid reducers that block the pumps responsible for supplying the acid to the stomach. PPIs include omeprazole, lansoprazole, pantoprazole, esomeprazole and others. These medications are generally safe and can be taken once or twice per day (half an hour before breakfast or dinner).
Other medications have been used to treat GERD. Antacids neutralize the acidity of the stomach and provide short-term relief. Other medications such as sucralfate provide a barrier that lines the esophageal and stomach mucosa and protect it from the gastric juices, thus providing the needed time to heal. Some antihistamines such as ranitidine and famotidine also can be used to decrease the secretion of acid into the stomach lumen.
Most commonly the refluxed gastric contents are acidic, and typical medical therapy for reflux aims to suppress gastric acidity. However, bile (non-acidic fluid) may also be present within the gastric juice that is refluxed up into the esophagus. Neutralization of acid does not prevent injury to the esophagus from the non-acidic fluid. Therefore, even with suppression of acid production and decrease or elimination of heartburn, damage to the lining of the esophagus may continue despite medical therapy in patients with bile (non-acidic fluid) reflux.
Surgical Treatment
Approximately 25 percent of patients with reflux disease will develop progressive disease and complications such as hiatal hernia and Barrett’s esophagus. In these patients, surgical treatment should be considered. In addition, surgery should be discussed with patients who continually regurgitate despite the reduction of acidity, have evidence of lung damage due to aspiration of acidic and non-acidic fluid from the esophagus into the lungs, have intolerance to medications used for treating gastroesophageal reflux, or respond well to these medications but do not want to continue taking them for the rest of their lives.
The aim of surgical treatment is to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) and to prevent the reflux of acid and bile from the stomach into the esophagus. The most common procedure to restore the function of the lower esophageal sphincter is a minimally invasive procedure called laparoscopic Nissen fundoplication.