By- Dr. David Rydell
Gastroesophageal reflux disease or acid reflux occurs when the lower esophageal sphincter or valve is faulty. This allows the food and fluid in the stomach which is very acidic to flow backwards into the esophagus. This can result in a burning sensation in the chest (heartburn) or a sour taste in the mouth. It can also cause a dry cough, asthma like symptoms or difficulty swallowing. These symptoms can be brought on in patients with a faulty valve by smoking, alcohol, overeating and laying down shortly after a meal.
The lower esophageal valve is aided in closing by the higher pressure inside the belly cavity. In the case of a hiatal hernia (where part of the stomach has slipped through the diaphragm into the chest) this assistance is no longer present.
Treatment begins by evaluating and eliminating the many food and lifestyle triggers. Symptoms are often brought on by eating citrus fruits, chocolate, caffeinated beverages (coffee, tea & soft drinks), alcohol, fatty & fried foods, mint flavoring, garlic, onions, tomatoes and spicy-foods. Lifestyle triggers include obesity and pregnancy due to the increase in pressure within the belly cavity and smoking.
Medications come in three basic types:
Acid neutralizers such as Tums, Maalox, Rolaids, Mylanta and Alka-Seltzer that contain hydroxide or bicarbonate ions to neutralize the acid that is inside the stomach.
Acid preventers such as short acting Tagamet, Zantac and Pepcid or longer acting Prilosec, Prevacid, Nexium, Aciphex or Protonix work to block the production of acid by the cells of the stomach wall.
The irritation of the esophagus is thus reduced, the patient is still refluxing they just have fewer symptoms.
The third type of medication is a group that works to tighten the valve and promote the emptying of the stomach in the proper direction, out into the small intestine. These include Urecholine and Reglan.
As with most medications there are a variety of potential side effects both mild and severe and these medications are only effective when we remember to take them at their regularly scheduled times.
When lifestyle changes and medications are not controlling symptoms adequately there are surgical and endoscopic ways of correcting the faulty lower esophageal valve. The Nissen fundoplication or wrapping of the upper part of the stomach around the esophagus to recreate the valve was first performed in 1955. Since that time the procedure has been performed using both an open and laparoscopic technique. The long term results are very good with about 90% of patients not needing regular anti-acid medication 10 years after surgery. The major drawback is that it is an invasive operative procedure with the associated risks and complications.
Two years ago a new endoscopic procedure was approved by the FDA. This procedure does not involve an incision, but rather with the patient asleep under a general anesthetic using the endoscope the valve can be recreated in patients with acid reflux and a hiatal hernia less than one inch. A permanent stitching material is used to create a one inch long 270 degree valve that has resulted in nearly 80% of patients being completely off all medications 2 years later.
For more information visit www.endogastricsolutions.com/esophyx_for-pt.htm
Healthy Living: GERD
By- Dr. David Rydell
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