Medical Blog

Treatment (medicine - surgery)
1.Geneesmiddelen

There are different views about the best treatment for GERD. There is agreement that must first be attempted through dietary measures, raising the head of the bed, weight loss, etc. to address the complaints.
If not or insufficiently help then medicines.
There are three main groups: acid-depleting agents, antacids and drugs that affect muscle function.
Usually starts with an acid-depleting agent (antacid) and if that medication is, it switches to an acid inhibitor. Increasingly, however, abandoned this method and is rather a 'step down' approach. A recent review article in the British Medical Journal (September 29, 2001) indicates in this connection the following schedule:

GERD Treatment schedule

Mild form of GERD (mild to moderate symptoms, no or mild esophagitis): 'step-up strategy
• Start with antacids
• If it does not work: an H2 acid inhibitor (for 4 to 6 weeks)
• PPI acid inhibitor only when the symptoms do not improve
• possibly can immediately start with PPI acid inhibitor, where the dose gradually reduced to the smallest possible effective dose ('step down' strategy).

Severe GERD (severe esophagitis, sometimes associated with bleeding, esophageal stricture &): 'step-down strategy
• Start with PPI acid inhibitor for 8 weeks.
• Try to adjust the dose.
• Evolution should be followed by endoscopy

atypical symptoms (such as breathing problems, nose and throat and ear problems):
• immediately start PPI acid inhibitor
• pH measurement and monitoring with pH test

Acid Breaking resources

Acid-busting drugs or Antacids (eg Rennie ®, Muthesa ®, Maalox ®, Mylanta ®, ® & Regla pH) can in most people with hygiene measures are not sufficient, in many cases the symptoms under control. Products in powder form or a liquid product is preferred.
Take these drugs immediately after a meal, but wait at least an hour so the time for the stomach acid.
Most of these products are freely on sale in pharmacies. Do not abuse, however. If you regularly suffer from heartburn, consult your doctor to see if there are no other measures.

Drugs that affect muscle function

A prokinetic agent, a drug that muscle movements (peristalsis) of the esophageal sphincter and promotes doing more tension, can sometimes be helpful (eg, metoclopramide, domperidone ...).

Antacids

For persistent or recurrent complaints, serious complaints, proven damage to the esophagus and respiratory symptoms, the doctor may prescribe an acid inhibitor. These are drugs that produce gastric acid suppression and very effective in reducing the heartburn. They are also effective against other symptoms associated with GERD (such as respiratory problems, throat problems ...)

Here are two classes:

• H2 (histamine) - receptor blockers (famotidine, cimetidine (Tagamet ®), ranitidine ®, nizatidine ...)
• acid pump inhibitors or PPIs (omeprazole, lansoprazole, pantoprazole ...). The PPI's are clearly the most active.

Problem with these antacids is that they can hide symptoms of an ulcer. Moreover, the long-term effects of a permanent suppression of gastric acid with still insufficiently known.

2. Surgery

For severe symptoms not responding to drugs, surgery may be appropriate. Even in infants and young children with severe reflux problems, surgery may be necessary.
The most common technique is the so-called fundoplication in which the upper part of the stomach as a whole or partial ring around the bottom of the esophagus is turned. This intervention, which often can be performed via laparoscopy, creates a higher pressure in the lower part of esophagus and reflux is impossible.