Chronic Acid Reflux Disease Treatment
If you had heartburn or any of the heart burn or reflux symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your "Chronic Acid Reflux Disease" is, treatment may involve one or more of the following lifestyle changes and medications or surgery.
- If you smoke, stop
- Do not drink alcohol
- Lose weight if needed
- Eat small meals
- Wear loose-fitting clothes
- Avoid lying down for 3 hours after a meal
- Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts - just using extra pillows will not help.
Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepsid Complete, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild chronic acid reflux disease symptoms. Many brands on the market use different combinations of three basic salts: magnesium, calcium, and aluminum - with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have "Chronic Acid Reflux Disease" symptoms. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.
Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone who has chronic acid reflux disease.
Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.
Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for "Chronic Acid Reflux Disease".
What if Symptoms Persist?
If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.
- A barium swallow radiograph uses x rays to help spot
abnormalities such as a hiatal hernia and severe inflammation
of the esophagus. With this test, you drink a solution and then
x rays are taken. Mild irritation will not appear on this test,
although nbullet3ing of the esophagus - called stricture - ulcers,
hiatal hernia, and other problems will.
- Upper endoscopy is more accurate than a barium swallow
radiograph and may be performed in a hospital or a doctor's
office. The doctor will spray your throat to numb it and slide
down a thin, flexible plastic tube called an endoscope. A tiny
camera in the endoscope allows the doctor to see the surface
of the esophagus and to search for abnormalities. If you have
had moderate to severe symptoms and this procedure reveals injury
to the esophagus, usually no other tests are needed to confirm
chronic acid reflux disease.
The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
- In an ambulatory pH monitoring examination, the doctor
puts a tiny tube into the esophagus that will stay there for
24 hours. While you go about your normal activities, it measures
when and how much acid comes up into your esophagus. This test
is useful in people with "Chronic Acid Reflux Disease" symptoms but no esophageal damage.
The procedure is also helpful in detecting whether respiratory
symptoms, including wheezing and coughing, are triggered by
Surgery for Chronic Acid Reflux Disease
Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for ChronicAcidRefluxDisease. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia.
This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camera. Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.
Recently the FDA approved an implant that may help people with "Chronic Acid Reflux Disease" who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have chronic acid reflux disease and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.