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Gastroesophageal Reflux
(a.k.a. GERD, heartburn, acid reflux, non-ulcer dyspepsia)
GENERAL
GERD is a common problem. To be perfectly honest, I suffer
from this condition a great deal. It is caused by the presence of acid getting up
into the swallowing tube, called the esophagus. When the lower part of this tube,
where it empties into the stomach, is exposed to acid, people will often experience a
burning or hot sensation. This may be associated with stomach contents or liquid
coming up into the throat, or even just a sensation of vomitting when you do not expect
it.
Some people have a hiatal hernia in association with this problem.
A hiatal hernia is present when part of the stomach is able to move up into the
chest cavity where your heart and lungs are. This part of your stomach may be there
all the time, or it may slide back and forth from the abdomen to the chest.
The reason acid can get back up into the swallowing tube is
complex. It is generally related to a decreased function in the muscles that hold
the entrance to the stomach closed. But the story is much more complicated.
For our purposes we just want to know how to stop this problem.
The following will be a listing and discussion of what you can do to treat this
problem. If you are really curious I will include a reference to a recent New
England Journal Article on the physiology of the esophageal sphincter that I found
fascinating.
What You Can Do
Food
Eat smaller meals, avoid stuffing
yourself
Eliminate or cut down on:
caffeine-containing foods such as coffee, teas, colas; chocolate, tomatoes, citrus, milk,
spearmint, peppermint, or any spicy food that seems to upset your stomach.
Drinks with carbonation may release
gas that increase pressure inside your stomach, allowing acid to get up into the
esophagus, so reduce your use of pop and sodas.
Habits
Quit smoking, chewing or use of
tobacco in any form
Avoid Alcohol containing beverages or
substances
Lose weight , if needed
Avoid clothes that fit tightly around
your belly
Sleeping
Eat several hours before you plan to
go to bed
Raise the head of your bed up around
4-6 inches, this is an excellent use for old National Geographic magazines
Avoid eating in bed
Medications
Advise your doctor of what medicines
you are taking, several are known to increase reflux. Don't forget those herbs and
vitamins. (I took zinc a couple of years back for a cold. I did not read the fine
print, zinc on an empty stomach is a great way to cause reflux and nausea)
Medication Therapy
Reflux exists on a continuum of severity from mild to severe. There are many
medicines that are used to treat this condition. You should always use the methods
mentioned above as a basis for any long term treatment. But, if this is not enough
then consider the following:
Mild Symptoms, Only
Occasionally:
Try a simple treatment such as an antacid by mouth. A liquid or tablet
preparation is often all you will need. I don't have any strong preferences, but if
you are an older woman consider taking TUMS, as the calcium intake is good. If you
are prone to edema or congestive heart failure try to avoid preparations with a lot of
sodium, such as Alka Seltzer. Some antacids contain mostly aluminum hydroxide, i.e.
Gaviscon, these types may cause constipation. Most antacids are a mix of
magnesium and aluminum hydroxide. The magnesium tends to loosen your bowel
movements, thus compensating for the aluminum's tendency to constipate you.
Mild Symptoms, Often:
Now you have a little more complicated problem. If
your symptoms are throughout the day and/or night, then I would suggest you consider and
over the counter H2-Blocker, such as Tagamet, Zantac, Axid, or Pepcid. These are the
same medicines you can get with a prescription, but the pill sizes are smaller. You
could try taking them once or twice a day to relieve your symptoms. They can be
taken in higher doses, but they quickly become more expensive than a prescription if you
take the dose up very far. You can take antacids at the same time still.
Moderate Pain,
Occasionally:
You can still use an antacid as noted above. An H2- blocker may also provide
good relief, but remember, an antacid will begin to neutralize acid right away when you
take it, so the relief may be very quick. An H2-blocker will take some time to work.
If you know you are going out for a big meal, you might consider taking a
pill a little while before the big meal, but better yet, think about eating less.
Moderate Pain, Often:
At this point, you should see your doctor if you have not so by this time.
Significant pain, occurring regularly, could be a sign of something else. We should
always consider alternative problems such as heart disease, ulcers, cancer, etc. Be
that as it may, you can still treat reflux pain with antacids or H2-Blockers.
You may need prescription strength medicines at this point. You may also want to
consider a class of drugs called Proton Pump Blockers, i.e. Aciphex, Prilosec,
Prevacid or Protonix. Another choice at this point are motility drugs such as
Reglan (metoclopramide).
Proton Pump Blockers work by greatly decreasing acid production in your stomach, but
they are expensive. They are well tolerated with few side-effects, except for your
wallet. They can heal a burn in your esophagus from acid. They work quite well.
Motility drugs improve how food and liquid are pushed out of your stomach and moved
through your intestines after you eat. For many people this is their major cause for
reflux of acid, a slow moving stomach and intestines. A medicine like Reglan
(metoclopramide) can work very nicely to clear reflux by moving food through the digestive
process faster. There are some possible major downsides to metoclopramide, including
depression and a an uncommon condition called tardive dyskinesia (TD). TD is rare
but it is a difficult neurologic side effect to develop. It is hard to treat.
It is like parkinson's disease in a way. But it is rare, and most people
never have any problems. Reglan is a good anti- nausea drug also.
Severe Pain, Reflux,
Occasionally:
More or less, you can pick from any of the above, but let me caution you here !
Any pain occurring to a severe degree, only occasionally, is worrisome. I
would strongly advise you have this further evaluated before you go off treating it with
various medicines for any length of time. Severe pain could be a heart, gallbladder,
pancreas, ulcer, kidney or other problem.
A severe problem is best treated with medication such as a proton pump blocker.
Antacids will still work, but they tend to have an effect that lasts for around 1
to 2 hours. H2-Blockers also work, but may require a large dose. Motility
drugs may work well, but may need larger doses, too.
Severe Pain, Often:
This pain should be evaluated by your physician. If it is caused by reflux,
then you will likely need one or more prescription medicines, in addition to your baseline
attention to diet, etc
MEDICATION TABLE
| Axid (nizatidine) |
75 mg |
OTC |
May be take once or twice a day |
| |
150 mg |
RX |
May be take once or twice a day |
| Pepcid (famotidine) |
10 mg |
OTC |
May take twice a day |
| |
20 mg |
RX |
May take twice a day |
| |
40 mg |
RX |
May take once or twice a day |
| Tagamet (cimetidine) |
200 mg |
OTC |
May take two to four times a day |
| |
400 mg |
RX |
May take twice a day |
| |
800 mg |
RX |
May take once a day |
| Zantac (ranitidine) |
75 mg |
OTC |
May take one or two twice a day |
| |
150 mg |
RX |
May take twice a day |
| |
300 mg |
RX |
May take once a day |
| Aciphex |
20 mg |
Rx |
May take once a day |
| Prilosec (omeprazole) |
20 mg |
RX |
May take one or two a day |
| |
40 mg |
RX |
May take one or two a day |
| Prevacid |
15 mg |
RX |
May take one or two a day |
| |
30 mg |
RX |
May take one a day |
| Protonix |
40 mg |
RX |
May take one a day |
| Reglan (metoclopramide) |
10 mg |
RX |
Take one to four times a day |
| Antacids- various |
|
OTC |
Take as often as needed |
HOME
INDEX
See also: www.GERD.com
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