Heartburn/GERD...part 2
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Heartburn/GERD...part 2
by jkakashi01 Sat Feb 16, 2008 2:07 pm
Treatment
Whether you have mild, moderate or severe heartburn, many treatment options are available. The most common treatments involve medications, but surgical and other procedures also are available.
Over-the-counter remedies
If you experience only occasional, mild heartburn, you may get relief from an over-the-counter (OTC) medication and self-care measures. OTC remedies include:
Antacids. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, neutralize stomach acid and can provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea or constipation.
H-2-receptor blockers. Over-the-counterH-2-receptor blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine Axid AR or ranitidine (Zantac 75), are available at half the strength of their prescription versions. Instead of neutralizing the acid, these medications reduce the production of acid. They don't act as quickly as antacids, but they provide longer relief. Take these medications before a meal that you think may cause heartburn because it takes them about 30 minutes to work. They're also effective in reducing reflux at night if taken at bedtime. H-2-receptor blockers can cause infrequent side effects, including bowel changes, dry mouth, dizziness or drowsiness. In rare instances they can also react dangerously with other medications.
Proton pump inhibitors. These medications block acid production and allow time for damaged esophageal tissue to heal. Omeprazole (Prilosec) was previously available only by prescription, but now is available in an over-the-counter form for treatment of heartburn.
Prescription-strength medications
If you have frequent and persistent heartburn, you may have GERD, leading to an inflamed esophagus (esophagitis). GERD usually requires prescription-strength medication. Prescription medications can help reduce and eliminate GERD symptoms, as well as help heal an inflamed esophagus — the result of continual exposure to stomach acid. The main types of prescription drugs are:
Prescription-strength H-2-receptor blockers. These significantly reduce acid production and have few side effects. They include prescription-strength Axid, Pepcid, Tagamet and Zantac.
Prescription-strength proton pump inhibitors. These are long-acting and are the most effective medications for suppressing acid production. They're safe and have few side effects for long-term treatment (at least 10 years). To prevent possible side effects, such as stomach or abdominal pain, diarrhea or headaches, your doctor will likely prescribe the lowest effective dose. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex).
Prokinetic agents. These don't reduce acid production. Instead, they help your stomach empty more rapidly and may help tighten the valve between the stomach and the esophagus. Because the prokinetic agents thus far sometimes cause serious side effects, researchers are working to develop safer versions.
Surgical and other procedures
Because of the effectiveness of medications, surgery for GERD is uncommon. However, it may be an option if you can't tolerate the medications, you can't afford their long-term use or your doctor determines that the medications are ineffective. Your doctor also may recommend surgery if you have any of these complications:
Large hiatal hernia
Severe esophagitis, especially with bleeding
Recurrent narrowing (stricture) of the esophagus
Barrett's esophagus, especially with progressive precancerous or cancerous changes
Severe pulmonary problems, such as bronchitis or pneumonia, due to acid reflux
Before 1991, a procedure called open Nissen fundoplication was the surgery of choice for severe GERD. Today, doctors are able to perform the same surgery with similar success laparoscopically — through a few small abdominal incisions, instead of one large one. The advantages of laparoscopic surgery are a shorter recovery time and less discomfort.
Nissen fundoplication involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. During laparoscopic surgery, a surgeon makes three or four tiny incisions in the abdomen and inserts small instruments, including a flexible tube with a tiny camera, through the incisions. To provide more space for your surgeon to see and work, your abdomen is inflated with carbon dioxide. The surgery takes about two hours and typically requires an overnight hospital stay.
People who benefit most from a Nissen fundoplication are those who gained relief from medications. If you have minimal or no relief from medications, your doctor must be certain that you have GERD before recommending surgery, which may mean additional testing. Most people who undergo Nissen fundoplication remain free of GERD symptoms for at least one year. For the majority of people, this benefit extends beyond five years. This success rate applies to both the laparoscopic and open procedures.
Other surgical procedures include Toupet fundoplication, Hill repair and the Belsey Mark IV operation. All involve restructuring the lower esophageal sphincter to improve its strength and ability to prevent reflux. These surgeries are done less often, and their success is often dependent on the skill of the surgeon.
Complications from surgery generally are mild, but may include difficulty swallowing, bloating, diarrhea and a sense of feeling full after eating only a moderate amount (early satiety). These complications generally go away two to three months after surgery.
Newer, less-invasive procedures
Your doctor may suggest a procedure for tightening the lower esophageal sphincter. These procedures generally take an hour or less to perform, they don't require any incisions, and you can go home the same day. The procedures are performed endoscopically through a long, flexible tube that's inserted into your mouth and threaded through your esophagus. These procedures are recommended if you have a hiatal hernia or Barrett's esophagus.
EndoCinch endoluminal gastroplication. This procedure uses a tool that's like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers (plications) to prevent stomach acid from washing into your esophagus. The barriers are located at and just below the junction of the esophagus and stomach. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.
Stretta procedure. This approach uses controlled radiofrequency energy to heat and melt (coagulate) tissues within the portion of the esophagus that contains the malfunctioning valve and at the junction of the esophagus and upper stomach. The procedure appears to work by creating scar tissue and altering the sensory nerves that respond to refluxed acid. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.
Self-care
You may eliminate or reduce the frequency of heartburn by making the following lifestyle changes:
Control your weight. Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.
Eat smaller meals. This reduces pressure on the lower esophageal sphincter, helping to prevent the valve from opening and acid from washing back into your esophagus.
Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter.
Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.
Avoid stooping or bending. Tying your shoes is OK. Bending over for longer periods to weed your garden isn't, especially soon after eating.
Don't lie down after a meal. Wait at least three to four hours after eating before going to bed, and don't lie down right after eating.
Raise the head of your bed. An elevation of about six to nine inches puts gravity to work for you. You can do this by placing wooden or cement blocks under the feet at the head of your bed. If it's not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head only by using pillows is not a good alternative.
Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking may also aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.
Complementary and alternative medicine
Several home remedies exist for treating heartburn, but they provide only temporary relief. They include drinking baking soda (sodium bicarbonate) added to water or drinking other fluids such as soda pop or milk.
Although these liquids create temporary relief by neutralizing, washing away or buffering acids, eventually they aggravate the situation by adding gas and fluid to your stomach, increasing pressure and causing more acid reflux. Further, adding more sodium to your diet may increase your blood pressure and add stress to your heart, and excessive bicarbonate ingestion can alter the acid-base balance in your body.
Whether you have mild, moderate or severe heartburn, many treatment options are available. The most common treatments involve medications, but surgical and other procedures also are available.
Over-the-counter remedies
If you experience only occasional, mild heartburn, you may get relief from an over-the-counter (OTC) medication and self-care measures. OTC remedies include:
Antacids. Antacids, such as Maalox, Mylanta, Gelusil, Rolaids and Tums, neutralize stomach acid and can provide quick relief. But antacids alone won't heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects such as diarrhea or constipation.
H-2-receptor blockers. Over-the-counterH-2-receptor blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine Axid AR or ranitidine (Zantac 75), are available at half the strength of their prescription versions. Instead of neutralizing the acid, these medications reduce the production of acid. They don't act as quickly as antacids, but they provide longer relief. Take these medications before a meal that you think may cause heartburn because it takes them about 30 minutes to work. They're also effective in reducing reflux at night if taken at bedtime. H-2-receptor blockers can cause infrequent side effects, including bowel changes, dry mouth, dizziness or drowsiness. In rare instances they can also react dangerously with other medications.
Proton pump inhibitors. These medications block acid production and allow time for damaged esophageal tissue to heal. Omeprazole (Prilosec) was previously available only by prescription, but now is available in an over-the-counter form for treatment of heartburn.
Prescription-strength medications
If you have frequent and persistent heartburn, you may have GERD, leading to an inflamed esophagus (esophagitis). GERD usually requires prescription-strength medication. Prescription medications can help reduce and eliminate GERD symptoms, as well as help heal an inflamed esophagus — the result of continual exposure to stomach acid. The main types of prescription drugs are:
Prescription-strength H-2-receptor blockers. These significantly reduce acid production and have few side effects. They include prescription-strength Axid, Pepcid, Tagamet and Zantac.
Prescription-strength proton pump inhibitors. These are long-acting and are the most effective medications for suppressing acid production. They're safe and have few side effects for long-term treatment (at least 10 years). To prevent possible side effects, such as stomach or abdominal pain, diarrhea or headaches, your doctor will likely prescribe the lowest effective dose. Prescription-strength proton pump inhibitors include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex).
Prokinetic agents. These don't reduce acid production. Instead, they help your stomach empty more rapidly and may help tighten the valve between the stomach and the esophagus. Because the prokinetic agents thus far sometimes cause serious side effects, researchers are working to develop safer versions.
Surgical and other procedures
Because of the effectiveness of medications, surgery for GERD is uncommon. However, it may be an option if you can't tolerate the medications, you can't afford their long-term use or your doctor determines that the medications are ineffective. Your doctor also may recommend surgery if you have any of these complications:
Large hiatal hernia
Severe esophagitis, especially with bleeding
Recurrent narrowing (stricture) of the esophagus
Barrett's esophagus, especially with progressive precancerous or cancerous changes
Severe pulmonary problems, such as bronchitis or pneumonia, due to acid reflux
Before 1991, a procedure called open Nissen fundoplication was the surgery of choice for severe GERD. Today, doctors are able to perform the same surgery with similar success laparoscopically — through a few small abdominal incisions, instead of one large one. The advantages of laparoscopic surgery are a shorter recovery time and less discomfort.
Nissen fundoplication involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus. During laparoscopic surgery, a surgeon makes three or four tiny incisions in the abdomen and inserts small instruments, including a flexible tube with a tiny camera, through the incisions. To provide more space for your surgeon to see and work, your abdomen is inflated with carbon dioxide. The surgery takes about two hours and typically requires an overnight hospital stay.
People who benefit most from a Nissen fundoplication are those who gained relief from medications. If you have minimal or no relief from medications, your doctor must be certain that you have GERD before recommending surgery, which may mean additional testing. Most people who undergo Nissen fundoplication remain free of GERD symptoms for at least one year. For the majority of people, this benefit extends beyond five years. This success rate applies to both the laparoscopic and open procedures.
Other surgical procedures include Toupet fundoplication, Hill repair and the Belsey Mark IV operation. All involve restructuring the lower esophageal sphincter to improve its strength and ability to prevent reflux. These surgeries are done less often, and their success is often dependent on the skill of the surgeon.
Complications from surgery generally are mild, but may include difficulty swallowing, bloating, diarrhea and a sense of feeling full after eating only a moderate amount (early satiety). These complications generally go away two to three months after surgery.
Newer, less-invasive procedures
Your doctor may suggest a procedure for tightening the lower esophageal sphincter. These procedures generally take an hour or less to perform, they don't require any incisions, and you can go home the same day. The procedures are performed endoscopically through a long, flexible tube that's inserted into your mouth and threaded through your esophagus. These procedures are recommended if you have a hiatal hernia or Barrett's esophagus.
EndoCinch endoluminal gastroplication. This procedure uses a tool that's like a miniature sewing machine. It places pairs of stitches (sutures) in the stomach near the weakened sphincter. The suturing material is then tied together, creating barriers (plications) to prevent stomach acid from washing into your esophagus. The barriers are located at and just below the junction of the esophagus and stomach. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.
Stretta procedure. This approach uses controlled radiofrequency energy to heat and melt (coagulate) tissues within the portion of the esophagus that contains the malfunctioning valve and at the junction of the esophagus and upper stomach. The procedure appears to work by creating scar tissue and altering the sensory nerves that respond to refluxed acid. The procedure may cause a sore throat or chest pain. The long-term effectiveness of the procedure is still unknown.
Self-care
You may eliminate or reduce the frequency of heartburn by making the following lifestyle changes:
Control your weight. Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus. Eat smaller meals. This reduces pressure on the lower esophageal sphincter, helping to prevent the valve from opening and acid from washing back into your esophagus. Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter. Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.
Avoid stooping or bending. Tying your shoes is OK. Bending over for longer periods to weed your garden isn't, especially soon after eating. Don't lie down after a meal. Wait at least three to four hours after eating before going to bed, and don't lie down right after eating. Raise the head of your bed. An elevation of about six to nine inches puts gravity to work for you. You can do this by placing wooden or cement blocks under the feet at the head of your bed. If it's not possible to elevate your bed, you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head only by using pillows is not a good alternative. Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking may also aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer. Complementary and alternative medicine
Several home remedies exist for treating heartburn, but they provide only temporary relief. They include drinking baking soda (sodium bicarbonate) added to water or drinking other fluids such as soda pop or milk.
Although these liquids create temporary relief by neutralizing, washing away or buffering acids, eventually they aggravate the situation by adding gas and fluid to your stomach, increasing pressure and causing more acid reflux. Further, adding more sodium to your diet may increase your blood pressure and add stress to your heart, and excessive bicarbonate ingestion can alter the acid-base balance in your body.
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Re: Heartburn/GERD...part 2
by nices Wed May 28, 2008 8:09 am
whaaaa i dont like to use pillow... part of the self care... thank for sharing bro and more power!!!! GOD bless!!!
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