Gastroesophageal reflux disease is a condition where LES or lower esophageal sphincter is not able to remain in the state of contraction which results in back flow of gastric acids from stomach to esophagus. The causes of Gastroesophageal reflux disease can be food, drugs and various drinks.
Diagnosis Of Gastroesophafeal Refux Disease [GERD]
If a person has Epigastric pain which is radiating below the sternum with bad metallic taste in mouth GERD can be suspected and treatment can be started. If clinical diagnosis is made treatment can be started immediately.
Only if the diagnosis of GERD is not clear or the patient's clinical presentation is equivocal a specific test called as 24-Hour PH monitoring is required. 24 hour PH monitoring is done by placing an electrode few centimeters below gastroesophageal junction (place where gullet and stomach meets). The instrument records the PH and average PH of that area is determined.
Endoscopy can be done to see the changes in the lower esophagus, but a normal endoscopic finding does not exclude the presence of Gastroesophageal reflux disease [GERD]
Treatment of Gastroesophageal Reflux Disease [GERD]
Medical Treatment: Drugs can be used to treat Gastroesophageal Reflux Disease effectively. Three types of drugs can be used
- Proton Pump Inhibitors (PPIs): Example: Omeprazole, Pantoprazole, Rabeprazole. All have equal efficacy. Goal is to keep PH of the stomach acid above 4.0.
- H2 Blockers: These class of drugs are used if the symptoms are mild or moderate and are intermittent.
- Prokinetic Drugs: Drugs like metachlopromide can be used to relieve the symptoms of GERD. Another prokinetic drug "Cisapride" was discontinued from US due to its fatal adverse effect. Cisapride was known to cause Ventricular Arrhythmias.
H2 Blockers and Prokinetic drugs have equal efficacy in treating mild intermittent forms of Gastroesophageal Reflux disease. But these drugs should not be used if symptoms are severe. For severe symptoms of GERD PPIs are the best class of drugs.
Surgical Treatment: The goal of surgical treatment is to tighten the Lower Esophageal Sphincter (LES) so that stomach acids do not flow back or upwards to esophagus. The indications of surgical treatment for GRED are as follows:
- If patient does not respond to medical treatment with Proton Pump Inhibitors
- Side Effects of PPIs: diarrhea & headache
- Alternative to life long or long term medical treatment with PPIs
Two surgical methods are most commonly used to treat GERD surgically:
- Laproscopic Nissen's Fundoplication
- Purse-String Suture in LES to make it tighter erektile apotheke.
