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DIGESTIVE SYSTEM
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Diseases & Conditions
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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. OTC remedies include:
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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.
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H-2-receptor blockers.
H-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 cause infrequent side effects,
including bowel changes, dry mouth, dizziness or drowsiness. In rare
instances they can also react dangerously with other medications.
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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:
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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.
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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).
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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, the medications are ineffective, or you can't afford their
long-term use. Your doctor also may recommend surgery if you have any of
these complications:
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Large hiatal hernia
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Severe esophagitis, especially with bleeding
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Recurrent narrowing (stricture) of the esophagus
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Barrett's esophagus, especially with progressive precancerous or
cancerous changes
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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 2 hours and typically requires an overnight hospital stay.
More than 90 percent of the people who undergo Nissen
fundoplication remain free of GERD symptoms for at least 1 year. At
least 60 percent are symptom-free for several years. This success rate
applies to both the laparoscopic and open procedures.
Other surgical procedures include Toupet partial
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).
Newer,
less invasive procedures
Your doctor may suggest one of several procedures for tightening the
lower esophageal sphincter. The 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. None of the procedures are recommended if you have a
hiatal hernia or Barrett's esophagus.
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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 (placations) 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.
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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.
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Enteryx.
This procedure involves the injection of a compound called ethylene
polyvinyl alcohol into the lower esophageal sphincter, just within
the stomach. The injection is done with guidance from real-time
X-ray. The compound is in liquid form outside the body, but when it
comes into contact with the tissues inside the body, it turns into
an expanding, spongy material. The procedure may cause a sore throat
or chest pain, and the long-term effectiveness of the procedure is
still unknown.
