 Treatment of Reflux
There are
general measures the patient can take to reduce reflux:
Eat smaller
and more
frequent meals.
Do not
lie down immediately after eating,
and avoid eating for
several hours before going to bed.
Excessive
bending, lifting, abdominal exercises, girdles, and tight
belts all increase abdominal pressure and provoke reflux.
If
overweight, lose weight. Being overweight promotes reflux.
Stop
using all tobacco; nicotine weakens the LES.
Avoid
fatty foods, alcohol, coffee, chocolate, and peppermint.
Elevate
the head of the bed 8” to 10” so gravity keeps stomach juices
out of the esophagus while the patient sleeps. Extra pillows, by themselves, are usually not helpful.
Certain
prescription or over-the-counter medications can weaken the
LES or aggravate reflux. Review all medications you are taking
with the physician.
Other treatments
include:
Antacids
- These can and should be used often. Generally, antacids should be
taken 30 to 60 minutes after eating and at bedtime. Liquids are
preferred to tablets, with the strongest being Maalox II, Mylanta
II, Gelusil II and Extra Strength Riopan.
Drugs -
Medicines are now available that effectively reduce and even
eliminate the secretion of stomach acid and increase the strength of
the LES muscle. The most potent of these are called proton pump
inhibitors. These remarkable drugs are often dramatically effective
in severe cases of reflux. The most popular of these is omeprazole
(trade name: Prilosec).
Surgery
- Surgery is rarely required in treating reflux. However, when the
treatment programs outlines above are ineffective, surgery must be
considered to strengthen the LES muscle. A newer method of
performing anti-reflux surgery is by laparoscopic technique. This
surgery is accomplished through tiny holes in the belly button and
upper abdomen. Recovery is far quicker with this technique. This
operation should only be performed by surgeons thoroughly familiar
with it. Surgery, however, is not always permanently successful and
there can be complications.
Summary
Heartburn
occurs so commonly that it is normal for everyone to experience it
at some time. However, when heartburn is persistent, it needs
to be evaluated, and long-term follow-up care is often
required. Medical treatment is usually very effective and can
prevent complications. For the few patients who are not helped
by medical treatment, surgery offers a viable and usually successful
alternative.
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