Tests and diagnosis
The first port of call for someone experiencing frequent acid reflux symptoms is the family doctor, who may refer on to a specialist in gut medicine, a gastroenterologist.
Gastroesophageal reflux disease is often diagnosed simply by finding no improvement in heartburn symptoms in response to lifestyle changes and acid reflux medication.
Gastroenterologists may also arrange the following investigations:
- Endoscopy (camera imaging)
- Biopsy (taking a tissue sample for laboratory analysis)
- Barium X-ray (imaging the esophagus, stomach and upper duodenum after swallowing a chalky liquid that helps provide contrast on images)
- Esophageal manometry (pressure measurement of the esophagus)
- Impedance monitoring (measuring rate of fluid movement along the esophagus)
- pH monitoring (acidity testing).
Treatment and prevention of acid reflux
The main treatment option for people who repeatedly experience acid reflux in gastroesophageal reflux disease is a class of drugs known as proton-pump inhibitors (PPIs for short).
Zantac – for heartburn relief
Zantac, a medication for heartburn relief, was one of the first blockbuster drugs.
The mode of action of proton-pump inhibitors is to decrease acid production and thereby reduce the potential for damage caused by acid reflux.
Here is the full list of proton-pump inhibitors available on prescription in the US (brand names given followed by generic names, 2014):
– Aciphex (rabeprazole)
– Dexilant (dexlansoprazole)
– Nexium (esomeprazole)
– Prevacid (lansoprazole)
– Prilosec (omeprazole; also available in pharmacies without prescription)
– Protonix (pantoprazole)
– Zegerid (immediate-release omeprazole with sodium bicarbonate).
Proton-pump inhibitors are generally safe and effective, but like any prescription drug, they are not appropriate for all people with reflux disease and can cause side-effects, such as malabsorption issues leading to nutrient deficiencies.
PPIs are blockbuster drugs – prescribed to millions and earning huge sums for pharmaceutical firms because of their common use.
Proton-pump inhibitors have superseded earlier drug therapies that were used for gastroesophageal reflux disease – H2 blockers (also known as H2-receptor antagonists). These were the first blockbuster drugs of modern medicine – Zantac (ranitidine), for example, was the drug that caused GlaxoSmithKline to become a key pharmaceutical giant.
Over-the-counter remedies for acid reflux
For people who experience heartburn or indigestion infrequently, perhaps in association with occasional food and drink triggers, treatments to reduce the acidity of the stomach contents are available without prescription from pharmacies (over-the-counter products).
These liquid and tablet formulations are called antacids and there are dozens of brands available, all with similar effectiveness. They may not work for everyone, and any need for regular use should be discussed with a doctor.
Antacids provide rapid but short-term relief by buffering the acidity through simple chemical reaction with the stomach contents (they do not act on acid-producing cells of the stomach lining).
They contain chemical compounds such as calcium carbonate, sodium bicarbonate, aluminum, and magnesium hydroxide, and can also inhibit nutrient absorption, leading to deficiencies over time.
Alginate drugs such as Gaviscon
Box of Gaviscon
Gaviscon is a well known over-the-counter heartburn medication
Gaviscon is probably the best known heartburn therapy, available over the counter at pharmacies. It has a different mode of action than antacid drugs, containing alginic acid. Alginate drugs such as this brand vary slightly in composition, but they usually also contain an antacid.
The alginic acid works by creating a mechanical barrier against the stomach acid, forming a foamy gel that sits at the top of the gastric pool itself. Any reflux is then relatively harmless as it consists of alginic acid and not damaging stomach acid
The active ingredient alginate is found naturally in brown algae.
The main options for the management of gastroesophageal reflux disease have been covered above. A long list of other therapies is available, however, with one pharmacological review listing the following additional options: sucralfate acid suppressants, potassium-competitive acid blockers, transient lower esophageal sphincter relaxation (TLESR) reducers, GABA(B) receptor agonist, mGluR5 antagonist, prokinetic agents, pain modulators, tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and the serotonin-norepinephrine reuptake inhibitor theophylline.
In rare cases, gastroesophageal reflux disease that is severe and unresponsive to medical treatment may warrant surgical intervention in the form of a procedure called fundoplication – the National Institutes of Health has detailed information about this operation at Medline.
Prevention of acid reflux through lifestyle control
As discussed above, lifestyle can play a large part in the development of acid reflux-related problems, and changes to lifestyle or behavior can prevent or improve symptoms.
One summary of the actions patients might take has been compiled by the American Gastroenterological Association. This includes advice for patients with troublesome irritation to keep a diary, so that they may find any links to lifestyle factors.
The American Gastroenterological Association also offers the following list of things to try to see if symptoms resolve:
- Avoid food, drinks and medicines that you find to be associated with heartburn irritation
- Eat smaller meals
- Do not lie down for two to three hours after a meal
- Lose weight if overweight or obese
- Avoid increased pressure on your abdomen, such as from tight belts or doing sit-up exercises
- Stop smoking.
There is also some suggestion that eradication of infection with Helicobacter pylori can lead to the development of gastroesophageal reflux disease, although this has only been seen so far in Asian countries where the prevalence of H. pylori infection is higher than in western countries.
Risks from long-term GERD
It is important to address persistent problems with gastroesophageal reflux disease as long-term untreated acid reflux can lead to serious complications including an increased risk of cancer.
Long-term, continual exposure to stomach acid can damage the esophagus, leading to:
- Esophagitis – where the lining of the esophagus is inflamed, causing irritation, bleeding and ulceration in some cases
- Strictures – where the damage caused by stomach acid leads to scar development and difficulties swallowing, with food getting stuck as it travels down the esophagus
- Barrett’s esophagus – a serious complication where repeated exposure to stomach acid causes changes in the cells and tissue lining the esophagus replacing normal cells with those that resemble cells in the lower gastrointestinal tract. This is considered a premalignant condition.
Both esophagitis and Barrett’s esophagus are associated with a higher risk of cancer.
Esophagitis may lead to precancerous changes in the pipe, and Barrett’s esophagus carries a clear risk of lethal cancer for a small number of patients.
There was a landmark study published in the New England Journal of Medicine in 1999 that found a link between untreated acid reflux and cancer. Its conclusion reads as a stark warning against leaving acid reflux untreated for a long time:
“There is a strong and probably causal relation between gastroesophageal reflux and esophageal adenocarcinoma.”
Source : http://www.medicalnewstoday.com