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By Phil Hariram
1. Acid reflux is common and increasing in the developed world.
A Gollop Poll
in USA reported that 44% had symptoms on a monthly basis. GERD is higher in
whites and the obese. There is also a higher prevalence in people aged 60-70
years. It is rare in blacks. It is also lower in Eastern countries. In India it
is 7.5%, Malaysia 3% and China 0.8%. It is suggested that this incidence will
increase as these countries introduce Western diet higher in fats.
2. Lifestyle change is an important aspect of treatment of acid reflux. Some
patients show marked improvement after losing only a small amount of weight.
Obesity increases abdominal pressure and affects the lower esophageal
sphincter (LES). Large meals distend the stomach and adds pressure on the LES.
Certain foods affect the sphincter. Avoid or consume in moderation, food such as
fats, coffee and alcohol.
3. Antacids neutralize acids in the stomach. This reaction raises the pH and
is likely to relieve heartburn or other symptoms of reflux. Trials, however,
show that antacids will not heal esophagitis.
The antacids commonly used are magnesium hydroxide, magnesium trisilicate and
aluminium hydroxide.
4. Acid Suppressant drugs should be used if lifestyle changes and antacids
are ineffective. The first group introduced are the H2-receptor antagonists such
as ranitidine. Side effects from this groups of drugs are rare.
The newer proton pump inhibitors like omeprazole and lansaprazole are more
effective than H2-receptor antagonists. They are safe and long term use has
shown no ill effects. They are so effective that most GERD patients that were
unresponsive to ranitidine were effectively treated with omeprazole.
5. A complication of GERD is bleeding from esophigitis. This can lead to
anaemia especially in children. Stricture is a distressing complication. It can
cause pain and difficulty on swallowing. Barrett's esophagus, experts think,
develop after damage to the mucosal lining by acid reflux.
6. Most infants reflux, and conservative measures such as thickened feeds
help. Reflux generally subside before the end of the first year. In the past
Barrett's esophagus was thought to be confined to adults but with the
introduction of smaller fibreoptic endoscopes, more biopsies are done and
Barrett's esophagus are being diagnosed in children.
7. Surgery for acid reflux is very uncommon since the advent of effective
acid suppressant medical treatment. Today stricures are not common and there are
only a rare few that do not respond to omeprazole as acid reflux treatment.
The commonest procedure is Nissen Fundoplication. Today laparoscopic
fundoplication is popular.
8. Smoking makes acid reflux symptoms worse, especially in children. Nicotine
relaxes the lower esophageal sphincter allowing acidic stomach contents to
reflux up into the esophagus. In addition deposited nicotine in the back of the
throat when swallowed is corrosive to the esophageal lining. Stop smoking if you
have acid reflux.
9. Raising the head of the bed is an effective acid reflux treatment. It is
useful for nocturnal acid reflux symptoms and reduces sensitization that results
in problems during the day. Tests have shown that adding additional pillows is
ineffective.
10. Do not ignore your symptoms. Lifestyle changes may be all that is
necessary to control your symptoms but if, in addition to over the counter
medications ,your symptoms persist see your family doctor. If you have GERD,
complications can be severe and the symptoms very distressing.
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