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You've Been Diagnosed with GERD. What Now?

Once your doctor determines that you are suffering from GERD, the initial goals of treatment are to relieve the heartburn symptoms, heal the esophagus, and prevent complications. Treatment options include lifestyle changes, medicines and surgery.

Lifestyle Changes

Your doctor will suggest lifestyle changes that minimize reflux. Some changes include:

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  • Elevate the head of your bed 4 to 6 inches when sleeping
  • Lose weight
  • Avoid large and late-night meals
  • Avoid caffeine, smoking and alcohol

Certain foods can be associated with reflux events and avoiding these foods is a good idea:

  • Citrus fruits
  • Chocolate
  • Drinks with caffeine
  • Fatty and fried foods
  • Garlic and onions
  • Mint flavorings
  • Spicy foods
  • Tomato-based foods

Medication

Your doctor may recommend medicines, including over-the-counter and prescription drugs, that stop acid production or help the muscles that empty your stomach.

Antacids, such as Alka-Selzer, Maalox, Mylanta, Pepto Bismol and Rolaids, act to decrease gastric acid production.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC) and ranitidine (Zantac 75), impede acid production and are available in prescription strength and over the counter. These drugs provide short-term relief. The over-the-counter H2 blockers should not be used for more than a few weeks at a time.

Proton pump inhibitors are all available by prescription. They include omeprazole (Prilosec), lansoprazole (Prevacid) and esomeprazole (Nexium), and can relieve symptoms in almost everyone who has GERD.

Prokinetics help manage GERD by increasing the barrier-muscle pressure and making the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan).

Drugs to treat GERD work in different ways, so combinations of drugs may help control symptoms. Your doctor is the best source of information on how to use medications for GERD.

Surgery

When medicine and lifestyle changes do not work, surgery may be required to treat GERD. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort. The standard surgical treatment for GERD is fundoplication, where the upper part of the stomach is wrapped around the barrier muscle (LES) to strengthen the sphincter and prevent acid reflux and repair a hiatal hernia. This procedure can also be done using a laproscope, and requires only tiny incisions in the abdomen. In 2000, the U.S. Food and Drug Administration approved two endoscopic devices to treat heartburn. In one, a suturing system is attached to the tip of the endoscope and puts tiny stitches in the LES muscle to strengthen it. The other uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. Preliminary studies have shown encouraging results for both techniques, but the long-term effects of these two procedures are unknown.

Treating GERD in Children

Many of the same treatments for GERD that work for adults are also applied to children. Lifestyle changes, such as elevating the head of the bed and avoiding certain foods, are common treatments for children with GERD. The same drugs used in adults may be tried in children with chronic GERD; however, it is very important to note that while some of the drugs are available over the counter, no one should give them to a child without a physician's supervision.

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  • Milder medications, such as antacids, are used first.
  • H2 blockers may be tried next, but only when advised by a physician.
  • Two of the proton pump inhibitors, omeprazole (Prilosec) and lansoprazole (Prevacid), have been extensively tested in children and are well tolerated by them.

Surgery is also an option for serious reflux in children, and fundoplication can be performed by laproscope. Newer techniques are not available for children. A pediatric gastroenterologist can diagnose your child and advise the right treatment for GERD.

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