Gastroesophageal reflux – diagnosis and Treatment

Gastroesophageal reflux – diagnosis and Treatment

How GERD Diagnosis is made?

Anyone who is experiencing frequent acid reflux symptoms should talk to their doctor, who may refer them to a specialist in gut medicine known as a gastroenterologist for further investigation.

There are several possible tests to diagnose GERD, including:

  • Upper gastrointestinal (GI) endoscope: This is a tube with a camera attached, which is used to inspect the esophagus. A small sample of tissue may also be taken at the same time in a biopsy.
  • Esophageal pH and impedance monitoring: This measures the amount of acid in the esophagus while the body is in different states, such as while eating or sleeping.
  • Esophageal manometry: This measures muscle contractions in the esophagus during swallowing. It can measure the strength of the sphincter.
  • Radiological tests such as ultrasound scan of abdomen, Upper GI series or CT scan depending upon case scenario.

Treatment

Treatment depends on the severity of the disease. If mild, it is initially treated with medications (acid reducing medications such as PPIs) along with dietary and lifestyle modifications.

Other options include:

  • H2 blockers: These are another option to help decrease acid production.
  • Antacids: These counteract the acid in the stomach with alkaline chemicals. Side effects can include diarrhea and constipation.
  • Prokinetics: These help the stomach empty faster. Side effects include diarrhea, nausea, and anxiety.
  • Erythromycin: This is a type of antibiotic that also helps empty the stomach.

What changes in Lifestyle and behavior changes can help relieve GERD?

  • Avoid the aggravating factors mentioned above
  • Eat moderate amounts of food and avoid overeating.
  • Avoid eating 2 to 3 hours before sleeping.
  • Quit or avoid smoking.
  • If a person is overweight, losing weight can help prevent symptoms.
  • Do not wear clothing that is tight around the abdomen.
  • Sleep at a slight angle with the head slightly elevated.

What are the other options if medications and diet didn’t help?

If lifestyle changes do not significantly improve the symptoms of GERD, or medications do not have the desired effect, a gastroenterologist may recommend surgery. In some cases, depending upon the severity of GERD, some patients will also be advised surgery upfront rather than waiting for response for medications.

Surgical treatments include:

Key hole ANTIREFLUX surgery called “Fundoplication” surgery : The surgeon sews the top of the stomach around the esophagus. This adds pressure to the lower end of the esophagus and is generally successful at reducing reflux.

Endoscopic procedures: This is a range of procedures include endoscopic sewing, which uses stitches to tighten the sphincter muscle, and radiofrequency, which uses heat to produce small burns that help tighten the sphincter muscle.

Is there any role of the Use of Complementaryand Alternative Medicines?

Complementary and alternative medicines (CAM) are those that are not an integral part ofconventional allopathic medical practice. India being a multicultural & multiethnic country, their use in the treatment for GERD isprobably more frequent in this regions where they have existed for centuries fortreatment of all kinds of illnesses. One study reported that 6.7% of patients usealternative treatment for heartburn. These include milk, peppermint, botanicalsand mixtures of herbs, melatonin, yoga, acupuncture, magnet therapy, hypnosis,massage, and other relaxation techniques. Some of these are detailed below.

Yoga helps relieve GERD too

Forms of yoga involving breathing control techniques (pranayama), like kapalbhati

and agnisar kriya, increase diaphragmatic tone and thereby can decrease gastroesophageal reflux. Kapalbhati involves passive inspiration and active expiration using abdominal muscles for clearance of the respiratory passage and strengthening the diaphragm. Agnisar kriya is a method in which contracting or flapping of abdominal muscles in and out is believed to help digestion. Another possible mechanism by which yoga works is impacting the autonomic nervous system via a relaxation response, which is associated with physiological changes in respiratory rate and lowering of heart rate and blood pressure mediated by reduction in epinephrine. Stress-induced increase in gastric acid secretion may also be decreased in the relaxation phase of yoga.

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