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Gastroesophageal Reflux Disease

One-third of the population experiences symptoms of heartburn at least monthly. The severity of gastroesophageal reflux disease (GERD) ranges from occasional mild symptoms to severe, erosive esophagitis with complications of ulcer, stricture, and hemorrhage.

Clinical Evaluation of Gastroesophageal Reflux Disease

The most common symptom of GERD is heartburn, a burning sensation in the epigastric or retrosternal area, often occurring postprandially. Regurgitation, dysphagia, and belching may also occur.

Hoarseness, nocturnal cough, and wheezing may be caused by chronic reflux, and asthma may be exacerbated by GERD.

Chronic reflux is associated with Barrett's esophagus Gastroesophageal Reflux Disease GERD (columnar metaplasia of esophageal mucosa). This complication may predispose to esophageal Gastroesophageal Reflux Disease GERD adenocarcinoma.

GERD is caused by decreased lower esophageal sphincter Gastroesophageal Reflux Disease GERD (LES) pressure. Sphincter tone can be impaired by consumption of fatty foods and Gastroesophageal Reflux Disease GERD anticholinergic medications.

Therapeutic Approach to Gastroesophageal Reflux Gastroesophageal Reflux Disease GERD Disease

Empiric Therapy. When classic symptoms (heartburn) are present, a presumptive diagnosis of GERD may be made and treatment initiated.

Non-Pharmacologic Therapy for Gastroesophageal Reflux Disease

Initial therapy consists of diet and lifestyle modifications and use of antacids as needed. Lifestyle modifications include weight loss, reduced dietary fat, limitation of caffeine, chocolate and peppermint. Meals should be smaller and more frequent, and smoking and alcohol should be limited.

Elevation of the head of the bed and avoidance of recumbency for three hours after a meal is recommended.

The patient's medications should be reviewed for drugs that exacerbate GERD, including alpha-adrenergic blockers, anticholinergics,benzodiazepines, beta-adrenergic agonists, calcium channel blockers, narcotics, nitrates, progestins, and transdermal nicotine.

Acid-Suppressive Treatment

Patients who continue to have symptoms should be offered an acid-suppressive treatment

The four available H2-blockers are equally safe and effective. A twice-daily schedule should be used to provide 24-hour acid control.

Promotility Drugs--Cisapride gastroesophageal reflux disease, heartburn, heart burn, indigestion, GERD, gerd (Propulsid).

Cisapride increases lower esophageal sphincter pressure and promotes peristalsis. Some studies have shown cisapride to have efficacy equal to that of H2 receptor antagonists.

Cisapride may also be its used in combination with acid suppression therapy. Cisapride works synergistically with H2 receptor antagonists to promote esophageal healing and reduce symptoms.

Cisapride is well tolerated, and side effects are limited to mildgastrointestinal symptoms, most

Omeprazole (Prilosec)

Omeprazole is more effective than H2-blockers in symptom relief (83%) and in healing of esophagitis (78%).

The majority of patients will respond to omeprazole 20 mg qd. Some patients may require 20 mg bid is rarely required.

Lansoprazole (Prevacid) appears to be similarly effective to omeprazole at a dosage of 30 mg qd.