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Overview

Gastroesophageal Reflux :Treatment, Procedure, Cost And Side Effects

What is the treatment of Gastroesophageal Reflux?

Gastroesophageal reflux or GERD disease is a kind of disorder which affects the lower esophageal sphincter (LES), which is a muscle ring that exists between esophagus and stomach. Gastroesophageal reflux can cause heart burns and acid indigestion where in the stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). It is believed that people with Gastroesophageal reflux can be because of a medical condition called hiatal hernia. Balanced and proper diet and lifestyle changes are mandatory to get rid of Gastroesophageal reflux. In severe cases, people may require medication or surgery. Gastroesophageal reflux is a medical condition in which contents of the stomach is returned to esophagus causing indigestion and heartburn. The common symptoms and signs of Gastroesophageal reflux include the following:

  1. Difficulty in swallowing
  2. A sensation of burning in chest, which worsen at night after eating
  3. Chest pain
  4. Food or sour liquid regurgitation
  5. A sensation of a lump in the throat
  6. If you are prone to acid reflux during the night, then you may experience
  7. A severe cough
  8. Worsening asthma
  9. Sleep disruption
  10. Laryngitis

It is advisable to consult a doctor if you experience shortness of breath, chest pain or arm pain. These can lead to a heart attack. If the above-mentioned symptoms are frequent and severe, then make an appointment with the medical surgeon and get diagnosed as soon as possible. If the sensation of heartburn still exists for more than two weeks even after taking the medication, then it is best to consult a doctor.

The cause behind Gastroesophageal reflux can be due to a frequent acid reflux. What happens when you swallow food is that a circular band of muscles located in the bottom of esophagus relaxes and the food and liquids flow into your stomach. The sphincter again closes. If the sphincter relaxes or weakens abnormally, the contents return backs to the esophagus. If this happens repeatedly, the acidic contents can irritate your esophagus making it inflamed. Conditions like obesity, pregnancy ,delayed stomach empting all can cause the chances of Gastroesophageal reflux in a person. Acid reflux can also be caused by smoking, eating large meals or late night meals, eating fatty fried foods or triggers, drinking alcohol or coffee and aspirin medications.

As far as the treatment is concerned, for mild cases of Gastroesophageal reflux the patient is asked to adapt to new changes in lifestyle and eating habits. For the case of burning sensation the patient is given anti-acid medicines. For severe cases the patient is treated with medicines and if the condition worsens further then the doctor may advice for further examinations and surgery.

How is the treatment done?

The treatment begins by diagnosing the Gastroesophageal reflux in a person. The diagnosis for GERD is done through the following:

  1. Upper endoscopy: A thin flexible tube fitted with camera and light known as an endoscope is inserted down the throat. The inside of esophagus and stomach is then examined. If the reflux is present, then the test results will be normal. Endoscopy can also detect esophagus inflammation and other complications. This is also used to check for Barrett's esophagus using a sample of tissues (biopsy)
  2. Ambulatory acid (pH) probe test: This is to identify for how long acids in the stomach are regurgitating by placing a monitor in the esophagus. A computer is connected with a strap to wear around your waist and strap around your shoulder. The monitor is a thin, flexible tube that is taken to examine esophagus through your nose. Often a clip is placed in your esophagus which gets passed through stool after two days.
  3. Esophageal manometry: the rhythmic muscle contractions when you swallow in the esophagus is measured. The force and coordination during exertion of muscles are measured through esophageal manometry.
  4. X-ray: X-ray of the upper digestive system: you will be asked to drink a chalky liquid which fills inside the digestive lining track and X rays are taken after drinking. The coating of the liquid allows the surgeon to examine the esophagus, stomach and upper part of the intestine. The narrowing of the esophagus can be examined by swallowing a barium pill which will interfere with swallowing.

    After the diagnosis, the treatment plan is chosen based on the condition of the patient. The available treatments are as follows:

  5. Medication:
    • Antacids which can neutralize stomach acid: Mylanta, Rolaids, and Tums are antacids may provide instant relief. This cannot heal the inflammation of esophagus which is being damaged by acids in the stomach. Side effects of antacids overdose are diarrhea and kidney problems.
    • Medications which resist acid production: they are known as H-2-receptor blockers. Cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (AXID AR) and ranitidine (Zantac). They are not as much action as antacids but provide long relief and can reduce the acid production up to 12 hours in the stomach.
    • Esophagus healing and acid production blockers: they are named as proton pump inhibitors, they stand somewhere between acid blockers and H-2 receptor blockers. They help to in healing of damaged tissue associated with the esophagus. H-2 receptor blockers: the prescribed H-2 receptor blockers include famotidine, nizatidine, and ranitidine commonly known as Pepcid and Zantac. Some of them are lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC, Zegerid OTC). Proton pump inhibitors : The common medications are esomeprazole(Nexium), omeprazole(Prilosec, Zegerid), pantoprazole (Protonix), lansoprazole(Prevacid), dexlansoprazole(dexilant) and rabeprazole(Aciphex). Baclofen can decrease the relaxation frequency of lower esophageal sphincter and helps in healing from GERD
  6. Surgery: When the symptoms are severe and when medications are not able to provide proper relief to the patient then, surgery may have to be opted accordingly. Surgery options available are as follows:
    • Fundoplication: the reflux is prevented by tightening the muscle around the lower esophageal sphincter by wrapping the top of the stomach. It is a minimally invasive procedure. The stomach wrapping can be sometimes partial or complete.
    • LINX device: the junction of the stomach and esophagus is wrapped with tiny magnetic beads. A sense of magnetic attraction between the beads is strong enough to close the reflux by restricting the food to return back to the esophagus. This is a minimally invasive implantation surgery.

Who is eligible for the treatment? (When is the treatment done?)

Patients who are having symptoms of chest burn and acidic indigestion and are facing these complaints frequently, he /she may opt for diagnosis and treatment. Patients who have taken over-the-counter medications for heartburn more than twice a week and in spite of it are not getting relief are eligible for the treatment. Surgery will be recommended when the medications don’t cure these symptoms. The option for going for the surgery shall depend on the patient other health conditions like Blood Pressure, Diabetes, auto-immune diseases, etc. and the doctor shall then recommend for the surgery based on the situation of the patient.

Who is not eligible for the treatment?

If the symptoms are minor and can be corrected using diet and lifestyle changes, then such patients need not avail the suggested treatment. Apart from that deciding the surgery for the patient shall depend on the situation of the patient and it shall be executed only after the recommendation of the specialist.

Are there any side-effects?

The medicines used for the treatment of the Gastroesophageal reflux disease are safe if consumed in right quantity. The medications if used excessively can lead to diarrhea, nausea, fatigue, headache, and vitamin B 12 deficiency. Long-term use of acid blockers and H-2 receptor blockers may trigger vitamin B-12 deficiency and bone fractures. Proton pump inhibitors have good tolerance but they can cause diarrhea, nausea, headache and vitamin B-12 deficiency. Excessive usage may lead to hip fracture. Excessive use of Baclofen can lead to nausea and fatigue.

What are the post-treatment guidelines?

The post-treatment guidelines for the Gastroesophageal reflux disease are as follows:

  1. Take medicines on time
  2. Eat a healthy balanced diet on time
  3. Drink plenty of water
  4. Follow up regularly with the doctor
  5. If severe chest pain or heartburn occurs, consult a doctor immediately
  6. Adopt diet and lifestyle changes
  7. Get adequate sleep
  8. Rest and low fat diet is recommended for few days after the surgery.

How long does it take to recover?

The recovery time may vary from person to person situation and medication condition. The severity of symptoms and indigestion can be prevented over a short course of time of few days. If adopted lifestyle changes and dietary changes, the results can be somewhat beneficial and the recovery may be soon with medication which can be of few days and weeks. Surgery may take 8 to 10 weeks to get cured and start a normal routine.

What is the price of treatment in India?

The treatment is reasonable and the medications would cost you around Rs 100 –Rs 300 on an average. However, depending upon the place and clinic the surgery can cost you around Rs 50,000 to Rs 2,00,000.

Are the results of the treatment permanent?

The medications and surgery often give good results for treating the Gastroesophageal reflux disease. It can be quoted as semi-permanent solution as one need to adopt lifestyle changes and dietary habits to make them better and thus have permanent solution. But the acid refluxes can occur again due to bad eating habits, thus a proper balanced diet and a perfect lifestyle is essential for permanent solution.

What are the alternatives to the treatment?

The available alternatives to the treatment for the Gastroesophageal reflux disease are as follows:

  1. Home remedies: Home remedies can be tried for this as this is a common condition. Apple cider vinegar, lemon juice, baking soda can be tried to treat this condition. Place a few thin slices of ginger root tea in a mug and steep in hot water for 10 – 20 minutes. Then drink. It can help calm an upset tummy or stop it from even occurring.
  2. Ayurveda and homeopathy are also effective in treating this condition.

Safety: High Effectiveness: High Timeliness: High Relative risk: Low Side Effects: Low Time for Recovery: Medium Price Range: From: Rs 50,000 to Rs 2,00,000.

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Table of Content

What is the treatment of Gastroesophageal Reflux?

How is the treatment done?

Who is eligible for the treatment? (When is the treatment done?)

Who is not eligible for the treatment?

Are there any side-effects?

What are the post-treatment guidelines?

How long does it take to recover?

What is the price of treatment in India?

Are the results of the treatment permanent?

What are the alternatives to the treatment?

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