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The goals of treatments are to
- Decrease gastroesophageal reflux,
- Improve esophageal clearance, and
- Protect the esophageal lining
These goals can be achieved by certain general measures and specific drug treatments. Treatment controls symptoms and reflux esophagitis but does not result in regression of Barrett's esophagus. Therefore the risk of cancer is not eliminated by any of these treatments.
Traditional advice to patients with uncomplicated cases has been to elevate the head of the bed by using blocks or a foam wedge. This simple procedure can help reduce the reflux that may occur while sleeping. Patients are also advised to lose weight, to avoid eating within 3 hours of bedtime; to cut back on large or high-fat meals. Chocolate, nicotine, peppermint, raw onions, caffeine, alcohol may aggravate reflux and are best avoided.
In mild cases of gastroesophageal reflux, the use of certain over-the-counter and prescription medicines can be indicated. These include histamine H2 receptor blocking agents such as cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid) and nizatidine (Axid) may be needed. Tums, Rolaids, or other quick-acting reflux medications can also be considered. In moderate to severe cases, H2 receptor blockers are used in higher doses.
Prokinetic agents, or drugs that help move food through the gastrointestinal tract more quickly, offer an attractive alternative either alone or in combination with acid inhibition.
For example, metoclopramide can be taken 30 min before meals and at bedtime to hasten gastric emptying and improve esophageal clearance.
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Proton pump inhibitors (PPIs), Prilosec (Omeprazole is available over the counter) and Prevacid, have also been shown to be effective. Histamine H2 receptor blocking agents are less potent suppressors of gastric acid secretion than are PPIs. However, some patients report that when the use of PPI is discontinued, symptoms recur within days. Thus patients often need to continue the PPI on a long-term basis. One drawback to long term PPI treatment is the cost. The safety of long-term use of PPIs is still being investigated. As noted above, treatment with PPIs and the other medications controls symptoms and reflux esophagitis but does not result in regression of Barrett's esophagus. Therefore the risk of cancer is not eliminated.
Reflux eosphagitis requires prolonged therapy for 3 to 6 months or longer if the disease recurs quickly. Endoscopy is needed in patients with persistent or recurrent symptoms of gastroesophageal reflux disease.
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