Tif And Other Endoscopic Therapy
Transoral incisionless fundoplication is an option to address GERD. TIF can mean a shorter treatment time, less pain and faster recovery compared to laparoscopic surgery. The procedure involves using a special TIF device to create a passageway for a flexible, tube-like imaging instrument called an endoscope. The procedure allows the physician to use preloaded tweezers and fasteners to repair or recreate the valve that serves as a natural barrier to reflux.Currently, there are clinical trials testing the efficacy of endoscopic therapy for GERD. One form of therapy uses an endoscopic sewing machine to place sutures in the stomach and increase the anti-reflux barrier.
TIF Procedure for GERD | Frank’s Story
What Treatments Are Available For Heartburn & Acid Reflux
Most treatments revolve around lifestyle changes as your symptoms are likely to lessen if you take measures to reduce the amount of reflux that you have. For example, stopping smoking and drinking less alcohol can all make a big difference to the discomfort you experience. Some foods are more likely than others to trigger reflux symptoms so you may find it helpful to look at how you eat as well as what you eat. Avoid late night, high fat meals so you dont go to bed with a full stomach. Propping up your head when you sleep may also alleviate symptoms. Eat little but more often if necessary. Try to avoid bending forward or wearing tight clothes as this can put extra pressure on your tummy.
There are also a variety of medicines you can buy at your local pharmacy to help lessen your reflux symptoms.
Antacids: alkaline liquids or tablets that reduce the amount of stomach acid. They work immediately and last for four hours. They are best taken after meals and before going to bed.
Acid-supressing medications: capsules or tablets which reduce the amount of acid produced by the cells in your stomach.
These are split into 2 groups:
- Histamine H2-receptor antagonists . These include Ranitidine, Cimetidine, Famotidine and Nizatidine. These can be taken prior to bedtime.
- Proton pump inhibitors . These include Omeprazole, Pantoprazoleand Esomeprazole. These are best taken 30 minutes prior to breakfast or evening meal.
Tomatoes And Citrus Fruit
Fruits and vegetables are important in a healthy diet. But certain fruits can cause or worsen GERD symptoms, especially highly acidic fruits. If you have frequent acid reflux, you should reduce or eliminate your intake of the following foods:
- tomato sauce or foods that use it, such as pizza and chili
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There Are Two Types Of Surgery: Total Fundoplication And Partial Fundoplication
What does the research say about surgery?
- Fundoplication surgery works as well as only taking medicine to keep you from getting acid reflux and heartburn. However, you may still need medicine after surgery to control your symptoms.
- There are different ways to do the surgery , but they all work about the same.
What are the side effects?
- Fundoplication surgery can cause you to feel bloated and make it hard to swallow. These side effects may last for 30 days or longer, and some side effects may require a second surgery to fix.
- Serious side effects, such as infection and heart attack, may be more common with surgery than with medicine. These side effects are rare.
How Should This Medicine Be Used
Prescription omeprazole comes as a delayed-release capsule, and packets of delayed-release granules for suspension to take by mouth or give through a feeding tube. Nonprescription omeprazole comes as a delayed-release tablet to take by mouth. Prescription omeprazole should be taken at least 1 hour before a meal. Prescription omeprazoleis usually taken once a day before a meal but may be taken twice a day when used with other medications to eliminate H. pylori, or up to three times a day, before meals when used to treat conditions in which the stomach produces too much acid. The nonprescription delayed-release tablets are usually taken once a day in the morning at least 1 hour before eating for 14 days in a row. If needed, additional 14-day treatments may be repeated, not more often than once every 4 months. To help you remember to take omeprazole, take it at around the same time every day. Follow the directions on your prescription label or the package label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take omeprazole exactly as directed. Do not take more or less of it or take it more often or for a longer period of time than prescribed by your doctor or stated on the package.
If you are taking the delayed-release tablets, swallow them whole with a full glass of water. Do not split, chew, or crush them or crush and mix them into food.
Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.
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Treatment Approaches For Gerd At Johns Hopkins
There are four approaches for GERD treatment, including medication and surgery. Often, patients respond well to a combination of lifestyle changes and a medication regimen.
Some patients do not find satisfactory relief from those methods and require surgical intervention. Other patients may choose surgery as an alternative to a lifetime of taking medication.
Treatment for GERD includes:
Gerd Diet: Foods That Help With Acid Reflux
Getting a case of acid reflux once in a while isn’t unusual, but some people suffer from burning discomfort, bloating and belching almost every time they eat. About 20% of the population has gastroesophageal reflux disease , a chronic acid reflux condition that’s diagnosed by a doctor.
Normally, the esophageal sphincter protects the esophagus from stomach acid. However, if the sphincter relaxes, food can push upward through the loosened opening and cause acid reflux.
“Diet plays a major role in controlling acid reflux symptoms and is the first line of therapy used for people with GERD,” says Ekta Gupta, M.B.B.S., M.D., gastroenterologist with Johns Hopkins Medicine.
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What Tests Might Be Done
Tests are not usually necessary if you have typical symptoms. Many people experiencing acid leaking up into the gullet are diagnosed with ‘presumed acid reflux’. In this situation they have typical symptoms and the symptoms are eased by treatment. Tests may be advised if symptoms are severe, or do not improve with treatment, or are not typical of GORD.
- Gastroscopy is the common test. A thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. With inflammation of the lining of the oesophagus , the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:
- Oesophagitis. This term is used when the oesophagus can be seen to be inflamed.
- Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal.
Common Medications For Acid Reflux And Gerd
If diet and lifestyle choices dont improve your acid reflux and GERD symptoms, a doctor may recommend medication. Acid reflux and GERD medicine is available over-the-counter and by prescription.
These medications come in three main types: antacids, H2 blockers and proton pump inhibitors or PPIs.
Many people who have mild or intermittent symptoms of reflux may be able to take over-the-counter treatments alone. Frankly, patients can often self-manage that with little to no clinical input, but many other patients may have more severe GERD symptoms or more complex GI disease, such as gastritis or erosive esophagitis or gastrointestinal ulcers which we dont see often, but they still can occur are times when a prescription treatment makes more sense, said Alexander.
If heartburn is mild and only happens occasionally, people can use weaker OTC medicines such as antacids.
For more serious acid reflux or GERD, medical providers may prescribe stronger medicines such as H2 blockers or PPIs. Weaker medicines like antacids dont treat GERD.
H2 blockers are generally used for more mild disease. For people that require more complete acid suppression, proton pump inhibitors are superior, Alexander said.
Each type has pros and cons and different side effects.
Common Medications for Acid Reflux
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Consider Eating Less Chocolate
GERD patients are sometimes advised to avoid or limit their consumption of chocolate. However, the evidence for this recommendation is weak.
One small, uncontrolled study showed that consuming 4 ounces of chocolate syrup weakened the lower esophageal sphincter .
Another controlled study found that drinking a chocolate beverage increased the amount of acid in the esophagus, compared to a placebo .
Nevertheless, further studies are needed before any strong conclusions can be made about the effects of chocolate on reflux symptoms.
There is limited evidence that chocolate worsens reflux symptoms. A few studies suggest it might, but more research is needed.
Dont Drink Too Much Citrus Juice
In a study of 400 GERD patients, 72% reported that orange or grapefruit juice worsened their acid reflux symptoms .
The acidity of citrus fruits doesnt appear to be the only factor contributing to these effects. Orange juice with a neutral pH also appears to aggravate symptoms .
Since citrus juice doesnt weaken the lower esophageal sphincter, it is likely that some of its constituents irritate the lining of the esophagus (
While citrus juice probably doesnt cause acid reflux, it can make your heartburn temporarily worse.
Most patients with acid reflux report that drinking citrus juice makes their symptoms worse. Researchers believe citrus juice irritates the lining of the esophagus.
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What Lifestyle Changes Help Heartburn
Preventing the triggers is one of the best ways to avoid heartburn discomfort. Making specific lifestyle modifications can make a big difference and help prevent acid reflux episodes. These include
- Avoid trigger foodsCertain foods are known to trigger heartburn. These include caffeine, chocolate, fried and fatty foods, carbonated beverages, and spicy foods.
- Avoid eating late at night Eating late night makes your condition worse. Eat two to three hours jumping going to bed. A minimum of one hour is essential for your stomach to push the food forwards into the intestines.
- Lose weightLosing weight and keeping it at normal values decreases the likelihood that you will experience heartburn.
- Elevate the bed Place a second pillow to elevate your head. Studies have shown that lifting head about six to eight inches help reduce stomach acid regurgitation and decrease the heartburn episodes.
- Avoid tobacco and alcohol Alcohol and tobacco smoking are known triggers for many health conditions, including heartburn.
Eat A Banana Or An Apple
Bananas contain natural antacids that can act as a buffer against acid reflux. If you want to try out the simplest home remedies for heartburn first, try letting a few bananas ripen up nicely and eating one every day. Another option is to try an apple a day. Slice one up and eat it a couple of hours before bedtime to relieve or prevent discomfort.
For Instant Relief Antacids
While preventative treatments such as H2 blockers and PPIs are more effective, antacid medication is just what you need if you want fast heartburn relief. These inexpensive, over-the-counter tablets can be used on demand for symptom relief, but it must be noted that antacids dont do anything to prevent acid reflux or GERD.
The common ingredients contained in antacids like calcium carbonate found in Tums and Rolaids and/or magnesium found in Mylanta and Maalox provide heartburn relief within 5 minutes and only work temporarily for 30 to 60 minutes at most. Antacids are typically available as chewable or dissolving tablets, but some brands come in liquid or gum form.
Common OTC Antacids
Side effects are mostly mild and include:
Be careful not to overuse antacids since some brands contain calcium, and excessive calcium intake can lead to kidney stones. If your symptoms persist for more than 2 weeks with an antacid, you might need stronger acid reflux medication.
Path To Improved Health
To find out which medicine is right for you, talk to your family doctor. He or she can tell you about the benefits and risks. Antacids and acid reducers rarely cause side effects. If they do, the side effects usually are minor and go away on their own. These may include headaches, nausea, constipation, or diarrhea.
Talk to your doctor before taking antacids if you have kidney disease. You should avoid any antacid that contains calcium carbonate or aluminum hydroxide and magnesium carbonate unless your doctor recommends it.
Talk to your doctor before taking a proton pump inhibitor if:
- You are elderly or have immune system problems. PPIs can increase your risk for pneumonia.
- You are a postmenopausal woman. PPIs reduce calcium absorption and increase your risk for osteoporosis.
- You have been treated for a Clostridium difficile infection in the past. PPIs may increase the risk that your infection returns.
If you are over the age of 55 and require long-term PPI treatment, your doctor may refer you for an EGD . This procedure examines the lining of the esophagus, stomach, and upper small intestine. If you have significant reflux, your doctor also may test you for the bacteria H. pylori prior to trying you on PPIs.
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Gerd Treatment: Lifestyle And Dietary Changes
Dietary and lifestyle changes are the first step in treating GERD. Certain foods make the reflux worse. Suggestions to help alleviate symptoms include:
- Lose weight if you are overweight of all of the lifestyle changes you can make, this one is the most effective.
- Avoid foods that increase the level of acid in your stomach, including caffeinated beverages.
- Avoid foods that decrease the pressure in the lower esophagus, such as fatty foods, alcohol and peppermint.
- Avoid foods that affect peristalsis , such as coffee, alcohol and acidic liquids.
- Avoid foods that slow gastric emptying, including fatty foods.
- Avoid large meals.
- Do not lie down immediately after a meal.
- Elevate the level of your head when you lie down.
What Is Gastroesophageal Reflux Disease
GERD is an ongoing condition in which the contents of the stomach come back into the esophagus . Doctors call this acid reflux.
There are several reasons why people have GERD. One possible reason has to do with the muscle at the bottom of the esophagus. Normally this muscle closes to keep food and stomach acid from coming back up the esophagus. In some people with GERD this muscle does not always work right.
- GERD often causes heartburn, a burning feeling in the chest and throat. Heartburn may happen many times a week, especially after eating or at night.
- GERD can also cause you to cough or have asthma symptoms. It can also make your voice sound hoarse and raspy. These symptoms can happen even if you do not have heartburn. The acid may also leave a bitter taste in your mouth.
How common is GERD?
- GERD is one of the most common health problems for adults.
What else should I know about GERD?
- Your heartburn may keep coming back if not treated.
- Untreated GERD can cause serious health problems. The acid can damage your esophagus and make it hard to swallow.
- In some people with GERD, the cells in the esophagus can become abnormal. These abnormal cells could lead to cancer of the esophagus, although this is rare.
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Take A Mindful Eating Approach
Eating quickly and overeating are correlated with heartburn and reflux. Sometimes you may not even realize that you’re eating quickly or eating after your body is signaling that it’s full. Practicing mindful-eating techniques may help you slow down and listen to what your body is telling you. Here’s how:
- Eliminate distractions at mealtime. Avoid reading, checking your phone, or watching television while you eat.
- Chew each bite thoroughly.
- Eat smaller meals rather than big meals. Overeating puts more pressure on your lower esophageal sphincter.
- Pause before each meal. Take a moment to look at your meal. Observe what is on your plate and take in the smells. Also, take a moment to notice how hungry you are before you take your first bite.
Treating Heartburn And Gerd
Heartburn is a feeling of burning pain in your lower chest, behind the breastbone. It comes from acid backing up from your stomach to your throat. You may have seen ads for heartburn drugs, such as Nexium, Prilosec or Prevacid. These drugs are called PPIs . They keep the stomach from making too much acid. They have been shown to heal irritation of the tube between the throat and the stomach .
In most cases, you dont need a PPI for heartburn. You can get relief from a less powerful drug. And when you do need a PPI, you should take the lowest dose for as short a time as possible. Heres why:
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How What And When
Watch how you eat: Dont inhale giant mouthfuls of food. Take smaller bites and eat slowly, allowing your stomach time to digest and without giving it an excuse to pump out excess acid.
Watch what you eat: Youre probably aware that specific foods trigger heartburn, usually foods high in acid or spicy foods. Avoid these as best you can to ward off
Watch when you eat: Dont eat within 3-4 hours before bed. Lying down puts more pressure on your LES and increases the likelihood of acid sneaking through.