By: Stiven Benson
The gastroesophageal reflux disease (GERD) is a chronic, due
to the retrograde flow of part of gastroduodenal contents into the esophagus
and / or organs adjacent to it, causing variable spectrum of symptoms and / or
signs of esophageal and / or extra-esophageal, or not associated with tissue
damage.
GERD is considered today the most prevalent digestive tract,
although it is difficult to obtain accurate estimate, since the vast majority
of individuals who suffer from reflux symptoms resulting from not seeking
medical care.
GERD has a negative impact on quality of life, increases
health costs and the risk for malignant lesions pre.
The main clinical manifestations of GERD are heartburn
typical (heartburn) and acid regurgitation, which means the return of food or
acid content toward the oral cavity. The occurrence of atypical manifestations
(retrosternal chest pain, feeling of "cake" in the throat, chronic
cough, asthma, hoarseness, throat clearing, halitosis, thrush) sometimes is a
real challenge to clinicians due to the difficulty of establishing an accurate
diagnosis.
Currently, the biggest challenge for clinicians is to find
the best strategy for the treatment of GERD, not only because of its broad
spectrum of severity, but also by its chronicity, and should always evaluate
each particular patient, since not infrequently, treatment involves the use of
medication for life.
Clinical treatment
aims to relieve symptoms, heal injuries, prevent relapses and prevent
complications.
With practical purposes, one can divide the therapeutic
approach in pharmacological and behavioral measures that must be implemented
simultaneously in all stages of disease. In order to minimize reflux episodes,
it imposes the changing habits of the patient's life, such as elevating the
head of the bed, does not lie in the two hours after meals, avoid foods that
promote reflux and irritate the mucosa esophagus (fried, greasy, garlic,
onions, sweets, chocolates, soft drinks, alcoholic beverages, coffee and black
tea), and not use drugs that attack the lining.
With respect to pharmacological treatment, a great variety
of drugs have been used to treat the symptoms of GERD and for the healing of
esophagitis. However, 10% to 20% of patients presumably remain partially or
completely unresponsive to antacid therapy.
Surgical treatment in
uncomplicated GERD should be considered in the following circumstances:
Patients who, for some reason (personal, economic,
intolerance, etc..) Find themselves unable to continue the clinical treatment,
including patients with atypical manifestations, whose reflux was proven
devidademente;
Cases where continuous treatment is required for maintenance
PPI (proton pump inhibitor) in the proper dose, especially in patients younger
than 40 years who opt for surgical treatment.
In the complicated GERD Surgical treatment is indicated in
stenoses and / or ulcer, and when there adenocarcinoma. Surgical treatment for
fundoplication has been advocated by some authors as therapy for Barrett's
esophagus. Is worth noting, however, that longitudinal studies comparing the
clinical outcome of patients treated (IBP high dose) and surgery (fundoplication)
demonstrate that all types of treatment was able to reduce the extent of
metaplastic mucosa. On the other hand, were described several cases of
adenocarcinoma in Barrett's esophagus occurred, years after the surgery.
Several new endoscopic treatments for GERD are undergoing
clinical trials and some have been introduced in the medical community, but
still a bit timid.
Finally, the definition of a therapeutic regimen in a
patient with GERD has to be analyzed case by case, in proposing the end of treatment,
one should take into account, in addition to the physician's experience, the
type of patient studied, their conditions socioeconomic and possibilities of
higher or lower adherence.
If you want to learn more info about the diagnosis and
treatment of gastritis and stomach ulcers
(www.tabletsmanual.com/wiki/read/gastritis), as well as ways of medical therapy
of the disorder, read the article about the medication Prevacid:
www.tabletsmanual.com/online/prevacid.