HealthCentral Talks to Dr. Eisner About Reflux Prevention and Treatment

1. Why do symptoms of GERD return if you stop taking your medicine?
Symptoms of GERD are most commonly related to acid exposure to the esophagus, resulting in heartburn. In some cases, the esophagus will become inflamed (esophagitis). Chronic esophagitis can lead to scar tissue formation or stricture, that may result in patients experiencing difficulty swallowing solid foods. Long-term acid exposure can lead to a pre-cancerous condition of the esophagus, Barrett's esophagus.

Most medications used to treat GERD inhibiting the production of acid. Others increase emptying of the stomach, resulting in less gastric contents to be refluxed into the esophagus. The result of the medications is to decrease the amount of acid refluxing into the esophagus. Once medications are stopped, in a large majority of cases, there will be increased acid production and increased acid to the esophagus.

2. What simple steps can people with GERD take to alleviate symptoms?
First-line therapy for GERD consists of lifestyle changes, that can be very effective in alleviating symptoms.

Avoid lying down for three hours after eating.

Elevate the head of the bed while you sleep, with either pillows or cinder blocks.

Try to avoid foods, such as caffeine, chocolate and peppermints. These foods raise the risk of getting reflux by decreasing the lower esophageal sphincter pressure, thereby allowing gastric contents to more easily reflux into the esophagus.

Don’t wear tight-fitting clothes and try not to bend over. These things can worsen GERD.

Ask your doctor if you are taking medicines that that can worsen the symptoms of GERD.

3. In what cases is surgery recommended for GERD?
Surgical treatment for GERD has become more popular since the procedure has been able to be done with a minimally-invasive laparascopic technique. The benefits of the laparascopic technique are reduced post-operative pain, shorter hospital stay, a faster return to work and an improved cosmetic result. While surgery is considered in patients that have not responded well to lifestyle changes and medications, the ideal candidate for surgery is the patient who has complete elimination of symptoms with medications but does not want to take the medicine long-term.

Read Dr. Eisner's other blogs.