Management of Gastroesophageal reflux disease (GERD) - ACG 2022 guideline - Refractory GERD Mx
Gastroesophageal reflux disease (GERD) is a chronic condition that occurs when stomach acid flows back into the esophagus, causing symptoms such as heartburn, regurgitation, and chest pain. The management of GERD typically involves a combination of lifestyle modifications, medication, and in some cases, surgery. Here are some steps to manage GERD:
Lifestyle modifications: Avoiding trigger foods and drinks (such as spicy, fatty, and acidic foods), eating smaller meals, avoiding lying down immediately after meals, quitting smoking, losing weight, and elevating the head of your bed can help reduce GERD symptoms.
Medications: Proton pump inhibitors (PPIs), H2 blockers, and antacids can be used to reduce stomach acid production and relieve symptoms. These medications are available over-the-counter or by prescription.
Surgery: In some cases, surgery may be recommended to treat GERD if lifestyle modifications and medications are not effective. The most common surgical option is laparoscopic Nissen fundoplication, which involves wrapping the upper part of the stomach around the lower esophageal sphincter to strengthen it and prevent acid reflux.
Refractory gastroesophageal reflux disease (GERD) is a condition where the symptoms of GERD persist despite optimal medical or surgical therapy. Refractory GERD can be challenging to manage, but there are several strategies that can be employed to help improve symptoms.
Lifestyle modifications: Patients with refractory GERD should continue with lifestyle modifications, including weight loss, avoiding foods that trigger symptoms, eating smaller meals, and avoiding lying down for at least two hours after meals.
Medications: Patients with refractory GERD may require higher doses of proton pump inhibitors (PPIs) or a combination of medications such as PPIs and H2 receptor antagonists. Patients who do not respond to medical therapy may benefit from the addition of prokinetic agents.
Endoscopic therapies: Endoscopic therapies, such as radiofrequency ablation, transoral incisionless fundoplication, and the Stretta procedure, have shown promise in managing refractory GERD.
Surgical intervention: Patients who do not respond to medical or endoscopic therapies may benefit from surgical intervention. The most common surgical procedure is laparoscopic fundoplication, which involves wrapping the upper part of the stomach around the lower part of the esophagus to create a barrier to reflux.
Psychological interventions: Anxiety and depression can exacerbate GERD symptoms. Cognitive-behavioral therapy (CBT) and relaxation techniques such as meditation and yoga can be helpful in managing stress and anxiety associated with GERD.