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The treatment of gastroesophageal reflux in adults has been the subject of many an article! This section sets out primarily on the basis of recent data instead of individual drugs in the treatment of gastroesophageal reflux. The clinical manifestations of gastroesophageal reflux disease are highly variable, and the heartburn is the most common complaint but complications such as esophagitis, esophageal stricture, ulceration and metaplasia of the lining of the esophagus are also found. General Measures Dietary recommendations and lifestyle adjustments (position, smoking, diet), combined with the administration of antacids have long been the mainstay of treatment. The effectiveness of such measures has however never been confirmed by well-controlled studies. Antacids While that no placebo-controlled study has demonstrated the effectiveness of antacids, it is clear from epidemiological studies as these with or without alginic acid, are often used successfully by people who don' t have not seek medical attention. The combination of antacids and alginic acid seems more effective than antacids alone. Gastroprocinétiques In the short-term treatment of gastroesophageal reflux, cisapride (40 mg to pj. 2 or 4 doses) appeared more effective than a placebo and almost as effective as H 2 antihistamines in relieving symptoms and healing of esophagitis. A 20 mg per j. in 1 or 2 doses, it also prevents recurrence in patients with moderate esophagitis. [Editor's note: cisapride may prolong the QT interval and cause torsades de pointes sometimes fatal, particularly in cases of association with drugs that slow down its metabolism such as ketoconazole, itraconazole, miconazole and some macrolides]. Metoclopramide and domperidone are less effective than cisapride and cause more side effects [note: most metoclopramide]. Sucralfate The results of studies with sucralfate, which is attributed a protective effect on the lining of the esophagus, are contradictory. The place of this drug in the treatment of gastroesophageal reflux disease is very limited. Inhibitors of gastric acid secretion H 2 Antihistamines H 2 antihistamines cimetidine, famotidine, nizatidine and ranitidine were the first inhibitors of gastric acid secretion whose effectiveness has been demonstrated in the short-term treatment of gastroesophageal reflux. Their effectiveness is limited, especially in cases of severe esophagitis. In addition, a maintenance treatment at usual doses does not prevent recurrences. The combination of an antihistamine H 2 and a gastroprocinétique is less efficient and more expensive that treatment with an inhibitor of the proton pump. However, because of their relative safety, an occasional treatment, that is to say when complaints by one of these H 2 antihistamines may be useful in mild forms of gastroesophageal reflux. Inhibitors of proton pump A recent meta-analysis of 43 studies in patients with moderate to severe gastroesophageal reflux showed superior efficacy of inhibitors of proton pump compared to H 2 antihistamines. This superiority is also evident in milder forms of esophagitis and in patients for whom the endoscopy was normal. Omeprazole has also appeared more effective than cisapride. The effectiveness of inhibitors of the proton pump is maintained over time and long-term studies have shown that a maintenance treatment with omeprazole (at 10 to 20 mg pj.) Performs better that a maintenance treatment with ranitidine (at 300 mg pj). In recent studies, administration occasionally, when complaints of omeprazole at 10 mg or 20 pj. To show its effectiveness in improving symptoms and quality of life. Although inhibitors of proton pump are well supported, a doubt remains about the risk of malignancy after 10 to 20 years of inhibition of gastric acidity. This risk is probably very small. Nevertheless, there is a risk of atrophic gastritis, which predisposes to adenocarcinoma. This risk appears to be associated with infection by Helicobacter pylori, which is why some authors recommend to eradicate the bacterium before undertaking a long-term treatment with an antihistamine H 2 or an inhibitor of the proton pump. The benefit of such a strategy n is not yet established. How should one treat gastroesophageal reflux disease? The management of gastroesophageal reflux disease depends mainly on the patient's age, the presence of other conditions, severity of symptoms and esophagitis, and the results of initial treatment. Initial treatment * In patients with mild to moderate heartburn, the first approach is usually to combine lifestyle modifications to antacids with or without alginic acid. However, for young patients with no symptoms of alarm as dysphagia, anemia or weight loss, there is now a consensus on the use of an inhibitor of gastric acid secretion without prior endoscopic evaluation. A short-term treatment with an antihistamine H 2 or an inhibitor of the proton pump can indeed be undertaken without risk of missing a condition can be life threatening. In patients over 45 years and in those with symptoms of alarm, an endoscopic examination is required to exclude cancer and to assess the severity of esophagitis. * In patients for whom endoscopy is revealed normal or have mild esophagitis, two possibilities arise. The first is to treat with cisapride or H 2 antihistamines and book inhibitors proton pump in case of insufficient response. The second possibility is to treat the outset by an inhibitor of the proton pump can decrease the dose or switching to an H 2 antihistamine or a gastroprocinétique. * In patients with moderate or severe esophagitis, inhibitors of proton pump are the mainstay of treatment. In case of insufficient response, the dose may be increased gradually. Long-term treatment In most cases, adequate initial treatment can relieve symptoms and heal esophagitis. An occasional treatment (in complaints) s may indicate for patients with mild to moderate symptoms and infrequent relapses. However, if symptoms recur soon after stopping treatment, a maintenance treatment, usually by an inhibitor of the proton pump, should be considered. In younger patients who have frequent recurrences, a surgical approach may, however, proves to be preferable to drug therapy of indefinite duration, provided that is addressed to a center specializing in this type of pathology. The Author have been writing articles for years. You can also check out his latest website: http://acidrefluxremedies.myweightlosssystem.com where he reviews acid reflux home remedies which contains reviews on the Acid Reflux Medications.
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