GERD
Information taken from: ADVANCE for Speech-Language Pathologist & Audiologists. April 14, 2003. Expert Panel Reaches Consensus on GERD Management Strategies.
The American Gastroenterological Association (AGA) has reached a consensus on
the most effective and appropriate treatments for 61 million patients in the
United States who are struggling to control the symptoms of gastroesophageal
reflux disease (GERD), which disrupts the quality of life. GERD occurs when
the lower esophageal sphinter (LES) relaxes and allows the contents of the stomach
to go back up into the esophagus. To prevent the LES from relaxing, causes GERD
symptoms, one can receive a surgery called fundoplication, where the top of
the stomach is wrapped around the esophagus. With this surgery only 40 percent
have complete, long-term relief after surgery. A least 20 to 30 percent of the
patients overall resume medial therapy one to three years after antireflux surgery.
Some of the side effects of the surgery include, late dysphagia and a lower
quality of life.
Endoscopy is a procedure where the goal is to provide a better understanding
the source and severity of the patient’s symptoms allowing them to tailor
therapy to each patient. The consensus panel found that there is no reason for
patients whose heartburn responds to drug therapy to have a routine endoscopy.
The panel also rated OTC and perscription medications. OTC products available
include antacids, H2 receptor antagonists (H2RAs), and an H2RA/antacid combination.
The panel concluded that, to a varying degree, all have been effective in relieving
mild to moderate GERD as compared to a placebo. The combination of H2RA/antacid
is better at symptom relief than the others alone. In prescription medication
they found that standard doses of lansoprazole, omeprazole, pantoprazole and
rabeprazole produce comparable rates of healing and remission in patients with
erosive esophagitis.
The consensus panel concluded that endoscopic treatment is not a recommended
therapy for GERD at present.