Esophageal Disorders

THE MERCK MANUAL, Sec. 3, Ch. 20, Esophageal Disorders

Treatment – Gastroesophageal Reflux Disease (GERD)

Management of uncomplicated GERD consists of (1) elevation of the head of the bed 6 inches; (2) avoidance of strong stimulants of acid secretion (eg, coffee, alcohol); (3) avoidance of certain drugs (eg, anticholinergics), specific foods (fats, chocolate), and smoking, all of which reduce lower esophageal sphincter competence; (4) use of an antacid 30 mL 1 h after meals and at bedtime to neutralize gastric acidity and possibly increase lower esophageal sphincter competence; (5) use of H2 blockers to reduce gastric acidity (sometimes with other drugs); and (6) use of cholinergic agonists (eg, bethanechol 25 mg po tid, metoclopramide 10 mg po 30 min before meals and at bedtime, or cisapride 10 mg qid–Caution: Risk of serious drug interactions with cisapride) to increase sphincter pressure. The hydrogen-potassium ATPase inhibitors omeprazole 20 mg/day for 4 to 8 wk or lansoprazole 30 mg/day for 4 to 8 wk are the most effective agents for rapid healing of peptic esophagitis. Omeprazole has been approved for long-term use to prevent the recurrence of erosive esophagitis.

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