Treatment of Reflux HOW TO ELEV ATE THE

There are gen eral m easures the patient can take HEAD O F BED
to redu ce ref)ux :
• Eat smaller and m ore frequ ent m eals.
• D o not lie dow n immediately aft er eating, and
avo id eating fo r several ho urs befo re going to
L
B- lO "
bed . r
• Excessive bendin&, liftin~, abd ominal exercises, Block Wedge
girdles, and tight belts alt increase abdo minal
press ure and provok e reflu x. . :-: . ~4t . ~ ~_
""~ ::~ j

• If overweight , lose weight. Being overweight

pro m otes re flu x.
• Sto p usin g all toba cco; nicotine we,lkens the
LES .
• Avo id fatt y foods, alco ho l, coffee, chocolate,
and peppermint.
• Elevate the head of the bed 8" to 10" so grav i-
ty keeps stomach juices o ut o f the esophagus
w hile the patient sleeps . Fo llow the dia gram .
Extra
pillows, by them selves, are usually not helpful.
• Certain prescription o r over-th e-co unter
m edicati o ns can weaken th e LES o r aggravate
reflu x. Review all m edicati o ns you are taking
w ith th e physician.
This surgery is accomplished throu gh tin y holes in
the belly button and upp er abd o men. R ecovery is
far quicker with this t echniqu e. This
operat io n sh ould only be perfo rmed by surgeo ns
th o rou ghly familiar with It. Surgery, however, is
not al w ays perm aneml y successfu l and th ere can be
complicatio ns.
Endoscopic Correction of Reflux - The STRETT A
procedure: A n ew end oscopic procedure now exists
w hich using radiofrequ ency energy,
Lo ng term studies su ggest
that this technique is 80 - 90% effective at two
years. The procedure is perfo rmed during a regular
endoscopy, w ith immediate recovery .

Other treatments include: Summary

Antacids - Th ese can and should be used o ft en . Heartburn occurs so co mmonly that it is normal
Ge nerall y, ;1I1tacids sh ould be taken 30 to 60 fo r ever yo ne to experi ence it at som e time.
minutes after eating and at bedtime. Liquids are
preferred to tablets, with the stron gest being ENDOSCOPIC MICROSURGERY ASSOC., P.A .
Maalox , M y lanta, Gelusil, Ri opan o r G aviscon . MARK D. NOAR, M .D. & ASSOCIATES
Drugs - M edicines are n ow available that effective- T herapeutic Endosco py, Gastroenterology & H epatology
ly reduc e and even eliminate t he secreti o n of
stomach acid and increase the strength of the 7402 York Road , Suite 100 (410) 494-1846
LES muscle. The most potent of these are called T owso n, MD 2 1204
proton pump inhibito rs (i .e. , Aciphex , Prilosec,
Prevacid, Protoni x and N exium) . These remark- 9110 Philadelphia RO;ld., Suire 108 (4 10) 574-2566
able d rugs are o ften Baltimore, MD 2 1237
dram aticall y effective in severe cases o f reflu x.
SUl'gery - Surgery is rarel y required in treating 620 W . McPhail Road., Suire 104 (41 0) 569-4444
retlu x. H owever, w h en the treatmem program s Bel Air, MD 210 14
o utlined above are ineffecti ve , surgery mu st be
con sid ered to stren gthen the LES muscle. Hun t Valley Medical Center (410) 494-1846
Unfo rtunately, recent studies dem o nstrate that
surge ry is o nl y 33% effective fi ve years after per- 10 Warren Road, Suire 11 0, Cockeysvi lle, MD 21 030
fo rm ed. A newer method o f perfo rming an t!-
T his materi al does not cover all info rm ati o n and is no t intended as
reflu x surgery is by laparoscopic techniqu e.
"substitute fo r profcssio""lmcd ical ca rc.

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Heartburn and Reflux
Everyone has heartburn occasionally. This
occurs when stomach acid flows backward (regurgi-
tates) into the esophagus. The esophagus is the tube
t hat carries food to the sto mach. People usually feel
heartburn as
a burning sensatio n o r pain behind the breastbone.
Often, regu rgitatio n of bitter-tasting stomach
acid acco mpanies hea rtburn . An antacid or milk
tempo raril y relieves hea rtburn fo r most people.
Why Does Heartburn
Occur?
T o understand he.lrtburn, let 's look at the body's
anatomy. The esophagus ca rries food and liCLuid to
the stomach. A sp hincter (specialized muscle) is
located at the end of the esophaau s. It is known as
th e lowe r esophage.l1 sphincter (LES). This muscle
contracts much the same as the anus does to close
the opening
of the rectum to the outsid e of the body . The LES
mu scle should on ly o pen when food o r liquid is
passed into the stomach.
However, the LES muscle does not always wo rk
perfectl y. Sometimes it is too weak to stay com-
pletely closed, and stomach juices seep back into the
esophagus. This is known as reflux . There are cer-
tain factors that contribute to reflu x. The most
common is eati ng a large meal. Along w ith
LOWER ESOPHAGEAL SPHINCTER
Reflux
-
<..
..
.-
swallowed air, a large meal causes pressure in the
stomach to rise, and overpowers the LES muscl e. The THINGS TO A VOID
following are other
factors that reduce the LES pressure and allo,,' reflux:
• Nicotine (cigarettes)
• Fried o r fatty foods
• C hocolate
• Coffee
• C itru s fruits and juices
• Peppermint
• Pregnancy
• Lying fla t
• Hiatus hernia
• Certai n prescription medicines
Is Heartburn Serious?
H eartburn and reflux are extremel y common, with
10 percent of the population experiencing them daily.
Twenty-five percent of pregnant women have hea ttburn .
• El ect rogast rogram (EGG) - This test is a meas-
Even though heattburn is common, it is rarely lifethreat- urement of t he stomach 's elect rica l activity.
ening. Severe cases, however, can result in injury to the
lower • 24 H our pH Probe - This stud y measures t he
esophagus that requires treatment. amoun t of acid which backs up from your
stomac h into you r esophagus.
What Is a Hiatus Hernia? Complications of Reflux
The diaphragm is a flat ho rizo ntal mu scl e that sepa-
rates the lungs from th e stomach and the rest of the In some people, acid in the lowe r esophagus
digesti ve tract. The esophagus passes t hrough an actuall y causes tissue damage. Certai n complica-
o pening in the diaphragm. If th e open in g enlarges, a tions can t hen result:
po rtion of the sto m.lch can protrude (herniate) • Chroni c bleeding wd anemia .
through it into the chest. This is called a hiatu s h er- • Scar formation and narrow in g of the lower
nia. A persistent hiatu s hernia may produ ce signifi- esopha gus. This is called a st ri cture. It usu.ll1 y
cant heartburn. H owever, man y is t reated by dilatation, a procedure to w iden
people w ho experience heartburn do not have a hiatus the area.
hernia . Likewise, man y people with a hiatus hernia • Barrett's esopha gus can occur w hen reflux irri-
do not experience heartburn. tates t he lower esop hagu s ove r a long period of
time. The stomach lining then actually grows
Diagnosis of Reflux into the esophagus. In these cases, there is a
There are vario us tests used to diagnose refl ux: sli oht but
derini'te , risk o f cancer develo ping.
• Upper GI Series - The patient drinks liquid bari-
um and x-rays are taken of the eso phagus and • Lung problems can develop w hen reflu x results
stomach to see ho\v they functi o n. in stomach fluid t rickling Into the breathing
tubes.
• Upper GI Endoscopy - The pati ent is given a mild
sed ative. Then, a thin, lighted, fl exibl e tube, lr ofte n occurs at night when a patient is lying
down. Thi s causes w heezing , bronchitis, and
called an endoscope, is inserted into the eso phagus
to visuall y inspect it and the stomac h. even pneumonia .
• Esophageal Manometry - Thi s test m easures thep-
ressures w it hin the esophagus, es pec ially LES
pressure.
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