Allergy, Asthma, Immunology of Delaware
Nasheds, PA          Maher Nashed MD

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Acid Reflux


When the acid from the stomach backs up to the esophagus, It may causes persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. it is called (Gastroesophageal reflux disease)​​
When the acid goes all the way up in the esophagus, it may causes bitter taste, a sensation of burning, or something stuck, hoarseness, difficulty swallowing, throat clearing, postnasal drip, difficulty breathing, dry cough, hoarseness of voice, bad breath and chest pain. All these can happen without heartburn. This is called (laryngopharyngeal reflux)
When the acid goes beyond the esophagus, It can cause recurrent ear and sinus infections.
Some patients might experience the symptoms of only one location and not the others. Some patients’ feel nothing at all when the acid goes up in the esophagus and that is called (silent acid reflux)

Acid Reflux

Acid Reflux Causes

Weakness of the ring of the muscles at the bottom of the esophagus
Risk factors
1. Overweight
2. Diet including smoking, alcohol, coffee and chocolate.
3. Stress
4. Others like: A. Hiatal hernia (Bulging of top of stomach up into the diaphragm), B. Pregnancy, C. Delayed stomach emptying
D. Medications, E. Diabetes, dry mouth, Asthma, and connective tissue diseases.


Acid Reflux 
Complications

1. Narrowing and scarring of the esophagus with possible oesophageal stricture.
2. An open sore in the esophagus (esophageal ulcer)
3. Precancerous changes to the esophagus (Barrett's esophagus)
4. Oesophageal cancer.
Changing life style
1. Diet: Eat smaller and more frequent meals, avoid anything you think triggers your symptoms. Avoid eating 2-3 hours before sleep.
2. Don't wear tight clothing – 
3. Raise the head of your bed by up to 20cm (8 inches) 
4. Try to relax – stress can make heartburn and GORD worse. 
5. Maintain a healthy weight.
6. Stop smoking.

Treatment of Acid Reflux

Treatment of Acid Reflux

Treatment of Acid reflux through Medications
There are 4 types of stomach medications
1. Antacids that neutralize stomach acid. They provide quick relief.
a. Examples of antacids: Maalox, Mylanta, Gelusil, Gaviscon, Rolaids and Tums.
b. Side effects: They won't heal an inflamed esophagus. Overuse can cause side effects, such as diarrhea or constipation. It might interfere with other medications absorption.
2. Medications to reduce acid production. Called H-2-receptor blockers. They provide longer relief and may decrease acid production from the stomach for up to 12 hours.
a. Examples: Cimetidine (Tagamet HB), Famotidine (Pepcid AC), Nizatidine (Axid AR) or Ranitidine (Zantac).
b. Side effects: They are uncommon, but can include diarrhea, headaches, dizziness, a rash and tiredness.
3. Medications that block acid production and heal the esophagus. Proton pump inhibitors are stronger blockers of acid production than are H-2-receptor blockers and allow time for damaged esophageal tissue to heal. 
a. Examples: Lansoprazole (Prevacid 24 HR), Esomeprazole (Nexium), Omeprazole (Prilosec, Zegerid), Pantoprazole (Protonix), Rabeprazole (Aciphex) and dexlansoprazole (Dexilant).
b. Side effects: These medications are generally well-tolerated. They may include headaches, diarrhea or constipation, feeling sick, abdominal (tummy) pain, dizziness and a rash. Long-term use may be associated with a slight increase in risk of bone fracture and vitamin B-12 deficiency
4. Medications to strengthen the lower esophageal sphincter. 
a. Example: Baclofen may decrease the frequency of relaxations of the lower esophageal sphincter and therefore decrease gastroesophageal reflux. It has less of an effect than do proton pump inhibitors, but it might be used in severe reflux disease. 
b. Side effects: Baclofen can be associated with significant side effects, most commonly fatigue or confusion.
GERD medications are sometimes combined to increase effectiveness.

Treatment of Acid reflux through Surgery.
Surgery and other procedures used if medications don't help
1. (Nissen fundoplication). This surgery involves tightening the lower esophageal sphincter to prevent reflux by wrapping the very top of the stomach around the outside of the lower esophagus.
Other procedures that appear to be safe, but not much is known about their long-term effects.
2. Surgery to strengthen the lower esophageal sphincter (Linx). The Linx device is a ring of tiny magnetic titanium beads that is wrapped around the junction of the stomach and esophagus
3. Endoscopic injection of bulking agents – where special filler is injected into the area between the stomach and oesophagus to make it narrower.
4. Endoluminal gastroplication – where folds are sown into the ring of muscles at the bottom of the oesophagus to restrict how far it can open.
5. Endoscopic augmentation with hydrogel implants – where implants containing special gel are placed into the area between the stomach and oesophagus to make it narrower.
6. Endoscopic radiofrequency ablation – where a tiny balloon is passed down to the bottom of the oesophagus and electrodes attached to it are used to heat it and make it narrower.

Treatment of Acid Reflux