“Within the armamentarium, we’ve got an array of lifestyle changes, we have an array of medical approaches, and we have an array of procedural approaches for treating reflux,” Smith says. “We really try to figure out where on the spectrum of reflux a patient falls and then try to counsel them appropriately after they’ve been worked up.”
In this segment, Brian Smith, MD offers a detailed examination of the specific treatment options available to patients suffering from reflux.
Let's start first with lifestyle modifications as a form of therapy for reflux. First, patients should try to stay away from spicy foods or trigger foods. More commonly, those are red wine, chocolate, caffeine, any sort of spicy foods. And patients oftentimes figure that out on their own, that those are the foods that, that make them more symptomatic. Other lifestyle changes include separating out your bedtime from your meal time so that people are not lying flat on a full stomach on a consistent basis. So having dinner 23, perhaps even four hours prior to bedtime works relatively well. And many patients find that they, if they sleep with the head of their bed propped up more, whether it be on a wedge pillow or occasionally even even elevating the head of their bed on um a couple of blocks so that their, their head of their bed is more inclined or even using one of the adjustable beds that are now commercially available. All of these options tend to work well for keeping patients under relatively good control when their reflux is not severe. So that takes care of lifestyle approaches as far as medicines, our standard first line medical therapy for acid reflux. These days are proton pump inhibitors. And there is a, a long list of proton pump inhibitors that are all in the same family and work very, very well. Approximate 20 million Americans are on proton pump inhibitors or PPIs on a daily basis. And it's actually one of the largest markets for drug manufacturers. Not surprisingly, as drugs have become generic and less expensive. Newer versions within the same sister class of PPIs have come out and some show improved efficacy. There's as a result, a long list of PP I options that work quite well. The standard FDA approved dose is usually one of those PPIs daily. Uh but they can safely be moved up to uh twice a day with most of the medications. And in fact, occasionally you can even double the dose um uh taking that on a twice daily basis. Although the FDA usually approves a single dose once daily uh for A PP I. Other antacids include over the counter Tums, which simply is a, is a, a neutralizer of stomach acid, um H two blockers which include uh famotidine uh and previously raNITIdine. Uh but famotidine is still uh a very effective Pepcid, still a very effective antacid uh that now can be purchased over the counter. And then there are some alternative drugs, but those really cover the mainstay treatment as far as medical therapy. And then finally, when we talk about different surgical options. Uh, we actually have a, a, an array of things to offer patients as well. Fundoplication has been the first line surgical therapy for reflux for greater than six decades. It's a procedure that has earned itself both a good and bad reputation. Uh, in terms of its ability to control reflux. A fund application works very, very well. Uh When you do a full fundoplication, some patients may have a bit more difficulty with belching or vomiting, but with a, a partial wrap or a three quarter wrap or, or a halfway wrap around the lower esophageal sphincter uh in the form of a to pay oftentimes, those patients have excellent control of their reflux but still maintain some ability to belch and vomit. So, fundoplications usually in conjunction with a hiatal hernia repair at the same time, often are quite effective at treating reflux. Other options include a concurrent hiatal hernia and Tiff procedure, which is a transoral fundoplication. We repair the hiatus and then we do a fundoplication endoscopically from inside the mouth that is equally efficacious to a hiatal hernia and a partial fundoplication. Other options include links which is uh the brand name for a lower esophageal sphincter, magnetic augmentation. It is a a ring of magnets that we placed around the lower esophageal sphincter simply to hold it closed. And because they're magnets, they can be opened up through the force of the esophagus, pushing food down through it and then they close after the food passes by and they keep that valve closed. So as to minimize acid washing up into the esophagus tends to be particularly effective against patients whose predominant symptom is regurgitation of food. Finally, uh there still is a role for strata, uh which is an endoscopic treatment that goes down and through radiofrequency, ablation causes hypertrophy of the lower esophageal sphincter. It's a relatively select group of patients that are good candidates for that. Um But that is still 1/4 treatment option within the armor material. So, we've got an array of lifestyle changes. We have an array of medical approaches and we have an array of procedural approaches for treating reflux. And we really try to figure out where on the spectrum of reflux a patient falls and then try to cancel them appropriately after they've been, uh they've been worked up.
