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In most cases, Most of the time patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause [[esophageal stricture]] which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds.  If stress has been idetified as the major riskfactor,  [[stress management|stress reduction techniques]] may be practiced, or if overweight, [[weight loss]] may be indicated. Certain medications causes  [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]] to relax those medications should be avoided.  Anti-acid drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to decrease the acid secretion.   
In most cases, Most of the time patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause [[esophageal stricture]] which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds.  If stress has been idetified as the major riskfactor,  [[stress management|stress reduction techniques]] may be practiced, or if overweight, [[weight loss]] may be indicated. Certain medications causes  [[lower esophageal sphincter]] (or [[Lower esophageal sphincter|LES]] to relax those medications should be avoided.  Anti-acid drugs like [[proton pump inhibitors]] and [[Histamine H2 receptor|H2 receptor]] blockers can be used to decrease the acid secretion.   
==Medical Therapy==
==Medical Therapy==
===Lifestyle Modifications===
*The following measures are recommended as the first line to treat GERD:<ref name="pmid17573791">{{cite journal |author=Piesman M, Hwang I, Maydonovitch C, Wong RK |title=Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2128–34 |year=2007 |pmid=17573791 |doi=10.1111/j.1572-0241.2007.01348.x}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref><ref name="pmid259568342">{{cite journal| author=Ness-Jensen E, Hveem K, El-Serag H, Lagergren J| title=Lifestyle Intervention in Gastroesophageal Reflux Disease. | journal=Clin Gastroenterol Hepatol | year= 2016 | volume= 14 | issue= 2 | pages= 175-82.e1-3 | pmid=25956834 | doi=10.1016/j.cgh.2015.04.176 | pmc=4636482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25956834  }}</ref><ref>Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. ''Am J Gastroenterol'' 1999;94:2069-73. PMID 10445529.</ref>
**[[Weight loss]]
**Elevating head of the bed
**No eating two hours before going sleep
*Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
**[[Coffee]]
**[[Alcohol]]
**Excessive amounts of [[Vitamin C]] supplements
**Foods high in fats
**[[tobacco smoking|Smoking]]
**Eating shortly before bedtime
**Large meals
**[[Chocolate]] and [[peppermint]].
**[[Acid]]ic foods, such as oranges and tomatoes.
**[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
**[[Milk]] and milk-based products
'''Sliding hiatus hernia''' :
'''Sliding hiatus hernia''' :
*Pharmacologic medical therapy is recommended among patients with Sliding hiatus hernia  when experince symptoms of ''gastroesophageal reflux disease'' (GERD) like<ref name="TranLowry2006">{{cite journal|last1=Tran|first1=T.|last2=Lowry|first2=A. M.|last3=El-Serag|first3=H. B.|title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies|journal=Alimentary Pharmacology and Therapeutics|volume=0|issue=0|year=2006|pages=061016063002004–???|issn=0269-2813|doi=10.1111/j.1365-2036.2006.03135.x}}</ref><ref name="pmid11854825">{{cite journal |vauthors=Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S |title=Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn |journal=Am J Ther |volume=2 |issue=8 |pages=546–552 |year=1995 |pmid=11854825 |doi= |url=}}</ref>
*Pharmacologic medical therapy is recommended among patients with Sliding hiatus hernia  when experince symptoms of ''gastroesophageal reflux disease'' (GERD) like<ref name="TranLowry2006">{{cite journal|last1=Tran|first1=T.|last2=Lowry|first2=A. M.|last3=El-Serag|first3=H. B.|title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies|journal=Alimentary Pharmacology and Therapeutics|volume=0|issue=0|year=2006|pages=061016063002004–???|issn=0269-2813|doi=10.1111/j.1365-2036.2006.03135.x}}</ref><ref name="pmid11854825">{{cite journal |vauthors=Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S |title=Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn |journal=Am J Ther |volume=2 |issue=8 |pages=546–552 |year=1995 |pmid=11854825 |doi= |url=}}</ref>
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*** '''[[Prokinetic|Prokinetic medications]]:'''
*** '''[[Prokinetic|Prokinetic medications]]:'''
**** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks
**** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks
****
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


==References==
==References==

Revision as of 19:25, 7 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

In most cases, Most of the time patients experience no discomfort and no treatment is required. However, when a hiatal hernia is large, it is likely to cause esophageal stricture which results in discomfort. Symptomatic patients benefit from not lying down immediately after meals and also benefit by elevating the head of their beds. If stress has been idetified as the major riskfactor, stress reduction techniques may be practiced, or if overweight, weight loss may be indicated. Certain medications causes lower esophageal sphincter (or LES to relax those medications should be avoided. Anti-acid drugs like proton pump inhibitors and H2 receptor blockers can be used to decrease the acid secretion.

Medical Therapy

Lifestyle Modifications

  • The following measures are recommended as the first line to treat GERD:[1][2][3][4]
    • Weight loss
    • Elevating head of the bed
    • No eating two hours before going sleep
  • Avoidance of the following foods and lifestyles is recommended in treatment of GERD:

Sliding hiatus hernia :

References

  1. ↑ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
  2. ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
  3. ↑ Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). "Lifestyle Intervention in Gastroesophageal Reflux Disease". Clin Gastroenterol Hepatol. 14 (2): 175-82.e1-3. doi:10.1016/j.cgh.2015.04.176. PMC 4636482. PMID 25956834.
  4. ↑ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
  5. ↑ Tran, T.; Lowry, A. M.; El-Serag, H. B. (2006). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies". Alimentary Pharmacology and Therapeutics. 0 (0): 061016063002004–???. doi:10.1111/j.1365-2036.2006.03135.x. ISSN 0269-2813.
  6. ↑ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S (1995). "Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn". Am J Ther. 2 (8): 546–552. PMID 11854825.
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