Gastroesophageal reflux disease medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Lifestyle Modifications=== | ===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> | * 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 | ** [[Weight loss]] | ||
* Elevating head of the bed | ** Elevating head of the bed | ||
* No eating two hours before going sleep | ** No eating two hours before going sleep | ||
* Avoidance of the following foods and lifestyles is recommended in treatment of GERD: | |||
**[[Coffee]] | |||
**[[Alcohol]] | |||
*[[Coffee]] | **Excessive amounts of [[Vitamin C]] supplements | ||
* | **Foods high in fats | ||
*Foods high in fats | **[[tobacco smoking|Smoking]] | ||
*Eating shortly before bedtime | **Eating shortly before bedtime | ||
*Large meals | **Large meals | ||
* | **[[Chocolate]] and [[peppermint]]. | ||
*[[Chocolate]] and [[peppermint]]. | **[[Acid]]ic foods, such as oranges and tomatoes. | ||
*[[Acid]]ic foods, such as oranges and tomatoes. | **[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts | ||
*[[Cruciferous vegetables]]: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts | **[[Milk]] and milk-based products | ||
*[[Milk]] and milk-based products | |||
=== Medical therapy === | === Medical therapy === | ||
* The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.<ref name="pmid17229239">{{cite journal |author=Tran T, Lowry A, El-Serag H |title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs |journal=Aliment Pharmacol Ther |volume=25 |issue=2 |pages=143-53 |year=2007 |id=PMID 17229239 | doi=10.1111/j.1365-2036.2006.03135.x}}</ref> | * The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.<ref name="pmid17229239">{{cite journal |author=Tran T, Lowry A, El-Serag H |title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs |journal=Aliment Pharmacol Ther |volume=25 |issue=2 |pages=143-53 |year=2007 |id=PMID 17229239 | doi=10.1111/j.1365-2036.2006.03135.x}}</ref><ref>Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. ''Am J Ther'' 1995;2:546-552. PMID 11854825.</ref> | ||
* The following medical therapies are strongly recommended by the American College of Gastroenterology: | * The following medical therapies are strongly recommended by the American College of Gastroenterology: | ||
** '''Antacids''': | ** '''Antacids''': | ||
*** Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time. | *** Preferred regimen (1): [[Aluminum hydroxide]] 640 mg 5 to 6 times daily PO after meals and at bed time. | ||
*** Preferred regimen (2): Calcium carbonate One gram PO. | *** Preferred regimen (2): [[Calcium carbonate]] One gram PO. | ||
** '''Histamine-receptor antagonists (H2RA):''' | ** '''Histamine-receptor antagonists (H2RA):''' | ||
*** Preferred regimen (1): Ranitidine 150 mg q12 daily PO | *** Preferred regimen (1): [[Ranitidine]] 150 mg q12 daily PO | ||
*** Preferred regimen (2): | *** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks | ||
*** Preferred regimen (3): | *** Preferred regimen (3): [[Famotidine]] 20 mg q12 PO for 6 weeks | ||
** '''Proton pump inhibitors:''' | ** '''Proton pump inhibitors:''' | ||
*** Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks | *** Preferred regimen (1): [[Omeprazole]] 20 mg q24 PO for up to 4 weeks | ||
*** Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV | *** Preferred regimen (2): [[Esomeprazole]] 20 mg or 40 mg q24 IV | ||
** '''Prokinetic medications:''' | ** '''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 | ||
==References== | ==References== | ||
Revision as of 19:42, 12 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Overview
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:
- Coffee
- Alcohol
- Excessive amounts of Vitamin C supplements
- Foods high in fats
- Smoking
- Eating shortly before bedtime
- Large meals
- Chocolate and peppermint.
- Acidic foods, such as oranges and tomatoes.
- Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
- Milk and milk-based products
Medical therapy
- The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.[5][6]
- The following medical therapies are strongly recommended by the American College of Gastroenterology:
- Antacids:
- Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
- Preferred regimen (2): Calcium carbonate One gram PO.
- Histamine-receptor antagonists (H2RA):
- Preferred regimen (1): Ranitidine 150 mg q12 daily PO
- Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
- Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
- Proton pump inhibitors:
- Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
- Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
- Prokinetic medications:
- Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks
- Antacids:
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther. 25 (2): 143–53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239.
- ↑ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. Am J Ther 1995;2:546-552. PMID 11854825.