Materiały źródłowe

• #1 Management of Gastroesophageal Reflux Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1001/p1311.html

  The primary treatment goals in patients with gastroesophageal reflux disease are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis, and prevention of complications of esophagitis. In patients with reflux esophagitis, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H2-receptor antagonist [H2RA] taken on demand or a proton pump inhibitor [PPI] taken 30 to 60 minutes before the first meal of the day). The preferred empiric approach is step-up therapy (treat initially with an H2RA for eight weeks; if symptoms do not improve, change to a PPI) or step-down therapy (treat initially with a PPI; then titrate to the lowest effective medication type and dosage). In patients with erosive esophagitis identified on endoscopy, a PPI is the initial treatment of choice.

• #1 Treatment for GER & GERD – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

  Your doctor may recommend that you make lifestyle changes and take medicines to manage symptoms of gastroesophageal reflux (GER) or gastroesophageal reflux disease (GERD). In some cases, doctors may also recommend surgery. […] Lifestyle changes may reduce your symptoms. Your doctor may recommend losing weight if you’re overweight or have obesity, elevating your head during sleep by placing a foam wedge or extra pillows under your head and upper back to incline your body and raise your head off your bed 6 to 8 inches, quitting smoking, if you smoke, changing your eating habits and diet. […] You can buy many GERD medicines over the counter. However, if you have symptoms that will not go away with over-the-counter medicines, you should talk with your doctor. Your doctor may prescribe one or more medicines to treat GERD.

• #1 Gastroesophageal reflux disease | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/gastro-oesophageal-reflux-disease-gord/

  GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed. […] The main treatments for GORD are: self-help measures this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight […] stronger prescription medicines including proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs). […] Surgery to stop stomach acid leaking into your oesophagus may be recommended if medication isn’t helping, or you don’t want to take medication on a long-term basis. […] Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines. […] If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  A healthcare professional is likely to recommend trying lifestyle changes and nonprescription medicines as a first line of treatment. If you don’t experience relief within a few weeks, prescription medicine and additional testing may be recommended. […] Options include: […] Antacids that neutralize stomach acid. Antacids containing calcium carbonate, such as Mylanta, Rolaids and Tums, may provide quick relief. But antacids alone won’t heal an inflamed esophagus damaged by stomach acid. Overuse of some antacids can cause side effects, such as diarrhea or sometimes kidney complications. […] Medicines to reduce acid production. These medicines known as histamine (H-2) blockers include cimetidine (Tagamet HB), famotidine (Pepcid AC) and nizatidine (Axid). H-2 blockers don’t act as quickly as antacids, but they provide longer relief and may decrease acid production from the stomach for up to 12 hours. Stronger versions are available by prescription.

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  Medicines that block acid production and heal the esophagus. These medicines known as proton pump inhibitors are stronger acid blockers than H-2 blockers and allow time for damaged esophageal tissue to heal. Nonprescription proton pump inhibitors include lansoprazole (Prevacid), omeprazole (Prilosec OTC) and esomeprazole (Nexium). […] Prescription-strength treatments for GERD include: […] Prescription-strength proton pump inhibitors. These include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex) and dexlansoprazole (Dexilant). […] Although generally well tolerated, these medicines might cause diarrhea, headaches, nausea or, in rare instances, low vitamin B-12 or magnesium levels. […] Prescription-strength H-2 blockers. These include prescription-strength famotidine and nizatidine. Side effects from these medicines are generally mild and well tolerated.

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  Potassium-competitive acid blockers (P-CABs). This new class of medicines may be recommended for someone with severe acid reflux if other medicines haven’t worked. They include vonoprazan (Voquezna) and tegoprazan (K-Cab). […] A technique known as diaphragmatic breathing may help improve GERD symptoms for some people. This exercise is done after eating. It involves breathing deeply into the diaphragm rather than shallowly into the chest. Diaphragmatic breathing techniques should ideally be taught by a trained medical professional. […] GERD can usually be controlled with medicine. But if medicines don’t help or you wish to avoid long-term medicine use, a healthcare professional might recommend: […] Fundoplication. The surgeon wraps the top of the stomach around the lower esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually done with a minimally invasive, called laparoscopic, procedure.

• #1

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/gastroesohageal-reflux-gerd

  Your doctor may also recommend over-the-counter acid reflux medicines such as: Antacids. These will address symptoms but won’t fix any damage stomach acid has caused in the esophagus, H-2 receptor blockers. This heartburn medication reduces the amount of acid the body makes. They can help relieve symptoms for longer periods of time, Proton-pump inhibitors. These block the acid the body makes, which allows the esophagus to heal. […] If over-the-counter acid reflux medicines don’t work, your doctor may recommend prescription medications for GERD treatment such as: Prescription-strength H-2 receptor blockers, Prescription-strength proton-pump inhibitors, Prokinetic agents to tighten the muscle between the stomach and esophagus (esophageal sphincter) and help the stomach empty faster. […] Surgery may be a good choice for GERD treatment for you if you: Still have persistent acid reflux or other symptoms while taking medication, Develop side effects from taking medication, Notice your symptoms return when you stop taking medication, Have damage to your esophagus such as bleeding or narrowing (stricture), Cant afford medication or prefer not to take lifelong medication.

• #1 Treatment of Gastroesophageal Reflux Disease (GERD) – Therapeutics Letter – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK598550/

  Treatment of gastroesophageal reflux disease (GERD) should involve antacids or H2-blockers as much as possible. […] In refractory cases omeprazole is effective. […] Long term omeprazole is indicated in relapsing severe erosive esophagitis, but must be prescribed with caution until more is known about long term safety. […] Most patients with heartburn do not seek medical attention, and the vast majority of those who do, respond to intermittent courses of antacid therapy. […] For those patients with persistent symptoms, suppression of acid secretion with cimetidine or other H2-blocker for a 6 week trial is effective in controlling the symptoms in 60 to 70 percent of patients with mild to moderate esophagitis. […] The prokinetic agents metoclopramide and cisapride are of similar effectiveness to H2-blockers.

• #1 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  Indications for fundoplication include the following: Patients with symptoms that are not completely controlled by PPI therapy can be considered for surgery; surgery can also be considered in patients with well-controlled GERD who desire definitive, one-time treatment. […] Long-term results of laparoscopic antireflux surgery have shown that, at 10 years, 90% of patients are symptom free and only a minority still take PPIs. […] Laparoscopic fundoplication is performed under general endotracheal anesthesia. […] The essential elements of the operation are as follows: Complete mobilization of the fundus of the stomach with division of the short gastric vessels, Reduction of the hiatal hernia, Narrowing of the esophageal hiatus, Creation of a 360 fundoplication over a large intraesophageal dilator (Nissen fundoplication).

• #1 Gastroesophageal reflux disease (GERD) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/diagnosis-treatment/drc-20361959

  The LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. […] Transoral incisionless fundoplication (TIF). This new procedure involves tightening the lower esophageal sphincter by creating a partial wrap around the lower esophagus using polypropylene fasteners. TIF is performed through the mouth by using an endoscope and requires no surgical incision. Its advantages include quick recovery time and high tolerance. […] Because obesity can be a risk factor for GERD, a healthcare professional could suggest weight-loss surgery as an option for treatment. Talk with your healthcare team to find out if you’re a candidate for this type of surgery.

• #1 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  The US Food and Drug Administration approved the LINX Reflux Management System in March 2012. This device is designed to augment the lower esophageal sphincter. […] In a systematic review, magnetic sphincter augmentation appeared to reinforce the lower esophageal sphincter to antireflux, effectively reducing the time percentage of esophageal acid exposure, improving the GERD health-related quality of life score, reducing the operative time (vs Nissen fundoplication), and achieving similar treatment success as that of fundoplication.

• #1 Gastroesophageal Reflux Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0301/p1161.html

  Lifestyle modifications are a key component in the management of GERD and should be incorporated into all treatment stages. […] In addition to lifestyle modifications, patients with mild symptoms often require periodic drug therapy for symptom relief. This is typically achieved through the as-needed use of antacids, alginic acid or over-the-counter histamine H2-receptor blockers. […] Instead of as-needed treatment, scheduled pharmacologic therapy is required in patients who have moderate to severe symptoms with or without documented erosive esophagitis. […] The agents used in stage III treatment of GERD include scheduled H2-receptor blockers, prokinetic agents and proton pump inhibitors. […] GERD has a high recurrence rate because no currently available pharmacologic agent is able to correct the underlying cause or causes of the disease. […] Surgery may be considered in patients who fail medical therapy or develop complications of GERD. […] Surgical intervention has been shown to provide long-term relief of symptoms in patients with GERD.

• #1 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine

  https://www.nature.com/articles/s43856-024-00632-6

  Proton pump inhibitors (PPIs) are the main treatment recommended and used for gastro-esophageal reflux disease (GERD). […] However, they fail to control symptoms in a substantial proportion of patients who have PPI-refractory GERD, which is defined as persistent symptoms attributable to objective findings of gastro-esophageal reflux. […] It has been suggested that response to PPIs is predictive of surgical outcome. […] We also discuss the traditional and newer surgical treatment options for people with PPI-refractory GERD. […] In broad terms, the main aims of treatment have been to pharmacologically reduce the acidity of refluxate or to surgically repair the failed anti-reflux barrier through hiatal hernia repair and fundoplication, in which the gastric fundus is wrapped around the distal esophagus to reinforce the lower esophageal sphincter and to keep the stomach below the diaphragm.

• #1 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine

  https://www.nature.com/articles/s43856-024-00632-6

  The 2021 SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) guidelines on the surgical treatment of gastro-esophageal reflux suggest that adult patients with confirmed chronic or chronic refractory gastro-esophageal reflux should be managed with surgical fundoplication rather than continued medical treatment. […] We urge those responsible for the continuing care of these patients, such as primary care physicians and gastroenterologists, to remain aware that these surgical options exist and are constantly evolving, and to consider surgical referral in patients who have persistent symptoms caused by GERD despite correct prescribing of and adherence to PPI therapy. […] We strongly advocate the new endoscopic and surgical interventions to be introduced first in experienced centers.

• #1 Gastroesophageal Reflux Disease: Surgical Treatment – Department of Surgery

  https://www.surgery.wisc.edu/2018/11/14/gastroesophageal-reflux-disease-surgical-treatment/

  Gastroesophageal reflux disease (GERD) is the most common GI disorder in the US. […] For many patients, lifestyle changes including weight loss, avoiding smoking and alcohol, and sleeping with the head of the bed elevated work well to manage GERD symptoms. […] For those with severe symptoms despite lifestyle modification, medical therapy including H2 blockers (ranitidine, famotidine, cimetidine) and Proton Pump Inhibitors (PPI, such as omeprazole, lansoprazole, pantoprazole, rabeprazole, dexlansoprazole) can control GERD. Proton Pump inhibitors are the mainstay of medical management of GERD. […] Surgical therapy for GERD is indicated in patients who have failed medical management with PPI therapy. […] In particular, those with uncontrolled GERD who have end organ damage such as stricture, esophagitis, or Barretts esophagus may be good candidates for surgical treatment of GERD.

• #1 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  Lifestyle modifications are the first line of management in pregnant women with GERD. Advise patients to elevate the head of the bed; avoid bending or stooping positions; eat small, frequent meals; and refrain from ingesting food (except liquids) within 3 hours of bedtime. […] H2 receptor antagonists are the first-line agents for patients with mild to moderate symptoms and grades I-II esophagitis. […] PPIs are the most powerful medications available for treating GERD. These agents should be used only when this condition has been objectively documented. […] The FDA approved vonoprazan (Voquezna), a potassium-competitive acid blocker, in 2023 for treatment and maintenance of erosive esophagitis. […] Prokinetic agents are somewhat effective but only in patients with mild symptoms; other patients usually require additional acid-suppressing medications, such as PPIs.

• #1 Gastroesophageal Reflux Disease (GERD) | Middlesex Health // Middlesex Health

  https://middlesexhealth.org/gerd1

  The TIF Procedure doesn’t require any incisions. The EsophyX device, which was specially designed for this surgery, is used to reconstruct the anatomy of the lower esophageal sphincter (LES) so that your body once again has the natural ability to prevent reflux. […] The LINX Reflux Management System is a small flexible band of magnetic beads that a surgeon wraps around a weakened lower esophageal sphincter (LES). […] A hiatal hernia occurs when a part of the stomach pushes up into the chest above the diaphragm. GERD, can be a symptom of a hiatal hernia.

• #1 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease

  If you have GERD and your symptoms still bother you even though you take medication, you may be a candidate for surgery. […] Several procedures are available to help reduce GERD symptoms, from fundoplication to weight loss surgery, if needed. At UChicago Medicine, well work with you to determine the best option so that you can find relief from your symptoms. […] Surgery can be offered to all patients with GERD, but should be strongly considered for: Patients that do not experience relief of symptoms with medications, Patients with voice or respiratory problems, including hoarseness, cough or asthma due to reflux, Patients with a hiatal or paraesophageal hernia, making it difficult to eat, Young patients, to avoid the cost and diminishing effectiveness of taking medications for many decades, Patients with Barrett’s esophagus, Individuals with a BMI greater than 35, Post-menopausal women, for whom some anti-GERD medications raise the risk of osteoporosis.

• #1 Management of gastroesophageal reflux disease (GERD) – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-gastroesophageal-reflux-disease-gerd/

  Management of gastroesophageal reflux disease (GERD) […] Diagnostic and management strategies for patients with gastroesophageal reflux disease (GERD). […] 1. AGA recommends weight loss should be advised for overweight or obese patients with esophageal GERD syndromes. 2. AGA recommends elevation of the head of the bed for selected patients who are troubled with heartburn or regurgitation when recumbent. Other lifestyle modifications including, but not limited to, avoiding late meals, avoiding specific foods or avoiding specific activities should be tailored to the circumstances of the individual patient. 3. AGA strongly recommends antisecretory drugs for the treatment of patients with esophageal GERD syndromes (healing esophagitis and symptomatic relief). In these uses, proton pump inhibitors (PPIs) are more effective than histamine2 receptor antagonists (H2RAs), which are more effective than placebo. 4. AGA recommends twice-daily PPI therapy for patients with an esophageal syndrome with an inadequate symptom response to once-daily PPI therapy. 5. AGA recommends a short course or as-needed use of antisecretory drugs in patients with a symptomatic esophageal syndrome without esophagitis when symptom control is the primary objective. For a short course of therapy, PPIs are more effective than H2RAs, which are more effective than placebo. 6. AGA recommends against metoclopramide as monotherapy or adjunctive therapy in patients with esophageal or suspected extraesophageal GERD syndromes. 7. AGA recommends endoscopy with biopsy for patients with an esophageal GERD syndrome with troublesome dysphagia. Biopsies should target any areas of suspected metaplasia, dysplasia or in the absence of visual abnormalities, normal mucosa (at least five samples to evaluate for eosinophilic esophagitis). 8. AGA recommends endoscopy to evaluate patients with a suspected esophageal GERD syndrome who have not responded to an empirical trial of twice-daily PPI therapy. Biopsies should target any area of suspected metaplasia, dysplasia or malignancy. 9. AGA recommends manometry to evaluate patients with a suspected esophageal GERD syndrome who have not responded to an empirical trial of twice-daily PPI therapy and have normal findings on endoscopy. Manometry will serve to localize the lower esophageal sphincter for potential subsequent pH monitoring, to evaluate peristaltic function preoperatively, and to diagnose subtle presentations of the major motor disorders. Evolving information suggests that high-resolution manometry has superior sensitivity to conventional manometry in recognizing atypical cases of achalasia and distal esophageal spasm. 10. AGA recommends ambulatory impedance-pH, catheter pH or wireless pH monitoring (PPI therapy withheld for 7 days) to evaluate patients with a suspected esophageal GERD syndrome who have not responded to an empirical trial of PPI therapy, have normal findings on endoscopy, and have no major abnormality on manometry. Wireless pH monitoring has superior sensitivity to catheter studies for detecting pathological esophageal acid exposure because of the extended period of recording (48 hours) and has also shown superior recording accuracy compared with some catheter designs. 11. AGA strongly recommends twice-daily PPI therapy as an empirical trial for patients with suspected reflux chest pain syndrome after a cardiac etiology has been carefully considered. 12. AGA recommends acute or maintenance therapy with once- or twice-daily PPIs (or H2RAs) for patients with a suspected extraesophageal GERD syndrome (laryngitis, asthma) with a concomitant esophageal GERD syndrome. 13. AGA recommends against once- or twice-daily PPIs (or H2RAs) for acute treatment of patients with potential extraesophageal GERD syndromes (laryngitis, asthma) in the absence of a concomitant esophageal GERD syndrome. 14. AGA recommends against routine endoscopy in subjects with erosive or nonerosive reflux disease to assess for disease progression. 15. AGA strongly recommends long-term use of PPIs for the treatment of patients with esophagitis once they have proven clinically effective. Long-term therapy should be titrated down to the lowest effective dose based on symptom control. 16. AGA recommends against less than daily dosing of PPI therapy as maintenance therapy in patients with an esophageal syndrome who previously had erosive esophagitis. 17. AGA recommends acute or maintenance therapy with once- or twice-daily PPIs (or H2RAs) for patients with a suspected extraesophageal GERD syndrome (laryngitis, asthma) with a concomitant esophageal GERD syndrome. 18. AGA recommends endoscopy with biopsy for patients with an esophageal GERD syndrome with troublesome dysphagia. Biopsies should target any areas of suspected metaplasia, dysplasia, or in the absence of any visual abnormalities, normal mucosa (at least five samples to evaluate for eosinophilic esophagitis). 19. AGA strongly recommends that when antireflux surgery and PPI therapy are judged to offer similar efficacy in a patient with an esophageal GERD syndrome, PPI therapy should be recommended as initial therapy because of superior safety. 20. AGA strongly recommends that when a patient with an esophageal GERD syndrome is responsive to, but intolerant of, acid suppressive therapy, antireflux surgery should be recommended as an alternative. 21. AGA recommends antireflux surgery for patients with an esophageal GERD syndrome with persistent troublesome symptoms, especially troublesome regurgitation, despite PPI therapy. The potential benefits of antireflux surgery should be weighed against the deleterious effect of new symptoms consequent from surgery, particularly dysphagia, flatulence, an inability to belch, and postsurgery bowel symptoms. 22. AGA recommends against antireflux surgery for patients with an esophageal syndrome with or without tissue damage who are symptomatically well controlled on medical therapy. 23. AGA recommends against antireflux surgery as an antineoplastic measure in patients with Barrett’s metaplasia.

• #1 Gastroesophageal Reflux Disease

  https://www.aaaai.org/conditions-treatments/related-conditions/gastroesophageal-reflux-disease

  Gastroesophageal reflux disease (GERD) is a digestive disorder that occurs when acidic stomach juices, or food and fluids back up from the stomach into the esophagus. […] If you have both GERD and asthma, managing your GERD will help control your asthma symptoms. […] Studies have shown that people with asthma and GERD saw a decrease in asthma symptoms (and asthma medication use) after treating their reflux disease. […] Lifestyle changes to treat GERD include: Elevate the head of the bed 6-8 inches Lose weight Stop smoking Decrease alcohol intake Limit meal size and avoid heavy evening meals Do not lie down within two to three hours of eating Decrease caffeine intake Avoid theophylline (if possible). […] Your physician may also recommend medications to treat reflux or relieve symptoms. Over-the-counter antacids and H2 blockers may help decrease the effects of stomach acid. Proton pump inhibitors block acid production and also may be effective. […] In severe and medication intolerant cases, surgery may be recommended.

• #1 Gastroesophageal Reflux Disease: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0301/p1161.html

  Gastroesophageal reflux disease (GERD) is a chronic, relapsing condition with associated morbidity and an adverse impact on quality of life. […] Management includes lifestyle modifications and pharmacologic therapy; refractory disease requires surgery. The therapeutic goals are to control symptoms, heal esophagitis and maintain remission so that morbidity is decreased and quality of life is improved. […] The management of GERD can be divided into five stages. Stages I through IV consist of medical management, and stage V entails surgical intervention. The ultimate goal of treatment is to minimize exposure of the esophagus to refluxate, thereby alleviating symptoms, healing the esophagus, preventing complications and maintaining remission. […] Most patients with GERD achieve adequate symptom control and esophageal healing through a combination of lifestyle modifications and drug therapy and therefore do not require surgical intervention. Antireflux surgery may be required in patients who continue to have severe symptoms, erosive esophagitis or disease complications despite adequate pharmacologic therapy.

• #1 Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

  Acid reflux happens when the sphincter muscle at the lower end of the esophagus relaxes at the wrong time, allowing stomach acid to back up into the esophagus. This can cause heartburn and other symptoms. Frequent or constant reflux can lead to GERD. […] Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it’s uncommon, some may need surgery to help with symptoms. […] GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. […] If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. […] Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult.

• #1 Refractory Gastroesophageal Reflux Disease: Diagnosis and Management

  https://www.jnmjournal.org/view.html?uid=1890&vmd=Full

  Identification and management of refractory GERD can reduce likelihood of undesirable effects of longstanding abnormal acid exposure, including erosive esophagitis, peptic stricture, BE, and esophageal adenocarcinoma. […] In general, pharmacologic, endoscopic, and surgical interventions for refractory GERD have benefits that outweigh risks in well-characterized GERD, and management needs to be personalized to each patient’s unique presentation. […] Persistent esophageal symptoms despite seemingly adequate acid suppressive therapy is the starting point for evaluation to determine if GERD evidence exists. […] While several non-pharmacologic, pharmacologic, endoscopic, and surgical interventions are available at the disposal of the clinician for effective treatment of refractory GERD, the management strategy should be personalized to each patient, taking into account underlying comorbidities, risk-benefit profile, and patient preference.

• #1 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease

  In most cases, GERD is a chronic condition that people live with for the rest of their lives. The only curative treatment is surgery, but medications and lifestyle changes are helpful for managing the symptoms of GERD. Our physicians and surgeons can help patients decide which treatment option best fits their needs. […] When lifestyle changes do not work, medications designed to suppress the production of excess acid are typically the next step. Antacids or histamine H2 receptor agonists therapy can be effective for many individuals with mild to moderate symptoms. Additional H2 blocker therapy or proton pump inhibitor medications may be prescribed for symptoms that are more persistent. […] A number of patients with GERD may be appropriate candidates for surgical treatment with an anti-reflux procedure. This procedure tightens the valve located between the stomach and the esophagus, called the lower esophageal sphincter, which prevents the stomach contents and acid from refluxing back into the esophagus. Unlike medications that provide only symptomatic heartburn relief, anti-reflux surgery can stop GERD symptoms for most patients, including regurgitation, trouble swallowing and voice changes.

• #1 GERD Treatment: Medications, Lifestyle Tips, and Surgery Options

  https://www.gastromedclinic.com/comprehensive-guide-to-managing-gerd-effective-treatments-and-lifestyle-changes-for-lasting-relief/

  By combining medication, lifestyle changes, and dietary modifications, many patients can effectively control their symptoms and improve their quality of life. […] Consulting with a healthcare provider like Gastroenterology Medical Clinic, is essential for developing an individualized treatment plan and ensuring the best possible outcomes. […] Treatments include antacids, acid blockers, proton pump inhibitors (PPIs), and medications to help stomach movement. […] Yes, surgery options like fundoplication or the LINX device can be used if medications and lifestyle changes don’t work. […] Losing weight, quitting smoking, eating earlier in the evening, elevating the head of your bed, and wearing loose clothing can help reduce symptoms.

• #2 Acid Reflux/GERD | ACG

  https://gi.org/topics/acid-reflux/

  Gastroesophageal reflux disease (GERD) is a chronic medical condition caused by the flow of contents from the stomach upwards into the esophagus resulting in both symptoms and complications. The most common symptoms of GERD are heartburn and regurgitation. […] GERD is one of the most common gastrointestinal diseases. It is thought that up to 20% of the US population has GERD. […] GERD can result in serious complications including severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding, or a pre-cancerous change in the lining of the esophagus called Barrett’s esophagus. […] Treatment should be designed to eliminate symptoms, heal irritation of the esophagus and prevent the long-term complications of GERD. In most patients outside of significant lifestyle changes such as weight loss, GERD is a chronic disease.

• #2

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/gastroesohageal-reflux-gerd

  When acid reflux starts to happen frequently and you have other symptoms, you may have developed gastroesophageal reflux disease (GERD). […] Consult your doctor for frequent heartburn, or if acid reflux symptoms dont get better with over-the-counter medications. […] If you have gastroesophageal reflux disease, your Aurora team will work with you to determine the best GERD treatment options for relief. […] GERD and acid reflux may be treated successfully with dietary and lifestyle changes like these: Maintain healthy weight, Eat smaller more frequent meals, Avoid citrus fruits, fatty or spicy foods, chocolate, caffeine, alcohol, carbonated drinks, and peppermint, Don’t smoke, Avoid lying down for two to three hours after eating, When lying down, elevate your head by six inches with a pillow wedge.

• #2 Gastroesophageal Reflux Disease (GERD) Home Remedies

  https://www.healthline.com/health/gerd/home-remedies

  Home remedies, including sitting up after eating and eating certain foods, may help relieve sporadic heartburn. But it occurs often, a doctor may recommend a prescription medication. […] If you experience acid reflux more than twice per week, you may have gastroesophageal reflux disease (GERD). In this case, heartburn is just one of many symptoms, along with coughing and chest pain. […] GERD is typically treated with over-the-counter (OTC) medications, such as antacids, and lifestyle or dietary measures. In severe cases, prescription medications may be needed to prevent damage to the esophagus. […] While medication is the most common form of GERD treatment, there are some home remedies you can try to reduce instances of acid reflux. […] Manage your weight with a balanced diet and regular exercise. Speak with your doctor if losing weight may be an option for helping GERD symptoms.

• #2

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/gastroesohageal-reflux-gerd

  Your doctor may also recommend over-the-counter acid reflux medicines such as: Antacids. These will address symptoms but won’t fix any damage stomach acid has caused in the esophagus, H-2 receptor blockers. This heartburn medication reduces the amount of acid the body makes. They can help relieve symptoms for longer periods of time, Proton-pump inhibitors. These block the acid the body makes, which allows the esophagus to heal. […] If over-the-counter acid reflux medicines don’t work, your doctor may recommend prescription medications for GERD treatment such as: Prescription-strength H-2 receptor blockers, Prescription-strength proton-pump inhibitors, Prokinetic agents to tighten the muscle between the stomach and esophagus (esophageal sphincter) and help the stomach empty faster. […] Surgery may be a good choice for GERD treatment for you if you: Still have persistent acid reflux or other symptoms while taking medication, Develop side effects from taking medication, Notice your symptoms return when you stop taking medication, Have damage to your esophagus such as bleeding or narrowing (stricture), Cant afford medication or prefer not to take lifelong medication.

• #2 Treatment for GER & GERD – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

  Doctors may recommend antacids to relieve mild heartburn and other mild GER and GERD symptoms. Antacids can help relieve mild symptoms. However, you shouldn’t use these medicines every day or for severe symptoms, except after discussing your antacid use with your doctor. […] H2 blockers lower the amount of acid your stomach makes. H2 blockers can help heal the esophagus, but not as well as proton pump inhibitors (PPIs) can. […] PPIs lower the amount of acid your stomach makes. PPIs are better at treating GERD symptoms than H2 blockers, and they can heal the esophageal lining in most people with GERD. […] Your doctor may prescribe one or more medicines to treat GERD. […] Your doctor may recommend surgery if your GERD symptoms don’t improve with lifestyle changes and medicines, or if you wish to stop taking long-term GERD medicines to manage symptoms.

• #2 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd

  GERD can damage your esophagus tissues over time. […] Chronic acid reflux can really affect your quality of life, and it can also do real damage to your tissues. […] GERD is chronic acid reflux in your esophagus. Acid reflux is considered chronic when you’ve had it at least twice a week for several weeks. […] But if you have chronic acid reflux or GERD, they also recommend medicines to reduce your stomach acid, so reflux is less damaging. These medicines are easily available and highly effective for GERD. […] Over-the-counter (OTC) medicines for acid reflux include: Antacids (like Tums and Rolaids) neutralize your stomach acid so that when reflux happens, it isn’t as corrosive to your esophagus. […] Prescription medications for GERD include: Proton pump inhibitors (PPIs). PPIs are stronger acid blockers that also promote healing. Your provider may prescribe them as a first-line treatment if your GERD is relatively severe or you have signs of tissue damage in your esophagus. They’re 90% effective in reducing acid reflux.

• #2 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  Lifestyle modifications are the first line of management in pregnant women with GERD. Advise patients to elevate the head of the bed; avoid bending or stooping positions; eat small, frequent meals; and refrain from ingesting food (except liquids) within 3 hours of bedtime. […] H2 receptor antagonists are the first-line agents for patients with mild to moderate symptoms and grades I-II esophagitis. […] PPIs are the most powerful medications available for treating GERD. These agents should be used only when this condition has been objectively documented. […] The FDA approved vonoprazan (Voquezna), a potassium-competitive acid blocker, in 2023 for treatment and maintenance of erosive esophagitis. […] Prokinetic agents are somewhat effective but only in patients with mild symptoms; other patients usually require additional acid-suppressing medications, such as PPIs.

• #2 Treatment of Gastroesophageal Reflux Disease (GERD) – Therapeutics Letter – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK598550/

  H2-blockers are only effective in about 30% of patients with severe erosive esophagitis, demonstrated by endoscopy. […] Omeprazole 20 to 40 mg per day for eight weeks provides the potent acid suppression necessary to achieve a healing rate of over 80% of these difficult patients. […] A small number of refractory patients require higher doses of omeprazole for up to 12 weeks to achieve healing. […] Those who relapse off medication frequently require long-term omeprazole maintenance therapy under the supervision of an endoscopist. […] Daily omeprazole dosing causes chronic hypochlorhydria with the following potential complications: gastric bacterial overgrowth with the risk of gram negative aspiration pneumonia, decreased vitamin B12 absorption, benign gastric polyps and other gastric pathology. […] Because of these concerns the patient must be involved in any decision concerning long-term omeprazole maintenance therapy, and the maintenance dose should be reduced to the minimum dose that will prevent relapses.

• #2 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  Indications for fundoplication include the following: Patients with symptoms that are not completely controlled by PPI therapy can be considered for surgery; surgery can also be considered in patients with well-controlled GERD who desire definitive, one-time treatment. […] Long-term results of laparoscopic antireflux surgery have shown that, at 10 years, 90% of patients are symptom free and only a minority still take PPIs. […] Laparoscopic fundoplication is performed under general endotracheal anesthesia. […] The essential elements of the operation are as follows: Complete mobilization of the fundus of the stomach with division of the short gastric vessels, Reduction of the hiatal hernia, Narrowing of the esophageal hiatus, Creation of a 360 fundoplication over a large intraesophageal dilator (Nissen fundoplication).

• #2 Treatment for GER & GERD – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/treatment

  Fundoplication is the most common surgery for GERD. In most cases, it leads to long-term improvement of GERD symptoms. […] If you have GERD and obesity, your doctor may recommend weight-loss surgery, most often gastric bypass surgery. Weight-loss surgery can help you lose weight and reduce GERD symptoms. […] In a small number of cases, doctors may recommend procedures that use endoscopy to treat GERD.

• #2 Gastroesophageal Reflux Disease Treatment & Management: Approach Considerations, Lifestyle Modifications, Pharmacologic Therapy

  https://emedicine.medscape.com/article/176595-treatment

  The US Food and Drug Administration approved the LINX Reflux Management System in March 2012. This device is designed to augment the lower esophageal sphincter. […] In a systematic review, magnetic sphincter augmentation appeared to reinforce the lower esophageal sphincter to antireflux, effectively reducing the time percentage of esophageal acid exposure, improving the GERD health-related quality of life score, reducing the operative time (vs Nissen fundoplication), and achieving similar treatment success as that of fundoplication.

• #2 Gastroesophageal Reflux Disease (GERD) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/esophageal-diseases/gastroesophageal-reflux-disease

  Anti-reflux surgery is very effective for treating gastroesophageal reflux disease. The different anti-reflux operations described below are performed by specialized esophageal surgeons at UChicago Medicine through small incisions using minimally invasive techniques. […] Our expert surgeons at UChicago Medicine with specialized training in minimally invasive techniques use high definition laparoscopy and advanced robotic technology, making anti-reflux surgery a very safe and effective treatment option. […] Fundoplication has been the standard operation for GERD treatment for nearly 50 years. This operation involves a wrap of the stomach around the esophagus to reconstruct the lower esophageal sphincter to function as a one-way valve again. […] The LINX System is a new treatment option for patients with GERD. This removable device is a small, flexible ring of magnetic, titanium covered beads that acts as a valve to stop reflux from the stomach.

• #2 Management of Gastroesophageal Reflux Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1001/p1311.html

  The primary treatment goals in patients with gastroesophageal reflux disease are relief of symptoms, prevention of symptom relapse, healing of erosive esophagitis, and prevention of complications of esophagitis. In patients with reflux esophagitis, treatment is directed at acid suppression through the use of lifestyle modifications (e.g., elevating the head of the bed, modifying the size and composition of meals) and pharmacologic agents (a histamine H2-receptor antagonist [H2RA] taken on demand or a proton pump inhibitor [PPI] taken 30 to 60 minutes before the first meal of the day). The preferred empiric approach is step-up therapy (treat initially with an H2RA for eight weeks; if symptoms do not improve, change to a PPI) or step-down therapy (treat initially with a PPI; then titrate to the lowest effective medication type and dosage). In patients with erosive esophagitis identified on endoscopy, a PPI is the initial treatment of choice.

• #2 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine

  https://www.nature.com/articles/s43856-024-00632-6

  Proton pump inhibitors (PPIs) are the main treatment recommended and used for gastro-esophageal reflux disease (GERD). […] However, they fail to control symptoms in a substantial proportion of patients who have PPI-refractory GERD, which is defined as persistent symptoms attributable to objective findings of gastro-esophageal reflux. […] It has been suggested that response to PPIs is predictive of surgical outcome. […] We also discuss the traditional and newer surgical treatment options for people with PPI-refractory GERD. […] In broad terms, the main aims of treatment have been to pharmacologically reduce the acidity of refluxate or to surgically repair the failed anti-reflux barrier through hiatal hernia repair and fundoplication, in which the gastric fundus is wrapped around the distal esophagus to reinforce the lower esophageal sphincter and to keep the stomach below the diaphragm.

• #2 Gastroesophageal reflux disease (GERD) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940

  Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. […] Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.

• #3 Gastroesophageal Reflux Disease (GERD) Home Remedies

  https://www.healthline.com/health/gerd/home-remedies

  By limiting or avoiding these triggers, you may experience fewer symptoms. You may also want to keep a food journal to help identify problem foods. […] Eating smaller meals puts less pressure on the stomach, which can prevent the backflow of stomach acids. […] The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends elevating your head with pillows to avoid nighttime heartburn. […] First, the American Academy of Family Physicians recommends low fat, high protein meals. Reducing dietary fat intake can decrease your symptoms while getting enough protein and fiber will keep you full and prevent overeating. […] If you smoke and have heartburn or GERD, quitting smoking can help your condition. […] Smoking damages the lower esophageal sphincter (LES), which is responsible for preventing stomach acids from backing up. […] The following herbs have been used for GERD: chamomile, licorice, marshmallow, slippery elm. […] These remedies alone may not work for acid reflux and GERD. Talk with a gastroenterologist about how some of these remedies may complement a medical treatment plan.

• #3 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd

  GERD can damage your esophagus tissues over time. […] Chronic acid reflux can really affect your quality of life, and it can also do real damage to your tissues. […] GERD is chronic acid reflux in your esophagus. Acid reflux is considered chronic when you’ve had it at least twice a week for several weeks. […] But if you have chronic acid reflux or GERD, they also recommend medicines to reduce your stomach acid, so reflux is less damaging. These medicines are easily available and highly effective for GERD. […] Over-the-counter (OTC) medicines for acid reflux include: Antacids (like Tums and Rolaids) neutralize your stomach acid so that when reflux happens, it isn’t as corrosive to your esophagus. […] Prescription medications for GERD include: Proton pump inhibitors (PPIs). PPIs are stronger acid blockers that also promote healing. Your provider may prescribe them as a first-line treatment if your GERD is relatively severe or you have signs of tissue damage in your esophagus. They’re 90% effective in reducing acid reflux.

• #3 GERD: A practical approach | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/4/223

  If lifestyle interventions fail, drug treatment options are PPIs, histamine 2 receptor antagonists (H2RAs), and antacids. […] PPIs are considered the therapy of choice for symptomatic relief and healing of erosive esophagitis. […] After the initial 8-week course of therapy, most patients with GERD should attempt to take the lowest dose required to manage their symptoms. […] If first-line therapy fails, PPIs have immensely changed the landscape of treatment for GERD since their introduction, but up to 40% of patients with GERD find partial or no symptom relief with first-line therapies. […] Alternative therapies are being investigated, but none have consistently shown significant benefits over placebo. […] Nissen fundoplication, first performed by Dr. Rudolph Nissen in 1955, gained popularity in the 1970s and is now the most widely performed antireflux surgery. […] The Linx procedure (magnetic sphincter augmentation; Torax Medical Inc., Shoreview, MN) is a minimally invasive alternative. […] Several endoscopic treatments for GERD have been developed over the last 2 decades.

• #3 Acid Reflux & GERD: Symptoms, What It Is, Causes, Treatment

  https://my.clevelandclinic.org/health/diseases/17019-acid-reflux-gerd

  A severe case of GERD may continue to cause complications despite medication, even if you can’t feel it. […] When this is the case, you need a more definitive treatment for acid reflux. This usually means a procedure to tighten your LES. These are minor, outpatient procedures, and they’re very effective. […] Surgery for GERD includes: Nissen fundoplication. Fundoplication is the most common surgery for GERD. […] If you have severe GERD or it causes complications that medicine can’t help, you might need surgery. But surgery is usually minor and effective. It’s worth treating GERD to prevent its complications.

• #3

  https://www.aurorahealthcare.org/services/gastroenterology-colorectal-surgery/gastroesohageal-reflux-gerd

  The most common surgery for GERD is called fundoplication. It can be done as an open procedure or as a laparoscopic procedure. During the surgery, the top of the stomach is wrapped around the end of the esophagus. This creates pressure that helps keep stomach acid and food from flowing up the esophagus.

• #3 Management of Gastroesophageal Reflux Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/1001/p1311.html

  In the treatment of erosive esophagitis, faster healing rates were achieved in patients who received PPI therapy for four to eight weeks (78 percent) than in patients who were given H2RAs (50 percent) or placebo (24 percent) for the same period. […] Consideration of antireflux surgery must be individualized. Indications for surgery include failed medical management, patient preference for surgery despite successful medical management, complications of GERD, medical complications attributable to a large hiatal hernia, or atypical symptoms with reflux documented on 24-hour pH monitoring. […] The goals of radiofrequency heating of the gastroesophageal junction (Stretta procedure) and endoscopic gastroplasty (endocinch procedure) are to reduce medication use, improve quality of life, and decrease reflux symptoms in patients who have GERD, without the costs and risks associated with conventional antireflux surgery.

• #3 Improving treatment of people with gastro-esophageal reflux disease refractory to proton pump inhibitors | Communications Medicine

  https://www.nature.com/articles/s43856-024-00632-6

  For many patients, PPIs allow effective symptom control and healing of inflammation of the esophagus (esophagitis). […] More recently potential side effects with long-term use have been highlighted, and, importantly, it is reported that PPIs fail to control symptoms in 30-40% of patients. […] We discuss pertinent research findings that may influence treatment decisions and highlight the potential role of surgery, an option that is often overlooked. […] A review paper also highlighted that despite aggressive acid suppression therapy failing to control symptoms in approximately 40% of GERD patients, less than 5% undergo fundoplication surgery. […] We agree entirely with their recommendations. […] This enables increased prediction of the success of anti-reflux interventions. […] More recent study findings appear to contradict the idea that PPI resistance is predictive of surgical failure, finding surgical treatment to be superior to medical treatment in those who had truly PPI-refractory GERD.

• #4 Gastroesophageal Reflux Disease (GERD) | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/patient-education/gastroesophageal-reflux-disease-gerd

  The goal of treatment for GERD is to reduce your symptoms. Most people feel better with medicine and lifestyle changes. […] Here are some ways you can reduce your GERD symptoms: […] Do not eat large meals. Eat smaller meals more often. This will allow you to eat the same amount of food, but in portions that are easier to digest. […] Do not lie down for at least 2 to 3 hours after eating. […] Avoid late-night snacks. […] Avoid some foods, such as: Peppermint and spearmint candy, gum, and mints. Fried or fatty foods. […] Avoid some drinks, such as: Acidic juices, such as orange juice. Alcohol. Peppermint and spearmint tea. Caffeinated drinks, such as coffee and tea. Carbonated (fizzy) drinks, such as soda. […] Take antacids (medicine that relieves the acid in your stomach) or sit upright to reduce heartburn.

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