Hiatus hernia medical therapy: Difference between revisions

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**** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks
**** 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
**** Preferred regimen (3): [[Famotidine]] 20 mg q12 PO for 6 weeks
*** '''[[Proton pump inhibitors]]:'''
*** '''[[Proton pump inhibitors]]:'''<ref name="pmid11677201">{{cite journal |vauthors=Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A |title=Step-down management of gastroesophageal reflux disease |journal=Gastroenterology |volume=121 |issue=5 |pages=1095–100 |year=2001 |pmid=11677201 |doi= |url=}}</ref>
**** 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

Revision as of 19:26, 7 February 2018

Hiatus Hernia Microchapters

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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.
  7. Inadomi JM, Jamal R, Murata GH, Hoffman RM, Lavezo LA, Vigil JM, Swanson KM, Sonnenberg A (2001). "Step-down management of gastroesophageal reflux disease". Gastroenterology. 121 (5): 1095–100. PMID 11677201.