Gastroesophageal reflux disease: Difference between revisions
| Line 21: | Line 21: | ||
==Treatment== | ==Treatment== | ||
=== Posture and GERD === | === Posture and GERD === | ||
Revision as of 22:59, 30 August 2012
| Gastroesophageal reflux disease | |
| ICD-10 | K21 |
|---|---|
| ICD-9 | 530.81 |
| OMIM | 109350 |
| DiseasesDB | 23596 |
| MeSH | D005764 |
|
Gastroesophageal reflux disease Microchapters |
|
Differentiating Gastroesophageal Reflux Disease from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Gastroesophageal reflux disease On the Web |
|
American Roentgen Ray Society Images of Gastroesophageal reflux disease |
|
Directions to Hospitals Treating Gastroesophageal reflux disease |
|
Risk calculators and risk factors for Gastroesophageal reflux disease |
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: GERD, GORD, gastroesophageal reflux, oesophageal reflux, peptic esophagitis, esophageal reflux
Treatment
Posture and GERD
In adults, a slouched posture is an important factor contributing to GERD. With a slouched posture there is no straight path between the stomach and esophagus; muscles around the esophagus go into a spasm. Gas and acidity get blocked in the spasm, causing coughing and other asthma-like symptoms. A meta-analysis suggested that elevating the head of the bed is an effective therapy, although this conclusion was only supported by nonrandomized studies.[1]
Surgical treatment
The standard surgical treatment, sometimes preferred over longtime use of medication, is the Nissen fundoplication. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal hernia. The procedure is often done laparoscopically.[2]
An obsolete treatment is vagotomy ("highly selective vagotomy"), the surgical removal of vagus nerve branches that innervate the stomach lining. This treatment has been largely replaced by medication.
Endoluminal fundoplication
In June 2006 EndoGastric Solutions introduced EsophyX ELF in the Europe Union as an alternative to surgical and pharmaceutical approaches for GERD treatment. EsophyX ELF is intended to deliver similar benefits as the time-proven laparoscopic fundoplication procedures, by reducing hiatal hernia, recreating the Angle of His, and creating a GastroEsophageal Valve (GEV). The key differences are that EsophyX ELF is an endoscopic non-invasive procedure that is performed transorally (through the mouth), does not require incisions, and does not dissect any part of the natural anatomy.
Previous endoluminal treatments focused predominantly on the LES. However, failure to effectively treat reflux long-term with endoluminal therapies that focused only on the Lower Esophageal Sphincter (LES) combined with the fact that surgical approaches like Nissen fundoplication recreate the GEV and have excellent long-term efficacy, has led to an awareness that the GEV is probably the most powerful component of the Anti-Reflux Barrier. The device has been designed to deploy multiple tissue fasteners to create a robust and durable valve and is intended to restore the geometry of the GastroEsophageal Junction and recreate the natural, unidirectional valve mechanism necessary to prevent GERD. EsophyX ELF has recently been cleared by the US FDA and is now available in the U.S.
Other treatments
In 2000 , the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. One system, Endocinch, puts stitches in the LES to create little pleats that help strengthen the muscle. Another, the Stretta Procedure, uses electrodes to apply radio frequency energy to the LES. The long term outcomes of both procedures compared to a Nissen fundoplication are still being determined.
Subsequently the NDO Surgical Plicator was FDA cleared for the endoscopic GERD treatment. The Plicator creates a plication, or fold, of tissue near the gastroesophageal junction, and fixates the plication with a suture-based implant. The Plicator is currently marketed by NDO Surgical, Inc. [2].
Another treatment that involved injection of a solution during endoscopy into the lower esophageal wall was available for about one year ending in late 2005. It was marketed under the name Enteryx. It was removed from the market due to several reports of complications from misplaced injections.
Barrett's esophagus
Barrett's esophagus, a type of dysplasia, is a precursor high-grade dysplasia, which is in turn a precursor condition for carcinoma. The risk of progression from Barrett's to dysplasia is uncertain but is estimated to include 0.1% to 0.5% of cases, and has probably been exaggerated in the past. Due to the risk of chronic heartburn progressing to Barrett's, EGD every 5 years is recommended for patients with chronic heartburn, or who take drugs for chronic GERD.
References
External links
- GERD patient information page at NIH
- KidsHealth GERD Information for Kids
- Mayo Clinic review of diagnosis and treatment options
- Overview at Cleveland Clinic
de:Refluxösophagitis it:Malattia da reflusso gastroesofageo no:Gastroøsofageal refluks sv:Gastroesofageal refluxsjukdom