Monday, December 31, 2018


By: Dr. Mohamed Kamel Sabry

Prof. , Head of Dep. of Internal Medicine & Immunology

Ain-Shams Univercity


The doctor might be able to diagnose GERD based on a physical examination and history

of your signs and symptoms.

To confirm a diagnosis of GERD, or to check for complications, your doctor might


•Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and

camera (endoscope) down your throat, to examine the inside of your esophagus and

stomach. Test results can often be normal when reflux is present, but an endoscopy

may detect inflammation of the esophagus (esophagitis) or other complications. An

endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for

complications such as Barrett›s esophagus.

•Ambulatory acid (pH) probe test. A monitor is placed in your esophagus to identify

when, and for how long, stomach acid regurgitates there. The monitor connects to a

small computer that you wear around your waist or with a strap over your shoulder. The

monitor might be a thin, flexible tube (catheter) that›s threaded through your nose into

your esophagus, or a clip that›s placed in your esophagus during an endoscopy and that

gets passed into your stool after about two days.

•Esophageal manometry. This test measures the rhythmic muscle contractions in your

esophagus when you swallow. Esophageal manometry also measures the coordination

and force exerted by the muscles of your esophagus.

•X-ray of your upper digestive system. X-rays are taken after you drink a chalky liquid that

coats and fills the inside lining of your digestive tract. The coating allows your doctor to

see a silhouette of your esophagus, stomach and upper intestine. You may also be asked

to swallow a barium pill that can help diagnose a narrowing of the esophagus that may

interfere with swallowing.


The doctor is likely to recommend that you first try lifestyle modifications and over-thecounter

medications. If you don›t experience relief within a few weeks, your doctor might

recommend prescription medication or surgery.

Over-the-counter medications

The options include:

•Antacids that neutralize stomach acid. Antacids, 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 problems.

Medications to reduce acid production. These medications — known as H-2-receptor

blockers — include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR)

and ranitidine .H-2-receptor 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.

•Medications that block acid production and heal the esophagus. These medications

— known as proton pump inhibitors — are stronger acid blockers than H-2-receptor

blockers and allow time for damaged esophageal tissue to heal. Over-the-counter proton

pump inhibitors include lansoprazole (Prevacid 24 HR) and omeprazole (Prilosec OTC,

Zegerid OTC).

Prescription medications

Prescription-strength treatments for GERD include:

•Prescription-strength H-2-receptor blockers. These include prescription-strength

famotidine (Pepcid), nizatidine and ranitidine. These medications are generally

well-tolerated but long-term use may be associated with a slight increase in risk of vitamin

B-12 deficiency and bone fractures.

•Prescription-strength proton pump inhibitors. These include esomeprazole,

lansoprazole (Prevacid), omeprazole (Prilosec, Zegerid), pantoprazole (Protonix),

rabeprazole (Aciphex) and dexlansoprazole. Although generally well-tolerated,

these medications might cause diarrhea, headache, nausea and vitamin B-12 deficiency.

Chronic use might increase the risk of hip fracture.

•Medication to strengthen the lower esophageal sphincter. Baclofen may ease GERD by

decreasing the frequency of relaxations of the lower esophageal sphincter. Side effects

might include fatigue or nausea.

Surgery and other procedures

GERD can usually be controlled with medication. But if medications don›t help or you

wish to avoid long-term medication use, your doctor might recommend:

•Fundoplication. The surgeon wraps the top of your stomach around the lower

esophageal sphincter, to tighten the muscle and prevent reflux. Fundoplication is usually

done with a minimally invasive (laparoscopic) procedure. The wrapping of the top part of

the stomach can be partial or complete.

•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. The Linx device can be implanted using minimally invasive surgery.

Lifestyle and home remedies

Lifestyle changes may help reduce the frequency of acid reflux. Try to:

•Maintain a healthy weight. Excess pounds put pressure on your abdomen, pushing up

your stomach and causing acid to reflux into your esophagus.

•Stop smoking. Smoking decreases the lower esophageal sphincter›s ability to function


•Elevate the head of your bed. If you regularly experience heartburn while trying to sleep,

place wood or cement blocks under the feet of your bed so that the head end is raised by

6 to 9 inches. If you can›t elevate your bed, you can insert a wedge between your mattress

and box spring to elevate your body from the waist up. Raising your head with additional

pillows isn›t effective.

•Don›t lie down after a meal. Wait at least three hours after eating before lying down or

going to bed.

•Eat food slowly and chew thoroughly. Put down your fork after every bite and pick it up

again once you have chewed and swallowed that bite.

•Avoid foods and drinks that trigger reflux. Common triggers include fatty or fried foods,

tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine.

•Avoid tight-fitting clothing. Clothes that fit tightly around your waist put pressure on

your abdomen and the lower esophageal sphincter.

Alternative medicine

No alternative medicine therapies have been proved to treat GERD or reverse damage to

the esophagus. Some complementary and alternative therapies may provide some relief,

when combined with your doctor›s care.

Talk to your doctor about what alternative GERD treatments may be safe for you. The

options might include:

•Herbal remedies. Licorice and chamomile are sometimes used to ease GERD. Herbal

remedies can have serious side effects and might interfere with medications. Ask your

doctor about a safe dosage before beginning any herbal remedy.

•Relaxation therapies. Techniques to calm stress and anxiety may reduce signs and

symptoms of GERD. Ask your doctor about relaxation techniques, such as progressive

muscle relaxation or guided imagery.

Preparing for your appointment

You may be referred to a doctor who specializes in the digestive system


What you can do

•Be aware of any pre-appointment restrictions, such as restricting your diet before your


•Write down your symptoms, including any that may seem unrelated to the reason why

you scheduled the appointment.

•Write down any triggers to your symptoms, such as specific foods.

•Make a list of all your medications, vitamins and supplements.

•Write down your key medical information, including other conditions.

•Write down key personal information, including any recent changes or stressors in your


•Write down questions to ask your doctor.

•Ask a relative or friend to accompany you, to help you remember what the doctor says