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The goals are to control symptoms, to heal esophagitis, and to prevent recurrent esophagitis or other complications.
The treatment is based on 1 lifestyle modification and 2 control of gastric acid secretion through medical therapy with antacids or PPIs or surgical treatment with corrective antireflux surgery.
Identifying the 20% of patients who have a progressive form of the disease is important, because they may develop severe complications, such as strictures or Barrett esophagus.
For patients who develop complications, surgical treatment should be considered at an earlier stage to avoid the sequelae of the disease that can have serious consequences.
Use of a patient management tool независимости.
Юбилейное издание (Blu-Ray) as the self-administered GERD Questionnaire GerdQ to stratify patients may improve the management of GERD patients in primary care settings.
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 читать полностью 3 hours of bedtime.
Antacids Antacids were the standard treatment in the 1970s and are still effective in controlling mild symptoms of GERD.
https://prognozadvisor.ru/100/jones-making-progress-to-fce-first-certificate-in-english-workbook-with-answers.html should be taken after each meal and at bedtime.
H2 receptor antagonists and H2 blocker therapy H2 receptor antagonists are the first-line agents for patients with mild to moderate symptoms and grades I-II esophagitis.
Options include ranitidine Zantaccimetidine Tagametfamotidine Pepcidand nizatidine Axid.
H2 receptor antagonists are effective for healing only mild esophagitis in 70%-80% of patients with GERD and for providing maintenance therapy to prevent relapse.
Tachyphylaxis has been observed, suggesting 4 pharmacologic tolerance can reduce the long-term efficacy of these drugs.
Additional H2 blocker therapy has been reported to be useful in patients with severe disease particularly those with Barrett esophagus who have nocturnal acid breakthrough.
Proton pump inhibitors PPIs are the most powerful medications available for treating GERD.
These agents should be used only when this condition has been objectively documented.
They have few adverse effects.
However, data have shown that PPIs can interfere with calcium homeostasis and aggravate cardiac conduction defects.
Long-term use of these agents has also been associated with bone fractures in postmenopausal women, chronic renal disease, acute renal disease, community-acquired pneumonia, and Clostridium difficile intestinal infection.
In November 2013, the FDA approved the first generic versions of rabeprazole sodium delayed-release tablets for the treatment of GERD in adults and adolescents ages 12 and up.
In clinical trials, the most commonly reported adverse reactions to rabeprazole were sore throat, flatulence, infection, and constipation in adults, and abdominal pain, diarrhea, 4 headache in adolescents.
For symptom relief at 4 weeks, esomeprazole 20 mg was equivalent, but esomeprazole 40 mg superior, to omeprazole 20 mg.
Long-term use of prokinetic agents may have serious, even potentially fatal, complications and should be discouraged.
As in many other fields, surgical therapy for gastroesophageal reflux has evolved a great deal.
A few historical procedures of note include the Allison crural repair, the Boerema anterior gastropexy, and the Angelchik prosthesis.
Both the Allison and the Boerema repairs have high failure rates and are rarely, if ever, 4 />The Angelchik prosthesis was rarely used in children and has been largely abandoned because of a high rate of complications.
The most commonly performed operation today in both children and adults is the Nissen fundoplication, which is a 360° transabdominal fundoplication see the image below.
Laparoscopic fundoplication has also quickly gained acceptance for use in children.
Lundell followed up his cohort of patients for 5 years and did not find surgery to be superior to PPI therapy.
Individuals who had received medication for their condition had taken them for a median of 32 months before participating in the study.
The investigators reported that by 12 months, 38% of those who had undergone surgery were taking reflux medication, compared with 90% of the individuals randomized to medical management.
At 5 years, among patients with a treatment response, almost twice as many of those Кассетный кондиционер Dantex RK-18UHTN/RK-18HTNE-W to medical management 82% were taking antireflux agents relative to those who had been randomized to surgery 44%.
Five small 5-mm to 10-mm incisions are used see image below.
The fundus of the stomach is wrapped around the esophagus to create a new valve 4 the level of the esophagogastric junction.
Laparoscopic fundoplication procedure takes about 2-2.
The hospital stay is approximately 2 days.
Patients resume regular activities within 2-3 weeks.
Approximately 92% of patients obtain resolution of symptoms after undergoing laparoscopic fundoplication.
The AHRQ found, on the basis of limited evidence, that laparoscopic fundoplication was as effective as open fundoplication in relieving heartburn and regurgitation, improving quality of life, and decreasing the use of antisecretory medications.
This device is designed to augment the lower esophageal sphincter.
The system is a small flexible band that is placed laparoscopically around the esophagus just above the stomach to create a natural barrier to reflux.
The band consists of interlinked titanium beads with magnetic cores.
The act of swallowing temporarily breaks the magnetic bond, allowing food and liquid to pass normally.
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The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements.
The vertical solid arrow indicates commencement of a nonacid gastroesophageal reflux GER episode diagonal arrow.
The vertical dashed arrow 4 the onset of a normal swallow.
Chief Editor BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor 4 of Medicine BS Anand, MD is a member of the following medical нажмите чтобы прочитать больше,Disclosure: Nothing to disclose.
Acknowledgements Piero Marco Fisichella, MD Assistant Professor по этому сообщению Surgery, Stritch School of Medicine, Loyola University; Director, Esophageal Motility Center, Loyola University Medical Center.
Piero Marco Fisichella is a member of the following medical societies:, and Disclosure: Nothing to disclose.
Fernando AM Herbella, MD, PhD, TCBC Affiliate Professor, Attending Surgeon in Gastrointestinal Surgery, Esophagus and Stomach Division, Department of Surgery, Federal University of Sao Paulo, Brazil; Private Practice; Medical Examiner, Sao Paulo's Medical Examiner's Office Headquarters, Brazil Fernando AM Herbella, MD, PhD, TCBC is a member of the following medical societies: Disclosure: Nothing to disclose.
John Gunn Lee, MD Director of Pancreaticobiliary Service, Associate Professor, Department of Internal Medicine, Division of Gastroenterology, University of California at Irvine School of Medicine John Gunn Lee, MD is a member of the following medical societies:,and Disclosure: Nothing to disclose.
Thomas F Murphy, MD Chief of Abdominal Imaging Section, Department of Radiology, Tripler Army Medical Center Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Manish K Varma, MD Chief of Interventional Radiology, Department of Radiology, Tripler Army Medical Center Manish K Varma, MD is a member of the following medical societies:, and Disclosure: Nothing to disclose.
Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada Noel Williams, MD is a member of the following medical societies: Disclosure: Nothing to disclose.
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