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Tuesday, 26 November 2013

Gastro-esophageal reflux disease (GERD)- Treatments In Conventional medicine Perspective

The prevalence of upper gastrointestinal (GI) diseases is increasing in subjects aged 65 years and over. Pathophysiological changes in esophageal functions that occur with aging may, at least in part, be responsible for the high prevalence of
1. Gastro-esophageal reflux disease (GERD) in old age.
2. The incidence of gastric and duodenal ulcers and their bleeding complications is increasing in old-aged populations worldwide.
3.  H. pylori infection in elderly patients with H. pylori-associated peptic ulcer disease and severe chronic gastritis
4.  Almost 40% of GU and 25% of DU in the elderly patients are associated with the use of NSAID(1) and/or aspirin(2).(a)
I.  Gastro-esophageal reflux disease (GERD)
Gastroesophageal reflux disease (GERD), also known as gastro-oesophageal reflux disease (GORD), gastric reflux disease, or acid reflux disease, is defined as a chronic condition of liquid stomach acid refluxing back up from the stomach into the esophagus, causing heartburn. According to the study of “Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease.” by DeVault KR, Castell DO; American College of Gastroenterology, GERD is defined as symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.
Treatments
A. Conventional medicine
A.1. Medication
1. Proton-pump inhibitors
Proton-pump inhibitors including omeprazole, esomeprazole, pantoprazole, are used to reduce the production of gastric acid in the stomach.
2. H2 receptor blockers
H2 receptor blockers include ranitidine, famotidine, cimetidine, etc.. In a study of ” Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies.” by Tran T, Lowry AM, El-Serag HB., posted in US National Library of Medicine National Institutes of Health , researchers found that Over-the-counter medications are effective in treating symptomatic gastro-oesophageal reflux disease. Compared with the placebo response, which ranged between 37% and 64%, the relative benefit increase was up to 41% with histamine-2 receptor antagonists, 60% with alginate/antacid combinations, and 11% with antacids.

3. 5HT4 agonist

According to the study of “The effect of mosapride, a novel prokinetic, on acid reflux variables in patients with gastro-oesophageal reflux disease.” by Ruth M, Hamelin B, Röhss K, Lundell L., posted in US National Library of Medicine National Institutes of Health, researchers found that
Mosapride 40 mg q.d.s. is effective in decreasing acid reflux in the oesophagus in patients with GERD and therefore has the potential to be effective in the treatment of this disease.
4. GABA-B Receptor Agonists
In an article of “Medical Management of GERD” From Medscape Gastroenterology by Ronnie Fass, MD, FACP, FACG., the author wrote that Richard Holloway from Adelaide, Australia, reviewed the current studies assessing the role of baclofen, a GABA-B agonist, in the treatment of patients with GERD. He emphasized that the drug inhibits 34% to 60% of the TLESRs and improves basal lower esophageal sphincter pressure.
5. Antacids
Antacids are oral medicine used to relieve symptom of heartburn of gastroesophageal reflux disease (GERB).
4. Promotility Agents
Promotility Agents are used to improve GERD symptoms for patients with slow gastric emptying by stimulating the muscles of the gastrointestinal tract to reduce acid reflux into the esophagus.
5. Etc.
A.2. Surgery: Fundoplication Surgery
The aim of the sugery is to reduce heartburn caused by acid reflux, in severe case of inflammation, hiatal hernia, damage of esophagus, etc.. Fundoplication surgery is the procedure to treat Gastroesophageal Reflux Disease (GERD) by strengthening the valve between the esophagus and stomach as the upper curve of the stomach is wrapped and satured around the lower end of the esophagus to prevent acid from backing up into the esophagus with a laparoscopic with a small tunnel made from the stomach muscle to allow foods of the lower part of the esophagus to pass through. The sugery is also by times for the esophagus to heal. Acccording to the artilce of Barrett’s esophagus: the role of laparoscopic fundoplication” by Abbas E. Abbas MD, Claude Deschamps MD, Stephen D. Cassivi MD, Mark S. Allen MD, Francis C. Nichols, III MD, Daniel L. Miller MD and Peter C. Pairolero MD, posted in ScienceDirect, researcher found that laparoscopic fundoplication is effective in controlling symptoms in the majority of patients with BE. While disappearance of BE may occur in some patients, the possibility of developing esophageal adenocarcinoma is not eliminated by laparoscopic fundoplication. Therefore, endoscopic surveillance should continue.
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/15588798
(1) http://www.ncbi.nlm.nih.gov/pubmed/16001646
(2) http://www.ncbi.nlm.nih.gov/pubmed/22542157