GASTRO-OESOPHAGEAL REFLUX DISEASE
Description
A common disorder caused by retrograde flow of gastric contents through an incompetent gastro-oesophageal junction. Dyspepsia is a chronic or recurrent pain or discomfort centred in the upper abdomen; patients with predominant or frequent (more than once a week) heartburn or acid regurgitation, should be considered to have gastrooesophageal reflux disease (GERD) until proven otherwise. Disease is classified as mild, if endoscopy reveals no or minimal oesophageal mucosal inflammation and moderate-to-severe, if there are ulcers with or without stricture formation in distal oesophagus.
Symptoms
Common symptoms include
• Retrosternal pain
• heart burn
• regurgitation mostly occurring after meals; …show more content…
• Patients with postprandial symptoms are advised to take small frequent meals.
Treatment
A stepwise approach as indicated below.
Mild gastro-oesophageal reflux
For immediate symptomatic relief, Antacid gel (with or without alginate) 10-15 ml or 2-3 tablets (chewed) taken 4-6 times a day ½ to 1 hour after meals; may be given for a long time depending upon patients symptoms. If no relief, add (1) and/or (2) as below.
Specific therapy
1. Tab. Domperidone 10 mg 3 times a day 30 minutes before meals for 4-6 weeks or even for longer, if needed.
2. Tab. Mosapride 5 mg 3 times a day 30 minutes before meals for 4-6 weeks or longer, if needed.
3. Cap. Omeprazole 20 mg once daily 30 minutes before meals for 4-6 weeks.
Moderate-to-severe gastro-oesophageal reflux disease (endoscopically proved erosive …show more content…
Cap. Omeprazole 20 mg twice daily 30 minutes before meals for 4 weeks, followed by further 4-8 weeks, if not fully healed.
2. Cap. Lansoprazole 30 mg 2 times a day 30 minutes before meals for 3 months.
3. Tab. Pentoprazole 40 mg 2 times a day 30 minutes before meals for 3 months.
Management
• Omeprazole courses may be repeated or continued for several months, if patient relapses while on antacids or Domperidone/Mosapride.
• Repeat endoscopy after 3 months to confirm healing of oesophagitis. If healed, continue maintenance treatment as in mild reflux disease or single daily dose of 10-20 mg Omeprazole (or any other PPIs). Refer to the specialist, if no or inadequate response.
• Explain about chronic nature of the illness, role of weight reduction and early small night-time meal.
• Wearing tight clothes around the abdomen may also increase the reflux.
References
1. Management of GERD in Adults. In: Approach to Patients with Chronic Gastrointestinal Disorder’.Corazziari E. (ed), Messaggi Milano SRL, Itali, 1999; pp. 255-69.
2. Oesophageal symptoms and Motility Disorders. In: Medicine International. Jewell DP, Thillainayagam (eds), The Medicine Publishing Co. Oxford, UK 1998; pp.
Description
A common disorder caused by retrograde flow of gastric contents through an incompetent gastro-oesophageal junction. Dyspepsia is a chronic or recurrent pain or discomfort centred in the upper abdomen; patients with predominant or frequent (more than once a week) heartburn or acid regurgitation, should be considered to have gastrooesophageal reflux disease (GERD) until proven otherwise. Disease is classified as mild, if endoscopy reveals no or minimal oesophageal mucosal inflammation and moderate-to-severe, if there are ulcers with or without stricture formation in distal oesophagus.
Symptoms
Common symptoms include
• Retrosternal pain
• heart burn
• regurgitation mostly occurring after meals; …show more content…
• Patients with postprandial symptoms are advised to take small frequent meals.
Treatment
A stepwise approach as indicated below.
Mild gastro-oesophageal reflux
For immediate symptomatic relief, Antacid gel (with or without alginate) 10-15 ml or 2-3 tablets (chewed) taken 4-6 times a day ½ to 1 hour after meals; may be given for a long time depending upon patients symptoms. If no relief, add (1) and/or (2) as below.
Specific therapy
1. Tab. Domperidone 10 mg 3 times a day 30 minutes before meals for 4-6 weeks or even for longer, if needed.
2. Tab. Mosapride 5 mg 3 times a day 30 minutes before meals for 4-6 weeks or longer, if needed.
3. Cap. Omeprazole 20 mg once daily 30 minutes before meals for 4-6 weeks.
Moderate-to-severe gastro-oesophageal reflux disease (endoscopically proved erosive …show more content…
Cap. Omeprazole 20 mg twice daily 30 minutes before meals for 4 weeks, followed by further 4-8 weeks, if not fully healed.
2. Cap. Lansoprazole 30 mg 2 times a day 30 minutes before meals for 3 months.
3. Tab. Pentoprazole 40 mg 2 times a day 30 minutes before meals for 3 months.
Management
• Omeprazole courses may be repeated or continued for several months, if patient relapses while on antacids or Domperidone/Mosapride.
• Repeat endoscopy after 3 months to confirm healing of oesophagitis. If healed, continue maintenance treatment as in mild reflux disease or single daily dose of 10-20 mg Omeprazole (or any other PPIs). Refer to the specialist, if no or inadequate response.
• Explain about chronic nature of the illness, role of weight reduction and early small night-time meal.
• Wearing tight clothes around the abdomen may also increase the reflux.
References
1. Management of GERD in Adults. In: Approach to Patients with Chronic Gastrointestinal Disorder’.Corazziari E. (ed), Messaggi Milano SRL, Itali, 1999; pp. 255-69.
2. Oesophageal symptoms and Motility Disorders. In: Medicine International. Jewell DP, Thillainayagam (eds), The Medicine Publishing Co. Oxford, UK 1998; pp.