American Medical Association Family Medical Guide - American Medical Association [486]
Treatment
The treatment of GERD depends on the symptoms. Your doctor may recommend an over-the-counter antacid or prescribe one to neutralize the stomach acid or reduce the amount of acid in your stomach. He or she may also prescribe a medication that increases the speed at which food passes through the stomach and into the intestines. If a hiatal hernia is causing GERD, your doctor may recommend surgery to repair the hernia. Untreated GERD can lead to a rare condition called Barrett’s esophagus (a change in the lining of the lower esophagus), which increases the risk of cancer of the esophagus.
Manometry
Manometry is a measurement of pressure. Esophageal manometry measures contractions of the muscular wall of the esophagus to evaluate the functioning of the esophagus. The contractions of the esophagus propel food to the stomach during digestion. In esophageal manometry, a thin, flexible tube that contains pressure sensors is inserted into the nose or mouth, and down the throat into the esophagus. Pressure measurements of the esophagus and of the upper and lower esophageal sphincters are taken while the person swallows water.
Anorectal manometry is used to measure contractions of the rectum and the anal sphincter. In this procedure, a ¼-inch flexible tube is inserted 3 to 4 inches into the rectum. Pressure measurements are taken while the rectum and anus are stimulated in various ways such as by moving the tube around in the rectum, inflating a balloon attached to the tube with air or water, or withdrawing the tube.
Preventing Acid Reflux
In addition to the steps recommended on the previous page to prevent indigestion, the following measures can help control GERD or prevent acid reflux:
• Lose weight if you are overweight, which can help reduce abdominal pressure.
• Eat small meals several times a day. When less food is in the stomach, less acid is produced.
• Don’t eat late at night or up to 2 hours before going to bed. The stomach produces more acid at night.
• Avoid caffeine and tobacco, which relax the muscle at the bottom of the esophagus.
• In bed, keep your head, neck, and shoulders propped up at a 30° angle. Gravity helps acid flow down and out of the esophagus.
• Don’t wear constricting clothing or belts. They can increase pressure inside the abdomen.
• Avoid positions such as lying down or activities such as jogging (especially right after a meal), which can cause acid reflux.
In severe cases, a doctor may recommend a surgical procedure called fundoplication. During this procedure, a section of the upper part of the stomach is pulled up and wrapped around the lower part of the esophagus to make it tighter, limiting the amount of acid that can flow back up into the esophagus.
Esophageal Stricture
Stricture (narrowing) of the esophagus is a common disorder that usually results from an accumulation of scar tissue in the esophagus. A stricture may be both the result and the cause of gastroesophageal reflux disease (GERD; see page 750). Even after treatment, an esophageal stricture caused by GERD can recur.
Symptoms and Diagnosis
Usually the only symptom of an esophageal stricture is difficulty swallowing. To diagnose a stricture of the esophagus, a doctor will order a barium X-ray (see page 767).
Treatment
To treat an esophageal stricture, your doctor will probably refer you to a gastroenterologist (a doctor who specializes in disorders of the digestive system). A gastroenterologist will most likely widen the channel of your esophagus with one of two techniques. In one technique, the doctor inserts a rigid, tapered instrument called a dilator through the stricture and, over a period of days or weeks, widens the channel of the esophagus with a series of increasingly wider dilators. Using an alternate method, the gastroenterologist inserts a lighted viewing instrument called an endoscope (see page 766) into the esophagus and passes a deflated bag or balloon that can be filled with air or water