Gastroesophageal reflux disease (GERD) - Treatment

The goal of treatment for gastroesophageal reflux disease is to relieve symptoms, improve quality of life, treat esophagitis, and prevent or eliminate complications.

Basic principles of treatment:

• decrease in the volume of gastric contents;
• increasing the antireflux function of the lower esophageal sphincter;
• enhancing esophageal cleansing;
• protection of the esophageal mucosa from damage.

Treatment methods for gastroesophageal reflux disease

Conservative treatment	Surgical treatment
Recommending a certain lifestyle and diet to the patient	Open and laparoscopic fundoplication according to Nissen, Toupet, Door
Taking antacids and alginic acid derivatives
Antisecretory drugs (histamine H2 receptor blockers and proton pump inhibitors)
Prokinetics (Cerucal, Motilium, Koordinaks)

Clinical symptoms of gastroesophageal reflux disease, both typical and poorly diagnosed, reduce the quality of life of patients. Therefore, one of the promising areas of therapy for patients with GERD is the dominance of clinical assessment of its effectiveness. According to J. Collins, a study conducted using a quality of life questionnaire 8 weeks after treatment of reflux esophagitis reliably showed an improvement in the quality of life of patients.

Conservative treatment

The success of therapy lies not only in adequate drug correction, but also in changing the patient’s lifestyle and dietary habits.

Recommendations for a certain lifestyle for the patient:

• changes in body position during sleep;
• changes in nutrition;
• abstinence from smoking;
• abstinence from alcohol abuse;
• if necessary, weight loss;
• refusal of medications that induce the occurrence of gastroesophageal reflux disease;
• avoiding loads that increase intra-abdominal pressure, wearing corsets, bandages and tight belts, lifting weights over 8-10 kg on both hands, work that involves bending the torso forward, physical exercises that involve overexertion of the abdominal muscles.

To restore muscle tone of the diaphragm, special exercises that do not involve bending the torso are recommended.

Conservative treatment of gastroesophageal reflux disease

Surgical treatment

When deciding on surgical treatment, other treatment options for patients should be carefully considered, since symptoms may be due to conditions other than GERD.

Surgical treatment of gastroesophageal reflux disease

Further management

In case of non-erosive reflux disease, with complete relief of clinical symptoms, control FGDS is not necessary. Remission of reflux esophagitis should be: confirmed endoscopically.

Maintenance therapy is essential, since without it the disease relapses in most patients within the next six months.

Dynamic observation of the patient is carried out to monitor complications, identify Barrett's esophagus and drug control of disease symptoms.

The patient should be specifically asked about the presence of symptoms suggesting the development of complications. If these signs are present, specialist consultations and further diagnostic tests may be required.

Intestinal epithelial metaplasia serves as a morphological substrate for Barrett's esophagus, which cannot be clinically distinguished from gastroesophageal reflux disease. Risk factors for Barrett's esophagus include heartburn more than twice a week, male gender, and symptom duration of more than 5 years.

If Barrett's esophagus is diagnosed, endoscopic examinations with biopsy should be performed annually against the background of continuous maintenance therapy with a full dose of proton pump inhibitors to detect dysplasia (a potentially curable precancerous condition) and esophageal adenocarcinoma. If low-grade dysplasia is detected, a repeat FGDS with biopsy and histological examination of the biopsy is performed after 6 months. If low-grade dysplasia persists, repeat histological examinations are performed annually. If high-grade dysplasia is detected, the results of the histological examination are independently assessed by two morphologists. If the diagnosis is confirmed, a decision is made on endoscopic or surgical treatment of Barrett's esophagus.

Forecast

Gastroesophageal reflux disease is a chronic condition; 80% of patients experience relapses after stopping medication. Therefore, many patients require long-term drug therapy or surgery. Nonerosive reflux disease and mild reflux esophagitis usually have a stable course and a favorable prognosis; a small number of patients eventually develop esophagitis. The disease does not affect the life expectancy of patients, but significantly reduces its quality during periods of exacerbation.

Patients with severe esophagitis may develop complications such as esophageal strictures or Barrett's esophagus. The prognosis worsens with long-term disease in combination with frequent long-term relapses, with complicated forms of gastroesophageal reflux disease, especially with the development of Barrett's esophagus due to the increased risk of esophageal adenocarcinoma.

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