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What treatments are on offer for those suffering from Acid Reflux Syndrome.

One of the simplest treatments for acid reflux syndrome is referred to as life-style changes, typically a combination of several changes in habit, particularly related to eating.

As discussed above, reflux of acid is more injurious at night than during the day. The consequence of a lack of effect of gravity allows the refluxed liquid to travel further up the esophagus and remain in the esophagus longer. These problems can be overcome partially by elevating the upper body in bed. The elevation is accomplished either by putting blocks under the bed's feet at the head of the bed or, more conveniently, by sleeping with the upper body on a wedge. It is important that the upper body and not just the head be elevated. Elevating only the head does not raise the esophagus and fails to restore the effects of gravity.

Elevation of the upper body at night generally is recommended for all patients with acid reflux. Nevertheless, most patients which suffer from reflux only during the day elevation at night is of little benefit for them. It is not possible to know for certain which patients will benefit from elevation at night unless acid testing clearly demonstrates night reflux. However, patients who have heartburn, regurgitation, or other symptoms at night are probably experiencing reflux at night and definitely should use upper body elevation. Reflux also occurs less frequently when patients lie on their left rather than their right sides.

Changes in eating habits can also be of signficant benefit, particularly given that acid reflux is worst after a meal. This is probably because the stomach is distended with food at that time and acid and transient relaxations of the lower esophageal sphincter are more frequent. Therefore, smaller and earlier evening meals may reduce the amount of reflux for two reasons. First, the smaller meal results in lesser expansion of the stomach. Second, by bedtime, a smaller and earlier meal is more likely to have emptied from the stomach than is a larger one. As a result, reflux is less likely to occur when patients lie down.

Certain foods are known to reduce the pressure in the lower esophageal sphincter and thereby promote reflux. These foods should be avoided and include chocolate, peppermint, alcohol, and caffeinated drinks.

One novel approach to the treatment is tha of chewing gum. Chewing gum stimulates the production of more bicarbonate-containing saliva and increases the rate of swallowing. In effect, chewing gum exaggerates the normal process that neutralizes acid in the esophagus. It is not clear, however, how effective chewing gum actually is in treating heartburn. Nevertheless, chewing gum after meals is certainly worth a try.

Despite the development of potent medications for the treatment of acid reflux, antacids remain a mainstay of treatment. Antacids neutralize the acid in the stomach so that there is no acid to reflux.

The first medication developed for more effective and convenient treatment of acid-related diseases, was a histamine antagonist, specifically cimetidine (Tagamet). Histamine is an important chemical because it stimulates acid production. Released within the wall of the stomach, histamine attaches to receptors (binders) on the stomach's acid-producing cells and stimulates the cells to produce acid. Histamine antagonists work by blocking the receptor for histamine and thereby preventing histamine from stimulating the acid-producing cells.

Because histamine is particularly important for the stimulation of acid after meals, H2 antagonists are best taken 30 minutes before meals. The reason for this timing is so that the H2 antagonists will be at peak levels in the body after the meal when the stomach is actively producing acid. H2 antagonists also can be taken at bedtime to suppress nighttime production of acid.

Foam barriers provide a unique form of treatment for acid reflux. Foam barriers are tablets that are composed of an antacid and a foaming agent. As the tablet disintegrates and reaches the stomach, it turns into foam that floats on the top of the liquid contents of the stomach. The foam forms a physical barrier to the reflux of liquid. At the same time, the antacid bound to the foam neutralizes acid that comes in contact with the foam.

For cases where the patient does not respond to the treatments, there is a surgical procedure that can be carried out. The surgical procedure that is done to prevent reflux is technically known as fundoplication and is called reflux surgery or anti-reflux surgery. During fundoplication, any hiatal hernial sac is pulled below the diaphragm and stitched there. In addition, the opening in the diaphragm through which the esophagus passes is tightened around the esophagus. Surgery is very effective at treating symptoms and complications of acid reflux syndrome. Approximately 80% of patients will have good or excellent relief of their symptoms for at least 5 to 10 years.

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