Therapy

Reflux—GERD—Heartburn

The efficient and sustainable treatment of the patients' reflux symptoms and the prevention of reflux-associated complications are certainly crucial and in the foreground.

For the successful treatment of reflux, the definition of the therapy goal is crucial. A) treating symptoms, B) treating reflux, C) preventing reflux-related complications. Ideally, the therapy includes an efficient and sustainable treatment of all therapy goals. Together with the collected results, an individually adapted, tailor-made therapy is developed with the patient.

Conforming to the consensus, the basis of the therapy are general measures for lifestyle changes (PDF) , such as weight reduction, avoidance of opulent, fatty and high-carbohydrate meals, especially late in the evening, as well as alcohol and nicotine abstinence. For patients who suffer from reflux - GERD, especially at night, raising the headboard to reduce reflux - GERD using gravity has been proven.

Acid blockers play an important role in the treatment of acid-associated symptoms and the uncomplicated, mild reflux disease in stages I and II.

As a “first aid” and purely symptomatic therapy of reflux to reduce heartburn, diagnostically and desirably only in selected cases as long-term therapy, drugs that reduce acid production in the stomach (proton pump inhibitors - PPI and Antacids). With this global acidity reduction, the esophagus is secondarily less burdened with acid. The acid-associated symptom of heartburn becomes less, but the & nbsp; reflux - GERD itself remains and the bilious reflux in particular remains completely untreated 3 ! With drugs that block acid production, only the reflux can be chemically changed, i.e. made less acidic. This means that all acid-associated symptoms disappear for the duration of the treatment—i.e. not lastingly, but the reflux itself = the flowing back of stomach contents into the esophagus remains unchanged, as the problem underlying reflux, the diaphragmatic hernia (= hiatal hernia), is not treated with medication can be. The reduction in acid production also has a negative effect on digestion per se, with long-term use it brings a number of potential deficiency symptoms (iron, vit B, calcium, magnesium. …) with itself and weakens the natural barrier against bacteria, viruses and fungi. In connection with the long-term use of proton pump inhibitors (acid blockers), a number of significant undesirable side effects include chronic clostridial infections - associated with intestinal inflammation (colitis)—and increased susceptibility to pneumonia (pneumonia) has been described. Other significant potential side effects or properties of long-term acid blocker use are: premature osteoporosis, premature dementia, and significant interactions with a large number of different drugs. Since the therapy is not causal, it must be administered for life. For young people and especially for patients who are subjectively (persistence of heartburn) or objectively inadequately treated, this strategy should be reconsidered. Newer drugs that protect the mucous membrane like a "sun cream" or drugs that are based on algae and lie like a "blanket" on the stomach contents and thus mechanically improve the reflux somewhat have no significant accompanying symptoms, side effects or drug interactions at the current level of knowledge. However, the effect of other drugs can be weakened by affecting the absorption. In this context, attention should be paid to the time interval between taking the medication. Furthermore, motility-enhancing drugs can be used with or without a combination of other drugs to accelerate gastric emptying and thus reduce reflux. A reduction in pressure in the abdomen through consistent stool regulation in the case of constipation (constipation) and a decrease in visceral fat also show an improvement in the symptoms in some cases

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