lunes, 8 de diciembre de 2008

Gastroesophageal reflux disease - patient information

Kahrilas, P. Gastroesophageal reflux disease N Engl J Med 2008; 359:1700-7


It is estimated that between 14 and 20% of the population of the United States is affected by gastroesophageal reflux disease (GERD).
It is important that you become aware of this disease because it is a frequent situation often requiring medication, that your family doctor is perfectly qualified to manage, and it increases the likelihood of developing esophageal cancer. This happens as the stomach, which produces the acid that is essential to digest food, spills out acid backwards to the esophagus more often than it should. The acid, in contact with the inner wall of the esophagus, and in substantial amounts, can damage the wall of the esophagus and thus cause symptoms.
Like I said, even though it is often necessary to take medication for GERD, I would like to focus instead on dietary and lifestyle measures, because, for several reasons, patients are often not adequately informed of simple measures they can do on their own to help them improve their symptoms. Foods that are acidic or promote the exit of acid to the esophagus, are likely to worsen your symptoms, so they should be avoided. Many of these food products may inclusively be difficult to eliminate or cut down from your diet, as we are so used to having them everyday, and they’re too ingrained in western diets, specially in a society which for professional reasons has to eat out most of the time. These products, include, for instance, carbonated beverages, coffee, tea, fatty/fried foods, chocolate, citrus fruits, and so on (I would refer you to table 2 in the article). Furthermore, do not forget also of lifestyle measures. Some may be easier to implement, like avoiding eating 3h before bedtime or elevating the head of the bed, while others may be extremely difficult to difficult to implement, like quitting smoking, losing weight or drinking less.
Another relevant issue I would like to raise is the eventual need for surgery, should lifestyle measures and medication turn out unsatisfactory. The surgery, which bears the pompous name Nissen fundoplication, basically entails making sort of a “collar” around the lowest part of the esophagus (which is usually the part most affected by the effects of the acid, as it is the segment of the esophagus closest to the stomach), using a portion of the stomach. It may be advisable that you discuss the pros and cons of undergoing the surgery with your family doctor before he refers you to the surgeon. For instance, besides the inherent risks of undergoing a surgery, the operation does not guarantee you that you will not require another operation nor will require you to continue taking the drugs indefinitely. Add to that the risk of developing swallowing difficulties, abdominal pain, diarrhoea, constipation, etc, and you will realize that the surgery may end up doing more harm than good.

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