Management

1. Behavior Management

• smoking cessation

• elevate head of bed at night

• avoid tight fitting clothing

• avoid overeating, eating before sleep

• abstain from caffeine, fatty foods, alcohol, mints, chocolate, and other reflux inducing foods

• avoid aspirin, nitrates, and calcium channel blockers

2. Medical Management

• Liquid Antacids (calcium carbonate, hydroxides of aluminum and magnesium, sodium bicarbonate): may be considered as first-line therapy, take after meals and before sleep, overuse may result in acid-base and other metabolic disturbances

• H2-blockers (cimetidine, famotidine, ranitidine, nizatidine): may be considered for uncomplicated GERD, blocks histamine interaction with its receptor; side effects include constipation, diarrhea, confusion, and elevated liver enzymes

• Proton Pump Inhibitors (omeprazole, lansoprazole): highly effective, indicated as first-line agents for complicated GERD or failed first-line regimens, blocks the "proton pump" responsible for acid secretion

• Prokinetic Agents (cisapride, metoclopramide): indicated for delayed gastric emptying, also increases lower esophageal sphincter pressure; side effects include tardive dyskinesia, drowsiness, depression, and confusion

• Sucralfate: nonsystemic medication, protects exposed ulcerated mucosal surfaces

3. Surgical Management

• indicated for failed medical regimen

• fundoplication procedures increase tone of distal esophagus (LES)

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