Treating GERD

BE represents the severe end of the spectrum of GERD. Patients typically have prolonged exposure to a pH < 4 in their distal esophagus, which is more acidic than that experienced by other patients with GERD. Appropriate therapy involves proton pump inhibitors (PPIs). The controversy with therapy is not what class of agents to use (the most potent one) but what the endpoint of therapy should be. Escalation to twice daily dosing may be necessary to control symptoms in some patients with BE. However, it is clear that even with control of reflux symptoms, patients with BE commonly have ongoing abnormal esophageal acid exposure. A randomized trial demonstrated that PPIs control esophageal acid exposure more effectively than H2 receptor antagonist therapy (Montgomery et al, 2001). There is also a trial showing similar outcomes in relation to dysplasia in patients treated medically with PPIs compared with antireflux surgery (Parilla et al, 2003). Antireflux surgery is usually effective in lessening reflux; it normal izes esophageal acid exposure in the majority of patients. If surgery, which usually prevents reflux of all gastric contents, fails to completely stop neoplastic progression, it would be unexpected for pharmacologic treatment to do so. Currently, in theory, therapy is driven by the pragmatic endpoint of relieving patients' symptoms. Until there is data showing that an intervention that more rigorously controls esophageal acid exposure has an impact on the development of cancer, the standard practice of relieving symptoms will not change.*

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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