Conservative management

Medical management is targeted at reducing the symptoms of GERD with drugs that inhibit gastric acid secretion.

• Proton pump inhibitors (PPIs)
• Histamine 2 receptor antagonists
• antacids
• metoclopramide or domperidone - is not recommended (1)

Drug management of reflux oesophagitis is described in the menu option.

Although evidence supporting the effectiveness of lifestyle modification is weak, these should be recommended according to patients’ circumstances

• weight loss
• avoidance of “trigger” foods
• eat frequent small meals, and not to eat just before bedtime
• not to lie down after eating a meal and advice to sleep with their head elevated, e.g. by extra pillows.
  • elevating the head of the bed by 6-8 inches (15-20 cm) and avoidance of food three hours before bedtime is especially helpful for patients who are prone to symptoms at night (1)
• patients should be dissuaded from smoking.

Inflammatory fibrous strictures can be dilated using gum - elastic bougies of progressively increasing size. This is usually done endoscopically

Reference:

• (1) Roman S, Kahrilas PJ. The diagnosis and management of hiatus hernia. BMJ. 2014;349:g6154