Rapid healers were more likely to be women and to not have hiatal hernias, but these were trends and did not rise to the level of significance. At each 2-week interval, approximately two-thirds of patients who had been unhealed at the previous exam had healed in the interim.
The authors indicate that clinically, this means that completely refractory RO is rare, and some patients need long treatment durations with good acid suppression to heal. July 29, Jeannette Y. Medicines for osteoporosis bisphosphonates , such as alendronate, ibandronate, or risedronate. Antibiotics , such as clindamycin or tetracycline.
Vitamin and mineral supplements, such as vitamin C, iron, and potassium pills. People who have a weak immune system are more likely to get esophagitis. This includes people with HIV , diabetes , or kidney problems, as well as older adults and people who take steroid medicine. Radiation therapy. Certain diseases that make it hard to swallow, such as scleroderma. Allergies, often food allergies, especially to seafood, milk, nuts, soy, or eggs.
What are the symptoms? Common symptoms of esophagitis include: Heartburn. Pain when you swallow. Trouble swallowing food or liquids.
Chest pain may be similar to the pain of a heart attack. A cough. Sometimes it also causes: Nausea or vomiting. Belly pain. How is esophagitis diagnosed? Your doctor will ask about your symptoms and past health. He or she may do tests such as: An endoscopy. During this test, the doctor puts a thin, flexible tube down your throat to look at your esophagus. This test also lets the doctor get a sample of the cells to test for infection.
Sometimes a small piece of tissue is removed for a biopsy. A biopsy is a test that checks for inflammation or cancer cells. A barium swallow. This is an X-ray of the throat and esophagus. Before the X-ray, you will drink a chalky liquid called barium. Barium coats the inside of your esophagus so that it shows up better on an X-ray.
How is it treated? Here are some things to try: Change your eating habits. Omeprazole has become the drug of choice for treating severe esophagitis or esophagitis unresponsive to H 2 -blockers [ 3 ]. There is growing awareness that most patients with healed erosive-ulcerative esophagitis will relapse within 6 to 9 months after discontinuation of drug therapy. Therefore maintenance therapy is unanimously recommended, but its efficacy is yet to be conclusively proven.
Recent studies suggest that cisapride 20 mg b. H 2 -blockers are also likely to be effective for mild to moderate disease, but require full twice daily dosages regimens. Patients with severe esophagitis will require maintenance therapy with omeprazole. Holiday therapy days out of the week does not seem to be effective. Prevention of complications Although it is logical and physiologically sensible, little data is available showing that aggressive medical therapy prevents the development of complicated GERD.
Furthermore, many of our patients have well established complicated disease at the time of presentation, which may be beyond relief with either medical or surgical treatments. Aggressive medical therapy can heal esophageal ulcers and prevent recurrent bleeding [ 8 ]. Recent studies in our laboratory suggest that omeprazole can resolve many peptic strictures associated with esophagitis and keep these patients dysphagia free for up to 6 months [ 9 ].
However, long-term studies are not available. Barrett's esophagus is more problematic and the major complication that should be prevented. Studies in dogs suggest that severe esophagitis often heals with the development of columnar metaplasia. However, esophagitis, in this animal model, heals with the persistence of squamous mucosa if acid reflux is markedly inhibited [ 10 ]. This supports the use of aggressive acid suppression in patients with severe esophagitis, either high dose H 2 -blockers or omeprazole.
Although formal studies are not available, the clinical experience of most gastroenterologists support these animal observations since Barrett's esophagus rarely develops de novo or progresses after effective control of esophagitis. Having said this, there is little convincing data that either omeprazole or surgery predictably produces regression of Barrett's esophagus once it is established. References 1. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease.
Arch Int Med ; Ramirez B, Richter JE. Review article: promotility drugs in the treatment of gastroesophageal reflux disease.
Aliment Pharmacol Ther ; Sontag SJ.
0コメント