What is the best treatment for erosive esophagitis?
REPLY:
The use of the specific term "erosive esophagitis" suggests that a person has undergone a flexible endoscopic examination of the esophagus which has demonstrated ulcers or erosions of that organ. This implies a more severe form of Gastro-Esophageal Reflux Disease (commonly abbreviated as GERD).
The treatment of GERD is generally approached in a stepwise fashion beginning with lifestyle changes such as weightloss, head-of-bed elevation, no eating or drinking for four hours before bedtime or other periods of recumbancy, no exercising after eating, diet restrictions including cessation of caffeine, carbonated beverages, alcohol, chocolate, mints, and other measures generally designed to minimize the reflux of acid and other gastric contents into the esophagus (and to minimize acid secretion and further weakening of the muscles which should prevent acid reflux).
Adding to this the use of antacids and drugs such as Zantac or others in the H2 blocker class is the next step in treatment. Other drugs such as Reglan or Propulsid may hasten the rate at which food and contents leave the stomach as well as strengthening the pressure in the Lower Esophageal Stricture (LES), the muscle mentioned above.
A more potent class of drugs including the drug Prilosec may be more effective in healing erosive esophagitis and is commonly used when erosive esophagitis is diagnosed in a person already using Zantac like drugs.
The problem with treating erosive esophagitis is that the condition is chronic and requires chronic treatment. All too often patients fall back on old habits or rely too much on drug treatment to cover dietary indiscretions, the inability to lose weight, etc. None of the drugs used in treating this condition are known to be absolutely safe over long periods of time. Some, such as Prilosec, are specifically labeled against use on a chronic basis. Some physicians are more willing than others to use these and other drugs in a continuing fashion after a detailed and careful review of the pro's and con's with their patient.
The advent of laparascopic surgical repair of hiatus hernias is of importance in those patients whose hiatus hernia is clearly related to recurring episodes of erosive esophagitis which can be associated with bleeding or the formation of strictures. These individual need to be informed of the risks and benefits of the repair of their hernias with the thought that they may be able, after successful surgery, to live a lifestyle not constantly concerned with preventing esophageal damage due to reflux. All individuals about to undergo any type of surgical repair to a hiatal hernia need to undergo a test of the muscles of the esophagus known as an esophageal motility or manometry test. This test can exclude those few individuals who may experience considerable swallowing problems after surgery.
If your diagnosis is "erosive esophagitis" you need to work closely with a physician familiar with this entity. A specialist such as a gastroenterologist may have information not available to your primary doctor. The problem requires a "team approach" between patient and doctor with the understanding that there is no simple cure available and that for each possible treatment there may be side-effects. Most important is that the patient understand the reason for life-long efforts to avoid excess body weight, waterbeds, certain foods/drinks, positions and activities close to meal completion, etc.
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Bruce Sckolnick, M.D.
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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