Reduce acid but don’t reduce reflux. These medications reduce expose of acid to the oesophagus, but will not change non-acid or weak acid reflux events. These medications reduce the strength of acid that the stomach produces so that reflux episodes can occur without causing discomfort.
Rennies, Gaviscon, Mylanta etc. These agents neutralise the acid to reduce symptoms.
Acid Suppression Tablets
Medical term: proton pump inhibitors, PPI’s
Nexium, Somac, Pariet, Losec, Omeprazole, Zoton etc. These medications reduce the amount of acid the stomach produces but have no effect on the total volume of fluid that the stomach and duodenum produce. If someone takes a tablet for “reflux”, the total number of reflux episodes they experience during the day is likely to be relatively unchanged, it’s just that the medications weaken the acid so that the majority of reflux episodes occur without the person being aware that they are happening.
“Old fashioned” Acid Suppression tablets
Zantac, Tasac etc. while significantly less powerful than PPI therapy, they are stronger than antacids and can be used in patients who still have symptoms while on PPI therapy.
Gastric Motility agents
Motilium and Maxalon speed up gastric emptying. If someone has reflux that stays severe despite acid suppression, an agent such as this can help reduce the amount of extra fluid in the stomach and therefore make reflux symptoms less likely.
These work by correcting/repairing the mechanical causes of reflux. The larger the procedure the more effective, but the larger the procedure the more important it is that accurate tests are done in order to avoid overtreatment and side effects.
Endoscopic surgical therapies
These incisionless procedures require an anaesthetic and are performed from within the oesophagus and stomach.
With this procedure, Radiofrequency energy is introduced to the lower oesophagus to “tighten it”. This is identical to the treatment that people have to reduce wrinkles on their faces by tightening their skin. Stretta has no direct effect on the lower oesophageal muscles, but it does reduce reflux symptoms in people who no longer wish to take antacid medications. Click here for more information.
RAP (Endoscopic Resection And Plication)
With this procedure, the junction of the oesophagus and stomach is tightened by bunching up some of the upper stomach to act as an extra cushion below the lower oesophageal valve. It may be ideal for people without significant hiatal hernia where the reflux is caused by a weak or inappropriately relaxing lower oesophageal valve.
Laparoscopic Surgical Procedures
These all have a lot in common. General anaesthesia, 1-2 night hospital stay, mostly 5mm incisions, and the ability to correct hiatal hernia, which is the greatest driver of reflux in most people with reflux associated with oesophagitis (oesophageal ulcers) or Barrett’s oesophagus.
Hiatus hernia repair and fundoplication
The aim of this procedure is mostly to restore normal anatomy. To repair a hiatus hernia, the stomach is first pulled back into the abdomen and then the hiatal muscles are tightened to snug around the oesophagus.
Hiatus hernia repair and Linx procedure
One problem with fundoplication is that some people after this type of surgery can end up experiencing bloating and the inability to belch, as well as problems swallowing if the fundoplication is too tight. The Linx device is a device that keeps the oesophagus closed when you are not eating but it completely opens when you eat or try to belch. In this way, it provides potentially better reflux control than a fundoplication but with fewer side effects.