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Pharmocological Therapy  (
1) Antacids: Antacids were the standard treatment in the 1970s and are still effective in controlling mild symptoms of GERD. Antacids should be taken after each meal and at bed time.
2) H2 receptor antagonist and H2 blocker therapy: H2receptor antagonists are the first- line agents with mild to moderate symptoms and grade 1-2 esopagitis.options include ranitidine (zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine(axid). H2receptor antagonists are effective for healing only mild esophagitis in 70-80% of patients with GERD and for providing maintenance therapy to prevent relapse tachyphylaxis has been observed, suggesting that pharmacologic tolerance can reduce the long-term efficacy of these drugs.
3) Proton pump inhibitors: PPI’s are the most powerful medications available for treating GERD .these agents should be used only when this condition has been objectively documented. They have few adverse effects and are well tolerated for long-term use. However, data have shown that pips can interfere with calcium homeostasis and aggravate cardiac conduction defects .these agents have also been responsible for hip fracture in postmenopausal women.Available PPI’s include omeprazole (Prilosec), rabeprazole (aciphex), and esomeprazole (medium).
4) Prokinetic medications and reflux inhibitors: Prokinetic agents are somewhat effective but only patients with mild symptoms; other patients usually require additional acid-suppressing medications such as ppi’s .The usual regimen in adults is metoclopramide ,10 mg/day orally, such as pips .long term use of prokinetic agents may have serious ,even potentially fatal ,complications and should be discouraged.
Surgical Treatment For GERD: ( )
Surgical therapy is also an option for the treatment of GERD. The main indication for surgical therapy is failure of medical management when symptoms persist despite appropriate medical therapy. Another indication for ant reflux surgery is personal preference .some people do not want to take lifelong acid suppression medication or have too many side effects from these medications and may want to consider anti reflux surgery.

Prevention: There are many ways to prevent GERD.

Table no-2: prevention of GERD ((  , Chourasia D,2011 Ghoshal UC,2010)

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