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Treatment of heartburn and gastroesophageal reflux disease with H2 blocker and PPI versus lifestyle change

Treatment of heartburn and gastroesophageal reflux disease with H2 blocker and PPI versus lifestyle change

Heartburn and reflux are usually treated with H2 blocker and PPI but often drugs are not effective because they require a radical change in lifestyle rather than a “simple” treatment of symptoms

Sleep bruxism has been associated with arousal response and has been reported to overlap with gastroesophageal reflux disease (GRD) in many patients. Among various phenomena occurring during sleep in humans, nocturnal gastroesophageal reflux has been found to be closely associated with sleep arousal such as micro-arousal supine position, and swallowing for esophageal lubrication (e.g., acid clearance). Sleep bruxism and gastroesophageal reflux are known for several common features. We dealt with 8 cases presenting both day heartburn and night heartburn. They were in treatment either with H2 blockers or PPI with poor results, if any. Common causes were found: in 5 cases the patients used to eat a heavy meal for dinner and then lie on their back;  2 patients were found with chronic obstructive pulmonary disease; 1 patient was a postmenopausal woman on hormone replacement therapy; 6 patients were smokers. All presented a very stressful life or previous very stressful situations. Major lifestyle changes and a re-education of the masticatory pattern and muscles was highly recommended to the patients. Only 5 out of 8 decided to accept both the lifestyle changes and the re-education process. 3 patients did not accept the rieducation and had some benefit from the lifestyle changes but some PPI were needed from time to time. Among those who accepted the re-education 4 totally resolved the problem within 24 weeks and 1 was addressed to a specialist for evaluation in suspect of hiatal hernia. Sleep bruxism and nocturnal GRD are common in patients with obstructive sleep apnoea.

Authors: T. Candiani, S. Vernocchi, A. Palazzolo, M. Tuvinelli, S. Bottinelli, A. Aceranti
Published: Italian Journal odìf Medicine, Sept 2017
Presented: Poster at FADOI national congress 2017

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