Reflux Esophagitis in the Elderly, with Special Reference to Antacid Therapy*

Abstract

The incidence of hiatal hernia increases with aging. When esophagitis occurs in the susceptible esophageal mucosa, it is probably the result of degenerative changes in the supporting tissues (collagen-elastin) and a diminution in cellular replication. The authors' concepts of the etiology of reflux esophagitis are described. Severe complications are not uncommon. In most patients, there is a good response to postural, dietary and antacid therapy, not only during the initial episode but during recurrence and in complicated cases. No surgical procedure has general acceptance. In the elderly patient, morbidity and mortality are of such significance that the benefits must be measured carefully against the disadvantages. Most operations are designed to correct a hiatal hernia and to enhance sphincteric competency. The complication, esophagitis, is a medical problem unless a concomitant disorder refractory to medical management requires operative intervention. The presence of hiatal hernia usually is a coincidence. The authors have found an antacid-combination (Gaviscon) treatment of reflux esophagitis.

Review article: alginate‐raft formulations in the treatment of heartburn and acid reflux

“…The foam raft remained visible within the upper stomach by radiographic analysis for up to 3 h, and was associated with an elevation in fundic pH to above 3.0. McHardy & Balart endoscopically observed floating Gaviscon (Marion Labs, USA) rafts, and reported the raft refluxed into the oesophagus ahead of gastric contents in normal volunters 56 . Although this approach demonstrated that the raft could enter the oesophagus, it does not confirm mucosal adhesion or formation of a protective ‘coating’ barrier as potential mechanisms of action 58 .…”

“…A variety of in vivo imaging techniques, including radiography, scintigraphy, and direct endoscopic visualization have demonstrated the formation and presence of floating alginate rafts from various alginate‐based formulations 39 , . 55 –57 The general conclusion from these studies is that alginate‐based raft‐forming formulations can rapidly form rafts that float on the surface of gastric contents, and can preferentially enter the oesophagus ahead of, or in lieu of, gastric contents during reflux episodes. Finally, these studies have demonstrated that the raft can be maintained within the stomach, for up to 4 h.…”

Rheological investigation of the shear strength, durability, and recovery of alginate rafts formed by antacid medication in varying pH environments

“…(Mandel et al, 2000;Richardson et al, 2004) Additionally, in vivo studies indicate that the rafts may be driven into the lower esophagus due to gastric pressure waves. (Malmud et al, 1979;McHardy and Balart, 1972) Penetration and extraction of the raft into the lower esophagus is expected to impart significant shear forces on the raft from frictional interactions with the esophagus and stomach wall. Thus, there is a clear need to investigate the mechanical properties of alginate rafts during exposure to shear forces.…”