As the patient’s symptoms of heartburn remain persistent, stronger antacids might be recommended to reduce the intensity of pain and the recurrence of symptoms. Antacid Maximum Strength can be prescribed to the patient, but only for one to two weeks, as its ineffectiveness might indicate that the patient does not have heartburn but rather GERD or other gastrointestinal tract diseases (U.S. National Library of Medicine, 2017). As the test results are positive for Helicobacter pylori, a standard treatment can be prescribed that includes “a proton pump inhibitor (PPI), amoxicillin and clarithromycin” (Kim, Choi, & Chung, 2015, p. 183). It is possible to prescribe one of the following PPIs: dexlansoprazole, esomeprazole, lansoprazole, omeprazole, etc.
As the Helicobacter pylori can be resistant to the triple therapy, Prasertpetmanee, Mahachai, and Vilaichone (2013) suggest using “a 14-day high-dose PPI and long-acting clarithromycin” to ensure the treatment is effective. In this case, the first type of triple therapy (seven days) is suggested as a first-step intervention; if it not effective, a 14-day treatment with PPI and clarithromycin is the second option.
Common side effects of triple therapy can include diarrhea, headache, nausea, vomiting, and are treated with probiotics such as Lactobacillus, Bifidobacterium, Saccharomyces, or other mixtures of probiotics (Lau, Ward, & Chamberlain, 2016). The prescription of probiotics both reduces the adverse effects of the triple therapy and also makes it more effective. Probiotics can reduce the risk of diarrhea, nausea, vomiting, and other symptoms common during the treatment focused on the eradication of Helicobacter pylori.
GERD can be treated using different ways. First, over-the-counter medications such as antacids (Mylanta, Rolaids, Tums), medications that reduce acid production (cimetidine, famotidine, nizatidine), and medications that both prevent acid from being produced and have a healing effect (PPIs) can be used. Second, prescription medications can also be used to treat GERD: H-2-receptor blockers such as famotidine, nizatidine, and ranitidine or PPIs such as esomeprazole, lansoprazole, omeprazole, etc. (Mayo Clinic, 2017). As the patient indicated that he had taken ranitidine and it did not help, it is possible to prescribe stronger medications or use medication that strengthens the lower esophageal sphincter, e.g., baclofen (Mayo Clinic, 2017).
GERD is normally treated with medications, but if they do not help, symptoms remain persistent, and/or the patient does not want to undergo long-term medication treatment, surgery is suggested as a possible intervention. During fundoplication, “the top of the stomach is wrapped around the lower esophageal sphincter”, which prevents reflux and increases the strength of the muscle (Mayo Clinic, 2017, para. 12). The surgery is moderately invasive as it can be done using laparoscopy. The second type of surgery is a LINX device, a ring of magnetic beads that are wrapped around the junction of the stomach. The advantage of this surgery is that the magnetic attraction between the beads does not allow the reflux to occur but it is not strong enough to prevent food from passing through (Mayo Clinic, 2017). This type of surgery can also be done using laparoscopy and is thus minimum-invasive.
As can be seen, both heartburn and GERD can be treated with medication. If a patient’s symptoms remain persistent, surgery is recommended in the case of GERD. If symptoms are persistent due to the resistance of Helicobacter pylori to treatment, other forms of therapy (10 days, 14 days, treatment supported with probiotics) can be suggested to the patient.
References
Kim, S. Y., Choi, D. J., & Chung, J. W. (2015). Antibiotic treatment for Helicobacter pylori: Is the end coming? World Journal of Gastrointestinal Pharmacology and Therapeutics, 6(4), 183-198.
Lau, C. S., Ward, A., & Chamberlain, R. S. (2016). Probiotics improve the efficacy of standard triple therapy in the eradication of Helicobacter pylori: A meta-analysis. Infection and Drug Resistance, 9, 275-0289.
Mayo Clinic. (2017). Gastroesophageal reflux disease (GERD). Web.
Prasertpetmanee, S., Mahachai, V., & Vilaichone, R. K. (2013). Improved efficacy of proton pump inhibitor–amoxicillin–clarithromycin triple therapy for Helicobacter pylori eradication in low clarithromycin resistance areas or for tailored therapy. Helicobacter, 18(4), 270-273.
U.S. National Library of Medicine. (2017). Antacid Maximum Strength. Web.