Info

clearance and gastric emptying

Metoclopramide

10 mg PO tid before meals

GI stimulant

Improves gastric emptying and increases LES pressure

Sulcrafate

1 g PO qid

Antiulcer

Forms a protective adhesive gel over areas of injury or inflammation

Independent

Many patients experience nighttime reflux because of the recumbent position and infrequent swallowing. Changing the patient's position by elevating the head of the bed during sleep may mitigate symptoms. Place 6-inch blocks under the head of the bed or place a wedge under the mattress to enhance nocturnal acid clearance. Encourage the patient to avoid food for 3 hours before going to sleep, and advise the patient to eat slowly and chew food thoroughly.

Lifestyle changes to reduce intra-abdominal pressure may be helpful to relieve symptoms. Encourage the patient to avoid the following: restrictive clothing, lifting heavy objects, straining, working in a bent-over position, and stooping. Support the patient's efforts to stop smoking and lose weight. Make appropriate referrals to the dietician to provide the knowledge essential for weight control.

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