**1. Introduction**

Esophagitis is thoroughly explained as a condition elsewhere in this book and its various causes discussed. There can be a variety of causes of esophagitis but in all cases it is aggravated if Gastro Oesophageal Reflux Disease (GERD) is present. It is that condition, reflux that will be discussed here: its treatments, causes, similar conditions, and a new and innovative treatment that simply and effectively addresses the root cause of reflux – not just its symptoms. Damage caused by reflux to the lining of the oesophagus can lead to the condition of Barrett's oesophagus in which cell changes indicate a pre-cancerous condition [1, 2]. This chapter will

explain what Hiatal hernia (HH) is and why it is near-exclusively [3, 4] responsible for all reflux-related conditions. It will be seen that the current most common active treatment for the symptoms of reflux is the administration of medication, often Proton Pump Inhibitor (PPI) drugs. These successfully alleviate the symptoms by reducing stomach acid production and its efficacy but, because they do not address the underlying cause of the condition, they are often prescribed for many years or even to end-of life. Their unwanted side-effects are well documented and referenced here. Medical science and healthcare professionals concerned with treating all symptoms caused by reflux should be excited and interested in a new, but proven, treatment that is simple, cheap, self-administered and with no negative side-effects. This disruptive technology to drug research and development is presented here.

#### **2. Current treatments**

In most cases clinicians first advise patients who present with reflux and the symptoms of reflux to implement lifestyle changes. These include changes in eating and drinking habits: lose weight, drink less alcohol, stop smoking, do not eat too close to bedtime, and more. Doctors also advise sleeping with the head of the bed raised, this encourages the neck of the stomach to remain correctly positioned and not intrude through the diaphragm at night allowing reflux. Changes in diet are often popular with patients with certain foods being excluded or included in their symptom-management routines.

The second, and most common type of treatment administered, is medication. This can be mild, over-the-counter (OTC) drugs, but is usually prescription drugs from the Proton Pump Inhibitor (PPI) class.

The third and last widely used type of intervention is surgery. Laparoscopic fundoplication is common, as are magnetic bands around the hiatal canal, and other operations. In essence each of these interventions is designed to compensate for the muscular incompetence in the diaphragm that allows the stomach neck to herniate into the chest cavity and reflux stomach contents.

#### **2.1 Shortcomings of current treatments**

Lifestyle changes are the most innocuous treatment and suffice for some people. Evidence [5] shows however, that their effect is weak.

Many OTC medications have a base pH and address the problem of reflux by reducing the acidity of the stomach acids which are being refluxed. Although the unpleasant sensations of reflux are reduced, the harmful effects on the vulnerable oesophagus and other organs continues. Long-term use of OTC medication is generally regarded to be free from harmful side-effects.

PPI medications act by inhibiting the amount and strength of the acids produced in the stomach. In the case of all medications there is no expectation that the underlying cause of the reflux – the weakened diaphragm musculature – will be addressed, merely the severity of the reflux symptoms.

However, in the case of the latter drug class there are significant known side effects. Long-term PPI usage is generally discouraged and several countries insist that clinicians perform a medication review before renewing PPI prescriptions. At least once per year is recommended in the UK [6]. PPI medication is usually not expensive, but the costs of repeat Healthcare Professional (HCP) interventions build to a considerable amount when prescribed for rest-of-life.

*Introducing an Innovative Oral Neuromuscular Treatment of the Underlying Reason… DOI: http://dx.doi.org/10.5772/intechopen.96773*

PPI drugs belong to one of the safest medication groups, but some research suggests a list of unwanted side effects [7, 8] include increased risk of cardiovascular disease, osteoporosis, dementia, male infertility, diabetes, increased vulnerability to severe covid19 infection.

In addition, harmful bacteria in the stomach like Helicobacter pylori (HP) that would not survive in normal circumstances, can thrive in the weakened acids after PPI treatment. These germs can enter the body and live in the digestive tract. After many years, they can cause sores, called ulcers, in the lining of the stomach or the upper part of the small intestine. For some people, an infection can lead to stomach cancer.

In the UK there are several initiatives in the NHS to reduce PPI prescription, Rotherham [9], All Wales [10] etc.

The final class of treatment is that of surgical intervention. Laparoscopic operations are minimally invasive, whilst other procedures can be more traumatic, all surgical operations carry risks [11]. Such operations require hospitalisation and the National Institute for Health and Care Excellence (NICE) in the UK advise that the cost is GBP 2076 [12].

The prevalence of success of these operations [13] is not 100%. In some cases the remedy is not long lasting and a second operation is required, or the patient will return to PPI medication. Some patients are not deemed suitable for surgery because of other pre-existing factors, and in periods like the Covid19 pandemic such interventions are not prioritised and can be delayed by years.
