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GERD is common in symptomatic CAPD patients. There is conflicting data concerning the effects of increased intra-abdominal pressure on reflux. There are no systematic changes in lower esophageal sphincter pressure in response to infusion of 1.5-2.5 liters of dialysate nor difference in esophageal sphincter pressures after 2 liters of infused dialysate between symptomatic and asymptomatic patients.
Treatment. Small frequent meals and avoidance of foods which reduce sphincter pressure (chocolate and alcohol) are generally recommended. Histamine-2 blockers, prokinetic agents (e.g. domperidon) or motilin agonists (e.g. erythromycin) are the mainstay of pharmacologic therapy. Reducing exchange volume while standing or sitting is often beneficial.
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