Do you have heartburn? Read on...

Gastroesophageal Reflux Disease (GERD) is commonly known as heartburn, is a condition where the contents inside the stomach leak (reflux) back into the esophagus, causing adverse symptoms and/or tissue damage to the esophagus.  Although GERD occurs at all ages, it is most prevalent in people over the age of 40.  There are 2 types of GERD:

1. Symptom Based GERD

·      may exist with or without injury to the esophagus

·      heartburn, regurgitation, painful swallowing, and increased salivation

2. Tissue-Injury Based GERD

·      esophagitis (inflammation of the lining of the esophagus).

·      esophageal strictures (narrowing of the esophagus)

·      Barrett esophagus (changes in the esophagus resulting in the lining of the esophagus to be similar to that of the stomach)

·      esophageal adenocarcinoma (cancer of the esophagus)

CAUSES AND RISK FACTORS

Risk factors for the development of GERD include obesity, pregnancy, certain medications, smoking, and excessive alcohol intake.  In terms of pregnancy, many women experience heartburn for the first time while pregnant, and the symptoms may go away after childbirth.  Some drugs that can lead to GERD include:

·      certain calcium channel blockers (used to treat high blood pressure)

·      drugs with anticholinergic effects (such as tricyclic antidepressants, certain antipsychotics and anthistamines)

·      theophylline (used to open air passages, making it easier to breathe)

·      nicotine

·      certain drugs used to treat Parkinson’s disease

·      progesterone

Although the absolute cause of heartburn is not known, lifestyle choices are commonly associated with GERD.  Foods and beverages suspected to play a role in GERD are:

·      spicy foods

·      acidic foods (such as citrus fruits and tomatoes)

·      chocolate

·      peppermint

·      caffeinated beverages

·      onions and garlic

·      greasy foods

 SYMPTOMS

·      burning sensation in the chest

·      feeling of food being stuck in chest

·      nausea after eating

·      belching

DIAGNOSIS

Diagnosing GERD involves consultation with your physician to discuss current symptoms and your specific medical history.  In preparation of your appointment, it is important to keep track of the frequency, severity, and onset of symptoms, since this information will be very helpful to your physician.  Depending on your symptoms, your doctor may recommend general lifestyle changes and non-prescription or prescription medications. If symptoms are not controlled with these measures, your doctor may direct you to someone who has extensive training in stomach and intestinal disorders, called a gastroenterologist.  This specialist will be able to offer other suggestions for treatment.

TREATMENT

The treatment of GERD falls into 3 categories:

1.     General Lifestyle Changes

·      avoiding foods that contribute to GERD

·      weight loss if obese

·      elevation of the head of the bed to help prevent acid reflux during sleep

2.     Common non-prescription and prescription medications

·      Non-prescription medications (over the counter (OTC) medications)

Ø  Antacids (Tums, Maalox, Rolaids)

Ø  Pepcid AC (famotidine)

Ø  Zantac (ranitidine)

Ø  Prevacid (lansoprazole)

Ø  Prilosec (omeprazole)

·      Prescription medications

Ø  Protonix (pantoprazole)

Ø  Nexium (esomeprazole)

Ø  Dexilant (dexlansoprazole)

Ø  Aciphex (rabeprazole)

3.     Anti-Reflux Surgery

·      fundoplication procedure

Ø  tightening the opening of the diaphragm

Ø  secure area with mesh

Ø  wrap and stitch upper area of stomach around the end of esophagus

 PREVENTION
For obvious reasons, the idea of preventing heartburn from occurring is more attractive to patients than waiting for an episode to come along before starting treatment.  Keeping a food diary and recording when symptoms occur is very useful in helping you determine GERD triggers.  Many people find that certain foods and drinks often cause symptoms, so you should avoid anything that seem to be related to the development of symptoms.  Apart from diet, here are some other tips to keep GERD symptoms at bay:

·      Avoid smoking as much as possible.

·      Try to limit the amount of food you eat at one sitting. Smaller meals are easier for your body to digest than larger ones.

·      Do not lie down soon after finishing a meal.  If you want to relax, remain upright or only slightly reclined.

·      Ask your doctor about medications which can prevent heartburn before it starts.

FOR MORE INFORMATION

American College of Gastroenterology (ACG)
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000

http://patients.gi.org/topics/acid-reflux/

American Gastroenterological Association (AGA)
4930 Del Ray Avenue
Bethesda, MD 20814
Phone: 301–654–2055

http://www.gastro.org/patient-center/digestive-conditions/heartburn-gerd

Contact your UIC Pharmacist, or stop into UIC Pharmacy

RESEARCH

To participate in a clinical trial, visit www.clinicaltrials.gov to see a list of ongoing research

REFERENCES

DynaMed [database online]. Ipswich (MA): EBSCO Publishing. http://www.ebscohost.com / DynaMed. Accessed October 25, 2011.

Longstreth GF, Zieve D. Gastroesophageal reflux disease. PubMedHealth. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001311/. Accessed October 26, 2011.

U.S. Department of Health and Human Services. Heartburn, gastroesophageal reflux (GER), and gastroesophageal reflux disease (GERD).  National Digestive Diseases Information Clearinghouse (NDDIC). May 2007. Available at http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/#3. Accessed October 25, 2011.

Williams DB, Schade R. Gastroesophageal reflux disease. In: DiPiro JT, Talbert RL, Yee GC

Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8^th

Ed.  http://www.accesspharmacy.com/content.aspx?aID=7977509. Accessed October 26, 2011.

By: Kaitlyn Kalata and Daniel Lee, UIC PharmD candidates, 2015