March 7, 2014
(Editor’s note: This column is being written by Melanie Sessoms, a doctor of pharmacy candidate graduating in May from Campbell University. She is currently finishing up her next to last rotation at Clinton Drug. Originally from Rockingham, Sessoms has been living in Clinton for the past two years. She is married to Chaz Sessoms; they have two boys, Cooper and Mason.)
Gastroesophageal Reflux Disease (GERD) is a medical condition in which acid from the stomach flows back into the esophagus. This leads to irritation of the esophagus and causes heartburn along with other symptoms. When we eat, food travels from the throat into the stomach through the esophagus, also known as the food pipe. Once food enters into the stomach, muscle fibers present in the stomach, called the lower esophageal sphincter (LES), prevent that food from leaking back into the esophagus. If the LES doesn’t close well, food and liquid along with stomach acid can leak back into the esophagus which is known as reflux. The typical symptoms of a person with GERD include heartburn or burning in the chest, belching, and regurgitation. Other symptoms that may present are hoarseness or wheezing, cough, dental erosion, and difficult or painful swallowing. If any of these symptoms start to appear, seek medical attention from a primary doctor. Some medications and foods affect the LES which predispose a person to GERD.
Anticholinergics (Benadryl, Detrol LA)
Osteoporosis medications (Fosamax )
NSAIDs (ibuprofen, naproxen)
Soda, coffee, tea, orange juice
Tomato based products
Spicy food, peppers
Some blood pressure medications
High fat foods
Risk factors that may influence the chance of GERD include increased fat intake, pregnancy, obesity, diabetes, dry mouth, smoking, and alcohol use. If GERD is not treated, it can cause complications such as ulcers, stricture or narrowing due to scarring, asthma symptoms, and Barrett’s esophagus (a change in the lining of the esophagus that can increase the risk of cancer). The treatment goals are to control the symptoms, treat the reflux, and prevent any further complications.
Symptom control begins with lifestyle modifications first. Lifestyle modifications consist of weight loss, avoiding foods that trigger symptoms (fried, spicy foods), smoking cessation, avoiding large meals, avoiding late night meals, avoiding tight-fitting clothing, drinking more water and chewing gum to help saliva production. After altering lifestyle choices, medications like antacids, H2 blockers, and proton pump inhibitors (PPIs) may be implemented.
Antacids help to neutralize stomach acid. Examples of these include Tums, Maalox, Rolaids, and Mylanta. Antacids may be taken after meals and at bedtime. They work quickly and have effects up to an hour. Side effects related to antacids include diarrhea with magnesium products and constipation with aluminum containing products. H2 blockers are another option when antacids do not suffice. H2 blockers take a little longer to work but provide longer relief. They have effects for up to 12 hours. They include the drugs Pepcid, Zantac, and Tagamet. They should be taken 30 minutes before meals and may be taken at bedtime for nocturnal reflux. Side effects with these drugs are headache, nausea, constipation and diarrhea. Proton pump inhibitors are the most effective class of drugs used in the treatment of GERD. They include Prilosec, Prevacid, Protonix, Nexium, and Dexilant. PPI’s are preserved for chronic cases of GERD not mild heartburn. PPI’s block acid production in the stomach and help heal the esophagus. It takes several days for PPI’s to exhibit their full effect on stomach acid which is why it should not be used for milder cases. They will provide relief for up to 1-2 days. PPI’s may interfere with some other medications so it is best to talk with your doctor or pharmacist before starting on one.