Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease

Author: Dian Han, Pharm. D Candidate Reviewed by: Dr. Bernard Ho, MD

Gastroesophageal reflux disease (GERD) is a confusing name - but the condition itself doesn’t need to be! GERD is caused by frequent acid regurgitation and characterized by the sensation of heartburn, a burning feeling in the upper stomach or lower chest rising to the neck. In a person without GERD, reflux of the stomach contents is prevented by the lower esophageal sphincter, a muscular structure designed to keep the stomach contents out of the esophagus. Often, in people with GERD, the lower esophageal sphincter becomes too relaxed, and the highly acidic stomach contents can damage the esophagus and cause heartburn. However, GERD can also be caused by other healthcare conditions including hiatal hernia, excessive gastric acid production, and impaired esophageal motility.

When the esophagus is exposed to stomach acid, the esophageal lining can be damaged. Although uncommon, long term exposure of the esophagus to stomach acid can lead to complications such as esophagitis (inflammation of the esophagus), esophageal strictures (narrowing of the esophagus, which can cause difficulty swallowing) or Barrett’s esophagus (long term changes to the lining of the esophagus that has a small chance of becoming cancerous). Appropriate treatment of GERD can reduce the chance of complications. So, if you’re experiencing GERD, how can you control it? Or, even better, how do you prevent it? Keep on reading for non-pharmacological and pharmacological ways to help control GERD.

Non-Pharmacological Interventions Avoid triggers for GERD. These include, but are not limited to:

- Fatty foods

- Chocolate, coffee and alcohol

- Carbonated drinks

Make lifestyle changes, including:

- Avoid lying down immediately after meals

- Quit smoking

- Reduce body weight if BMI >30kg/m2

- Eat smaller, more frequent meals

- Avoid tight fitting clothes around the waist

- Elevate the head of the bed about 10 cm

Some medications can make GERD worse. Be sure to speak with your doctor before stopping or changing any medication regimens. Medications that can exacerbate GERD include:

- Acarbose

- Amiodarone

- Antibiotics

- Bisphosphonates

- Digitalis

- Iron supplements

- NSAIDS (ibuprofen, naproxen)

- Potassium supplements

- Theophylline

Pharmacological Interventions

(1) Over-the-counter antacids: Neutralizes the acid of the stomach to provide relief of the symptoms of heartburn. Relief of heartburn is short-term, and occurs in about 20% of patients. Antacids may increase the risk of constipation or electrolyte abnormalities. These include Tums, Pepto-Bismol, Maalox, Rolaids etc.

(2) Histamine H2 Receptor Antagonists (H2RAs): Includes famotidine (Pepcid), ranitidine (Zantac), cimetidine (Tagamet), and nizatadine (Tazac). They function by temporarily blocking the acid pumps in the stomach, therefore reducing acid in the stomach. H2RAs are more effective at reducing stomach acid and provides longer relief of heartburn compared to antacids.

(3) Proton Pump Inhibitors (PPIs): Includes esomeprazole (Nexium), pantoprazole (Tecta), lansoprazole (Prevacid), omeprazole (Losec) and rabeprazole (Pariet). PPIs function by irreversibly blocking the acid pumps in the stomach, and is very effective in reducing stomach acid and controlling symptoms of GERD. Long term use of PPIs may be associated with serious side effects including increased risk of fractures, increase gastrointestinal infections, and chronic kidney disease.

(4) Alginic Acids : forms a physical layer on top of the stomach contents, creating a protective barrier between the stomach contents and the esophagus. There is less evidence for the effectiveness of alginic acids, and it is generally not used on a long-term basis.

It is important to note that with GERD, there are some cases in which it is important to seek immediate medical care. This is because symptoms of other more serious medical conditions can resemble those of GERD too. If you experience any of these symptoms, seek immediate medical care:

Abdominal mass (abnormal growth or swelling of abdomen)

Dizziness, fatigue, cold extremities, pale appearance (can be symptoms of anemia)

Chest pain (resembling cardiac pain)

Dysphagia (difficulty swallowing)

Gastrointestinal bleeding (blood in the vomit or stool, or passing black, tarry stools)

Unintentional weight loss

Vomiting

If you have any additional questions on how to manage your GERD, reach out to your family doctor or community pharmacist for additional advice.

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