GASTROESOPHAGEAL REFLUX DISEASE (GERD)
 

WHAT IS GERD?

Gastroesophageal Reflux Disease or GERD occurs when acid and contents from the stomach regurgitate or ?reflux? back into the esophagus, the tube that carries food from your mouth to your stomach.  The lining of the esophagus is very sensitive to the effects of acid and causes a feeling of heartburn.  GERD has been described as ?a burning feeling rising from the stomach or lower chest towards the neck?.  Less common symptoms of GERD include trouble swallowing, cough, asthma and laryngitis.

WHAT CAUSES GERD?

In GERD, the muscular ring (called the esophageal sphincter) at the entry into the stomach fails to hold back regurgitation of acid into the esophagus.  This activity also prevents the normal flow of contents into the stomach, irritating the esophagus even more.  Eventually, the lining of the esophagus may become inflamed to the point where ulceration and narrowing of the esophageal passageway occur.  The symptoms of GERD can be made worse by fatty foods, spicy foods, coffee, milk and dairy products, peppermint and by taking certain medications (e.g. iron preparations, nitroglycerine products, theophylline, ASA, and nonsteroidal anti-inflammatory medications).

WHAT CAN I DO TO PREVENT GERD SYMPTOMS?

There are many non-drug measures which help to minimize the risk of GERD symptoms:

• Lose weight
  
• Quit smoking
  
• Avoid wearing tight clothing around the waist
  
• Eat smaller, more frequent meals
  
• Keep track of foods that have caused GERD symptoms and avoid them in the future
  
• Limit intake of alcohol
  
• Avoid lying down or bending down shortly after eating
  
• Raise the head of the bed about 15 cm

WHEN SHOULD I VISIT MY DOCTOR ABOUT GERD SYMTOMPS?

Your pharmacist can help you treat the symptoms of occasional heartburn that are brought on by food.  You should visit a doctor under the following circumstances:

• Your symptoms include vomiting, bleeding, unexplained weight loss or difficulty in swallowing.
  
• Your discomfort includes pains that radiates to the back, neck, jaw or left shoulder/arm
  
• Your symptoms don?t go away or have been present for more than two weeks.
  
• Your symptoms came on suddenly and are not explained by anything that you have eaten

Your Pharmacist can recommend appropriate medication for the treatment of occasional stomach upset caused by overindulgence or eating certain foods.

Antacids ? These medications can help to neutralize stomach acid that causes the pain of heartburn.  Antacids may consist of various ingredients.  Many contain a combination of aluminum hydroxide and magnesium hydroxide.  These medications should not be taken in the presence of kidney disease unless prescribed by a doctor.  Calcium carbonate is also a common antacid ingredient.  Antacids can prevent some antibiotics (e.g. tetracycline, ciprofloxacin, norfloxacin) from working properly.  Your Pharmacist can help you choose a product best suited to your circumstances.

Alginic Acid ? This ingredient helps to prevent reflux by acting as a barrier to regurgitation.

H2 Antagonists ? These medications (e.g. ranitidine, famotidine, cimetidine, nizatidine) reduce the amount of acid produced by the stomach.  Lower strengths of some of these medications are available without prescription

Proton Pump Inhibitors (PPls) ? These are the most potent blockers of stomach acid production available. Examples include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole.  These medications are available by prescription only.  Some medications do not work as well when the stomach is low in acid content.

GERD SYMPTOMS AND DIAGNOSTIC TESTS

Gastroesophageal reflux disease (GERD) symptoms are classified according to their severity.

Trivial to mild GERD symptoms include the following:

• Symptoms occur less than 3 times per week
  
• Symptoms do not occur during the night
  
• Symptoms do not interfere with daily activity
  
• Pain (heartburn) is rated at 3 or less out of 10
  
• There are no complications (e.g. vomiting, bleeding, unexplained weight loss, trouble swallowing)

Severe GERD Symptoms include the following:

• Symptoms are severe enough to see a doctor
  
• Symptoms have been present for more than 6 months
  
• Symptoms interfere with daytime activities and occur at night
  
• Pain (heartburn) is rated at 7 or more out of 10
  
• Complications are present

If you have GERD and do not get adequate relief from antacids or other acid suppression medications or you have any of the symptoms of severe GERD, a visit to the doctor is warranted.  Evaluation of your condition will likely include a procedure called upper gastrointestinal (GI) endoscopy.

Upper GI Endoscopy is performed under sedation.

A small, flexible telescope is passed through your mouth, down the esophagus and into the stomach.  The doctor checks for irritation of the wall of the esophagus and takes a piece of tissue (biopsy) for testing if necessary.  Additional tests that may be performed include manometry (checks the strength and coordination of the esophagus muscles) or an esophageal pH study (checks the amount of stomach acid refluxed back into the esophagus during a 24 hour period).

WHERE TO FIND MORE INFORMATION:

National Institute of Diabetes & Digestive & Kidney Disease

www.niddk.nih.gov/index.htm

The Society of Thoracic Surgeons

www.sts.org/doc/4119

American Gastroenterological Association

www.gastro.org/public/brochures/heartburn.html