Lifestyle Modifications Suggested for Patients with GERD

-Reduce the size of meals

-Avoid eating for a minimum of 3 hours before retiring

-Avoid foods that decrease LES pressure such as coffee, chocolate, citrus fruit juice

-Elevate the head of the bed 4-8 inches or use a foam wedge pillow to decrease nocturnal esophageal contact time

-Avoid smoking

-Avoid alcohol ingestion

-Loss weight (if overweight)

-Avoid tight-fitting clothing (to reduce the risk of stress reflux)

Useful Sites and Resources

American Gastroenterological Association website:

Johnson & Johnson/Merck Consumer Pharmaceuticals co.

References:

Harold L. Kirsenbaum MS, PharmD. A Pharmacist’s Perspective: GERD, A Continuing Education Program for Pharmacists

Allen LV, Berardi RR, Desimone EM, Engle JP, Popovich NG, Rosenthal WM Editors. AphA Handbook of Nonprescription Drugs 12th Edition. Washington, DC 1996

American Gastroenterological Association website:

Johnson & Johnson/Merck consumer Pharmaceuticals co.

HILDA BI

PHARM D CANDIDATE

UNIVERSITY OF COLORADO

SCHOOL OF PHARMACY

GERD is the return of stomach’s contents back up into the esophagus. In normal digestion, a sphincter between the esophagus and the stomach, called lower esophageal sphincter (LES) allows food to pass into the stomach, and closes to prevent food and stomach acid from flowing back into the esophagus. GERD occurs when the sphincter is weak or relaxes inappropriately and allows the stomach’s contents to flow up into the esophagus.

GERD disrupts quality of life more than conditions such as congestive heart failure and hypertension.

GERD has 3 major subcategories:

  1. Reflux esophagitis is an alteration in the esophageal mucosa or epithelium, associated with inflammation
  2. Erosive esophagitis represents a progression of reflux esophagitis in which erosion and ulcerations may be seen via endoscopy
  3. Barrett’s esophagus a.k.a Barrett’s metaplasia or Barrrett’s syndrome is probably the most severe histologic consequence of GERD where normal squamous epithelium of the esophagus is replaced by abnormal columnar epithelial cells. This condition as been associated with the development of adenocarcinoma of the esophagus and may be a premalignant condition

SYMPTOMS

HEARTBURN is the most common health-related complaints made by persons who are otherwise considered healthy

Epidemiologic data suggest that between 4-7% of adults in the United States experience heartburn on a daily basis and 44% of adults experience heartburn at least once a month

Patients commonly seek advice from pharmacists concerning the use of antacids and histamine H2 receptor antagonists.

Heartburn was reported to be the primary and secondary reason for 2.5 million visits to physicians over a one-year period.

WHEN SHOULD A PATIENT GO FOR SCREENING?

Patients should be referred for consultation, endoscopy, or surgery if:

  1. They have persistent heartburn symptoms everyday
  2. They have difficulty swallowing and pain swallowing
  3. Their symptoms are not relieved by high doses of antacids and H2 blockers

RISK FACTORS FOR GERD

-Age > 50 years

-Obesity

-Alcohol

-Smoking

-Coffee consumption

-Citrus fruit juices

-Foods such as fat, onion, chocolate

-Medications such as dopamine, morphine, anticholinergics, CCB, meperidine, diazepam, theophylline

Therapeutic Approaches to the Patient with GERD

OTC Medications frequently used to treat GERD include:

Antacids such as Tums

H2-receptor antagonists:

Cimetidine (Tagamet®) Famotidine (Pepcid® Nizatidine (Axid®) Ranitidine (Zantac®)