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Lifestyle Modifications
Suggested for Patients with
GERD
- Reduce the size of meals
- Avoid eating for a minimum of 3
hours before retiring
Useful Sites and Resources
American Gastroenterological
Association website: www.gastro.org
Johnson & Johnson/Merck Consumer
Pharmaceuticals co.
www.pepcidcomplete.com
- 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)
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: www.gastro.org
Johnson & Johnson/Merck consumer
Pharmaceuticals co. www.pepcidcomplete.com
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.
SYMPTOMS
RISK FACTORS FOR GERD
HEARTBURN is the most common
health-related complaints made by
persons who are otherwise considered
healthy
-
Age > 50 years
-
Obesity
-
Alcohol
-
Smoking
-
Coffee consumption
-
Citrus fruit juices
GERD disrupts quality of life more than
conditions such as congestive heart
failure and hypertension.
Patients commonly seek advice from
pharmacists concerning the use of
antacids and histamine H2 receptor
antagonists.
-
Foods such as fat, onion, chocolate
-
Medications such as dopamine,
morphine, anticholinergics, CCB,
meperidine, diazepam, theophylline
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
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
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?
Therapeutic Approaches to the Patient
with GERD
Patients should be referred for
consultation, endoscopy, or surgery if:
OTC Medications frequently used to
treat GERD include:
i.
They have persistent heartburn
symptoms everyday
Antacids such as Tums
ii.
They have difficulty swallowing
and pain swallowing
iii.
Their symptoms are not relieved
by high doses of antacids and H2
blockers
H2-receptor antagonists:
Cimetidine (Tagamet®)
Famotidine (Pepcid®
Nizatidine (Axid®)
Ranitidine (Zantac®)