Download GASTROESOPHAGEAT REFTUX DTSEASE (GERD) Whqt is GERD

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American College of Gastroenterology
Digestiue Disease Specialists Committed to Quality in Patient Care
Common Gastrointestinal Problems
A Consumer Heolth Guide
GASTROESOPHAGEAT REFTUX DTSEASE (GERD)
Whqt is GERD or Hesrtburn?
Gastroesophageal refluxrefers to thebaclnvard flow ofacid
from the stomach up into the esophagus. Peoplewill experience
heartbum, also known as acid indigestion, when excessive
amounts of acid refluxinto the esophagus. Mostpeople describe
heartbum as afeeling of buming chestpain, localized behind the
breastbone that moves up toward the neckand throat. Some
evenexperiencethebitterorsourtasteoftheacidintheback
.
.
v Dysphagia A feeling that food is trapped behind the
breastbone.
v Bleeding Vomiting blood ortarry, blackbowel
movements.
v Choking Sensationofacidrefluxedintothe
windpipe causing shortness of
breath, coughing, hoarseness of thevoice.
.
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How common is
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Your ooctor may wlsn to evaluate your symploms
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GERD? ,. :jlHHrjffI.ffit.l;ni:t}f?;*:'*sffll3jitrl;?
Over 60 millionAmericans experience acid indigestionat
CSffDsuihasdysphagi4bleedi.,g, choki.,g, orifyoursymp[oms
leastonce amonthand some studieshave suggestedthatover failtoimprovewithprescriptionmedications.yourdoctormay
15 million Americans experience acid indigestion daily.
Symptoms of acid indigestion are more common among the
elderly and women during pregnancy.
Are
GERD?
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decide to conduct one or more of the following tests.
v
or'
Baium Esophagram or tlpper
GI
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lifestyles and proper use of over-the- t
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In many cases, doctors find that acid indigestion can
controlled by modifuing
.
.
Endoscopy
countermedicines.
This test involves insertion of a small lighted flexible tube
v Avoid foods and beverages which contribute to acid . throughthemouthintotheesophagusandsltomachtoexamine
indigestion: chocolate, coffee, pepperminf greasy or spicy forabnormalities. Thetestisusuillyperformed
foods, tomato products and alcoholic beverages.
. with the aid of sedatives.
v Stop smoking. Tobacco inhibits salivawhich is the body's
major buffer. Some studies have concluded that tobacco ' t EsophagealManometryorEsophagealpH
stimulates stomach acid production and relaxes the muscle . ttris test iivolves insertin"g a smai Reilte [uUe through the
betweentheesophagusandthestomach,permittingacidreflux nose into the esophagus and stomach in order to measure
to occur'
. pressures and function of the esophagus. With this test, the
V Reduce weight if obese.
degree ofacid refluxed into the esophagus can be measured as
v Avoid eating 2-3 hours before sleep.
well.
v Take an over-the-counterantacid oran Hr-blocker, some : ^
ofwhicharenowavailablewithoutaprescription. SUfgefy
Surgeons perform anti-reflux surgery on patients with
.
When ShOUld
YOU See q
longstandinggastroesophagealrefluxdiseasenotcontrolled
qbOni
D6CtOf
GEnD?
Whensymptoms ofacidindigiestionarenotcontuolledwith . ]lth ledication' Thesurgicaltechniqueattempts to improve
modifications in lifestyle, and ovEr-the-count.r-.oi.i".i'*. thenaturalbanierbetweenthestomachandtheesophagusthat
' prevents acid reflux from occurrin$'
needed more often than twice a weeh, yo, shorld-i;;G;
doctor.
WhenGERDisleftuntreatedserious,complicationscan.
MediCOliOnS Often PreSCribed
occur,suchasseverechestpainthatcanmimicaheartattaclE
fOf GERD
esophageal strichrre (a narowing or obstruction of the '
PrescriptionmedicationstotreatGERDandulcersinclude
esophagus), bleeding, orBanett's esophagus (apre-malignant . drugs calledH, receptorantagonists (Hr-blockers) andproton
conditionoftheesophagus). Symptomssuggestingthatserious puripinhibitolrswhichhelpt6reducetliestomachacidwhich
damage has already occurred include:
For More lnformotion obout Digesiive Heolth ond Gl Conditions
Coll the Americon College o{ Gostroenterology Hotline oi l-800-978-7666
or visit our Website ot http://www.ocg.gi.org
Whqt Everyone Should Know About
GASTROESOPHAGEAL REFLUX DTSEASE (GERD).
tends to exacerbate symptoms, and work to promote healing,
as well as promotility agents which aid in the clearance of acid
from the esophagus.
Hr-Receptor
Antogonists
-
Since the mid-1970's H,-receptor antagonists have been
used to treat GERD and ulce-r disease. In GERD, H,-receptor
antagonists improve the symptoms of heartb-urn and
regurgitation and heal mild-to-moderate esophagitis.
Symptoms are eliminated in somewhat
ov
er 50o/o of patients
with twice a day prescription dosage of the Hr-receptor
antagonists. Healing of esophagitis may require higherdosing.
These aglents maintain remission in about 25% of patients.
Hr-receptorantagonists are generally less expensive than
proton pump inhibitors and provide adequate, cost-effective
approaches as the firstJine treatment as well as maintenance
agents in GERD and ulcer disease. In mid-1995, the FDA
approved availability of some Hr-blockers without prescription
in dosage levels appropriate for treatment of heartbum.
Prolon Pump lnhibitors
Protonpumpinhibitors (PPIs),suchas omeprazole, and
more recently lansoprazole, have been found to heal erosive
esophagitis (serious forms of GERD) more rapidly than H,
receptor antagonists. PPIs provide not only symptom relie{
butalso symptom resolution in most cases, even in thosewith
esophageal ulcers. Studies have shown PPI therapy can
provide complete endoscopic mucosal healing of esophagitis
at 6 to 8 week in 7 5o/o to 1 00% of cases. Daily PPI treatment
provides the best long-term maintenance of esophagitis,
particularly in keeping symptoms and disease in remission for
those patients with moderate-to-severe esophagitis, plus this
form of treatmenthas been shown to retain remission forup
to five years.
are effective in the
.Over-the-Counler
'Medicotions
Large numbers of Americans use over-the-counter
antacids and other agents that are available without a
prescription to treat minor GI discomforts, infreqr4ent
heartbum or acid indigestion. Recenfly, FDA approved the
non-prescription availability of important acid suppression
agents, call H,-blockers (Tagamet Pepsid, Zantac andAxid alrlady available at certain dosages for OTC uses,
others are expected to be available soon) for tueatment of
heartbum. Over-the-counterantacids alone accountfor over
$1 billion in sales peryear. Early indications are that
over-the-counter Hr-blockers will also account for major
consumerpurchases.
Over-the-counter medications have an important role
in providingi relief from heartbum and other occasional GI
discomfor.ts. More frequent episodes of heartbum or acid
indigestion may be a symptom of a more serious condition
which could worsen if not treated. If you are using an
over-the-counterproductmore than twice awee[ you should
consultaphysicianwho canconlirmaspecificdiagnosis and
treatment plan with you.
- some are
Americon College
Promoliliry Agents
Promotility drugs
patients on contraindicated medications or in patients with
contraindicated medical conditions, such as underlying heart
disease. In March of 2 000, the manufacturer announced that
it had reached a decision in consultation with the FDA to
discontinue the marketing of the drug. The product will
remain available only througfi a limited-access program. This
progr?rm has been established for patients who fail other
treatment options and who meet clearly defined eligibility
criteria.
of
Gostroenlerology
4900 B South 3lsi
treatment of mild to
moderately symptomatic GERD. These drugs increase lower
esophagieal sphincter pressure, which helps prevent acid
reflux, and improves the movementof food from thestomach.
They decrease heartbum symptoms, especially at nigfit, by
improving the clearance of acid from the esophagus. Recent
developments have greatly limited the availability of one of
theseagents, i.e. cisapride. Cisapridehadbeenusedwidely for
several years in treatingi night-time hearlbum and was also
used by somepractitioners intreatmentof GERD symptoms
in children. More recenfly, rare but potentially serious
complications have been reported in some patients taking
cisapride. These complications seem to be related to usage in
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