GERD can be a tough condition to live with. But with proper care and maintenance you can minimize symptoms and future complications. Luckily, lifestyle changes can play a dramatic role in reducing the symptoms and complications related to GERD.
Gastroesophageal reflux disease or GERD is a chronic digestive disease where patients have reduced lower esophageal sphincter (LES) pressure and stomach content can backflow into the esophagus. The most common symptoms of GERD are daytime or nighttime heartburn, too much saliva in the mouth (hypersalivation) and regurgitation.
The less common symptoms include nausea, sore throat, epigastric pain, cough or chest pain. GERD is usually diagnosed based on the symptoms reported by the patient, frequency of those symptoms and other risk factors such as family history and eating habits.
Pharmacists play a big role in the treatment of GERD as most patients tend to self-treat GERD symptoms. The principles of GERD treatment include lifestyle modification, initial treatment with proton pump inhibitors or histamine-2 receptor antagonists and maintenance treatment if symptoms are persistent.
Lifestyle modifications include weight loss, avoid eating fatty meals 2 to 3 hours prior to bedtime, avoid food and drinks such as chocolate, caffeine, spicy food, carbonated beverages that can trigger reflux and it is recommended to elevate the head of the bed with foam wedges or blocks to help with regurgitation.
Weight loss has the best evidence for improvement of symptoms. Drugs that can worsen GERD symptoms include NSAIDs (Ibuprofen), Fish oil containing products, Iron supplements, Steroids, Estrogen containing products and others.
The symptoms are treated with Antacids which work by neutralizing gastric acid and the commonly available products on the market include Tums, Mylanta and Maalox. These products are available as suspension, chewable tablets and capsules. The most effective medications for GERD are proton pump inhibitors (PPIs) which work by blocking gastric acid secretion. All PPIs are equally effective and an eight week course of treatment is recommended for relief of symptoms and to heal the erosion. If PPIs are used for maintenance therapy long-term, the lowest effective dose should be used.
Some examples of PPIs are Esomeprazole (Nexium), Lansoprazole (Prevacid), Dexlansoprazole (Dexilant) and (Omeprazole + sodium bicarbonate (Zegrid). PPIs are available with prescription or without prescription over the counter depending on the strength. Consult with your primary care provider prior to starting any medications.
Other medications used for the treatment of GERD are Histamine-2 receptor antagonists (H2RAs). They are used as needed for mild heartburn and can be used as maintenance therapy for GERD in patients without esophageal erosion. Commonly available H2RAs medications are Famotidine (Pepcid) and Ranitidine (Zantec). Similar to PPIs they are available with or without prescription depending on the strength.
GERD can decrease quality of life and can lead to esophageal erosion and other complications if symptoms are not treated at their earliest onset. In severe cases endoscopy can be performed to further investigate the problem.