WELL Duquesne University Mylan School of Pharmacy
aware
UPDATE from the Pharmacy Care Awareness Program
March-April 2004
Gastroesophageal Reflux Disease-GERD More Common Than You Think! What is GERD?
Who is at risk?
Gastroesophageal reflux disease (GERD) is a disorder experienced by 5 to 7 percent of the world’s population. It affects men, women, and children in all age groups. GERD is a term given to a condition in which stomach acid flows back into the esophagus and causes irritation. This is why some people refer to GERD as “acid reflux” or heartburn. Over time, the presence of acid and other stomach contents can erode the lining of the esophagus and cause more serious complications. The most frequent symptoms of GERD are persistent heartburn and pain. These generally occur more than twice weekly. Other symptoms of GERD include: hoarseness, chronic cough, asthma, laryngitis, recurrent pneumonia, ear, nose and throat infections, nocturnal choking, sleep apnea, loss of dental enamel, and bad breath.
There are numerous factors that increase your risk for GERD. Some of these include age over 40, obesity, pregnancy, smoking, alcohol consumption, spicy foods, and certain medications. Certain medications, foods, etc. can also aggravate this condition. More details can be found on the Web sites provided at the end of the newsletter.
Complications of GERD If left untreated, GERD can lead to numerous health problems. Esophagitis occurs when the esophagus is inflamed and irritated due to repeated exposure to stomach acid. If esophagitis is not diagnosed and treated properly, it can lead to esophageal ulcers and even Barrett’s esophagus. Barrett’s esophagus is a change in the structure of cells lining the esophagus. This cellular change could potentially progress to cancer. GERD can also
cause stricture formation. A stricture is scar tissue that forms after chronic damage due to stomach acid. These strictures can interfere with eating and drinking by blocking the flow of food and liquid into the stomach.
Diagnosis When patients present with the classic symptoms of heartburn and pain, the diagnosis of GERD is generally apparent. Less common symptoms such as hoarseness, cough, or difficulty in swallowing require further diagnostic tests to rule out alternative conditions. Some of these tests include radiologic exams such as a barium swallow. This is performed to detect possible damage to the esophagus or the presence of a hiatal hernia that can produce or worsen GERD symptoms. A hiatal hernia occurs when a portion of the stomach bulges through the diaphragm. This permits gastric contents to more easily enter the esophagus resulting in the symptoms of GERD.
Upcoming Events Mark Your Calendar All events will be held in the Center for Pharmacy Care, Room 320 Bayer Learning Center, unless otherwise noted.
Center for Pharmacy Care ■
New Hours!
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9:00 a.m. - 1:00 p.m. The Center will be open on the following Mondays: March 1, 15, 22 & 29 and April 19 & 26 and will be offering these complimentary screenings: Bone Density, Lung Function Testing, Body Composition Analysis, Facial Skin Analysis, and Cholesterol. Please call 412.396.5874 for an appointment.
MARCH – National Nutrition Month • March 3, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • March 17, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • March 24, 2004, 11:00 a.m.-1:00 p.m. Blood Pressure Check-Up Location: Union, 3rd Floor Concourse
• April 21, 2004, 10:00 a.m.-2:00 p.m. Body Composition Analysis Derma-View Facial Skin Analysis Location: Union, 4th FloorEmployee Benefits Fair • April 28, 2004, 11:00 a.m.-1:00 p.m. Blood Pressure Check-Up Location: Union, 3rd Floor Concourse
APRIL – Irritable Bowel Syndrome Awareness Month • April 7, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • April 14, 2004, 9:00 a.m.-1:00 p.m. Cholesterol Screening Blood Pressure Check-Up
Call x5874 to RSVP for screenings and lunchtime lectures.
www.duq.edu
Suggested Treatments... Non-Drug Treatment
■ TABLE ONE
Available Medications for the Treatment of GERD Antacids
H2-Antagonists (Rx & OTC)
Proton-Pump Inhibitors(Rx only)
aluminum and magnesiumcontaining products (Maalox®, Gaviscon®, Mylanta®, etc.)
Zantac® (ranitidine)
Prilosec® (omeprazole) (Prilosec OTC® is available over-the-counter)
calcium carbonate (Tums®, Rolaids®)
Pepcid® (famotidine)
Nexium® (esomeprazole)
sodium bicarbonate
Tagamet® (cimetidine)
Prevacid® (lansoprazole)
Axid® (nizatidine)
Protonix® (pantoprazole)
There are various ways to manage GERD symptoms without resorting to medications. Changes in lifestyle can make a world of difference in preventing heartburn and GERD. Lifestyle changes such as diet, smoking cessation, and proper sleep technique are listed in Table 2. ■ TABLE TWO
Aciphex® (rabeprazole)
Pharmacologic Treatment Table 1 lists numerous treatment options for patients who suffer from heartburn and GERD. The first option is antacids (Maalox®, Mylanta®, etc.). These are available without a prescription and can be used for immediate relief of mild to moderate heartburn. Antacids can be used on an as-needed basis; however, ask your doctor or pharmacist before beginning antacid therapy if you are also taking prescription drugs. Antacids can interfere with the absorption of some medications. Occasionally they may produce diarrhea or constipation. Another treatment option for GERD is a group of drugs known as H2-antagonists. A subtype of histamine known as histamine2 (H2) plays a key role in acid release from some cells in the stomach. Drugs like cimetidine (Tagamet®), ranitidine (Zantac®), or famotidine (Pepcid®) block the site on stomach cells where H2 attaches; thus, these drugs are called H2-blockers or antagonists. By decreasing the concentration of acid, these agents reduce the pain associated with reflux of gastric contents. H2-antagonists have been used for several years and typically produce few side effects. They are available in over-the-counter (OTC) and prescription strengths. Cimetidine has the potential to interact with more medications than the other drugs in this class.
The newest class of drugs to treat GERD is known as the proton-pump inhibitors (PPI’s). These medications shut off “pumps” that release stomach acid. These products are not indicated for immediate relief, but for longterm control. Most of the medications in this category are available by prescription only. Prilosec OTC® has recently been approved for the self-treatment of frequent heartburn. Remember, antacids and H2-antagonists will usually produce faster symptom relief than PPI’s. Prilosec OTC® is only indicated for a fourteen-day course of treatment that may subsequently be repeated in four months. Symptoms lasting longer than fourteen days may indicate a more chronic problem requiring physician evaluation.
Newsletter Contributors
• www.gerd.com • www.aboutgerd.com • www.diagnosishealth.com/gerd.htm • www.gicare.com/pated/ecdgs39.htm
Avoid consumption of foods such as caffeine, chocolate, alcohol, carbonated beverages, citrus fruits, peppermint, and spicy foods Lose weight if you are obese Avoid wearing tightfitting garments (they increase pressure on the abdomen) Eat smaller, more frequent meals
Elevate head of bead at least 6 inches (you can use wooden blocks underneath legs of the head of the bed or a foam wedge under the head of the mattress) Do not eat 3-4 hours before bedtime Do not lie down immediately after eating If you smoke, quit
GERD is an extremely common condition; however, the proper use of various prescription and OTC drugs usually provides symptomatic relief. Attention to lifestyle factors can also have a positive impact in reducing the frequency of pain and heartburn associated with this disorder.
A publication of the Duquesne University Mylan School of Pharmacy
John G. Lech, Pharm.D. David E. Nichols, Pharm.D. Candidate Tara L. Abbondanza, Pharm.D. Candidate
For more information on GERD check out the following Web sites:
Lifestyle Modifications
Pharmacy Care Awareness Program (PCAP) & Pharmaceutical Information Center (PIC) Additional information on any of the topics discussed may be obtained from the Pharmaceutical Information Center by calling 412-396-4600 or sending an e-mail to pic@duq.edu. Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417 2/04 1.5M DIH