GERD

Esophageal stricture of the esophagus is believed to be the result of fibrosis, when inflammation and damage extend below the mucous membrane due to chronic gastroesophageal reflux. It seems that 11% of patients with gastroesophageal reflux disease develop strictures. Factors predisposing to the formation of stricture include prolonged gastroesophageal reflux, supine reflux, nasogastric intubation, duodenal ulcer, hypersecretory stomach conditions, conditions after gastrectomy, scleroderma, and treated achalasia.

Gastroesophageal reflux disease is a chronic disorder. It is important to educate the patients to modify their lifestyle and habits that may promote Gastroesophageal reflux and encourage them to adopt new habits that will bring long-term beneficial results. Frequent use of antacids and lozenges (e.g., every 2 hours) is recommended.

Acid-suppressive therapy is the mainstay of treatment for gastroesophageal reflux disease (GERD). Antacids, histamine2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) can be used in patients with GERD.

The prevalence of heartburn, the most common clinical manifestation of Gastroesophageal reflux, is difficult to determine. Most people consider this sensation normal and do not seek medical attention.

Bernstein test — A provocative test in which acid is infused into the lower esophagus, followed by a salt solution (saline control). Esophagitis: Esophagitis (inflammation of the esophagus) results from excessive reflux of gastric juice rather than excessive acid secretion.

Surgical therapy is generally undertaken when medical therapy is ineffective or not desired by the patient. Surgery to improve the barrier between the stomach and esophagus is an appropriate option if the patient has a mechanically defective cardia as defined by low LES (lower esophageal sphincter) pressure (<6 mmHg), short LES length (<2 cm) or short intra-abdominal LES segment (<1 cm).

OTC (over-the-counter) antacids and acid suppressants are appropriate initial patient-directed therapy for mild heartburn. Patients should be advised to take these agents when symptoms arise or if they anticipate symptoms after an activity that can promote heartburn (eg, a heavy meal, spicy food, alcohol consumption). Antacids have the most rapid onset of action, followed by H2RAs, while it may take one to four days to experience full symptom relief from OTC omeprazole.

Prescription therapies aimed at reducing acid secretion in patients with gastroesophageal reflux disease (GERD) are H2RAs and PPIs. Ample clinical evidence supports the superiority of acid suppression with proton pump inhibitors (PPIs) over other agents. A meta-analysis of 33 trials in over 3,000 patients revealed that symptomatic relief can be expected in 27% of placebo-treated, 60% of H2RA-treated, and 83% of PPI-treated patients.

Incidence/Prevalence in USA: 65% of adults have suffered heartburn; 24% have had symptoms for > 10 years. 17% of adults use indigestion aids at least once weekly, only 24% of sufferers have consulted a physician. Children affected 1/300-1000. 30-80% of pregnant women report heartburn. Mild to moderate disease: H2 blockers in equipotent oral doses, eg, cimetidine (Tagamet) 800 mg bid or 400 mg qid or ranitidine (Zantac) 150 bid orfamotidine (Pepcid) 20 mg bid or nizatidine (Axid) 150 mg bid.

Symptom relief should be the primary concern when selecting a strategy to manage gastroesophageal reflux disease (GERD). Healing erosive esophagitis is another important outcome in GERD, since reversing esophageal injury can prevent long-term complications. Speed of symptom relief is also important, especially in patients who choose on-demand or intermittent therapy.

Resolving symptoms and maintaining remission are primary goals of therapy (Table 3). Other therapeutic goals include esophageal healing in esophagitis, and preventing complications.

Many diagnostic tests and procedures can be performed to confirm gastroesophageal reflux disease (GERD) and establish disease severity, such as endoscopy, barium swallow tests, and ambulatory pH monitoring. However, pharmacists are often the first health professionals that patients approach to seek advice about heartburn relief.

If lifestyle changes do not effectively reduce symptoms, pharmacologic therapy is warranted. Pharmacologic therapy is designed to decrease the amount of acid that refluxes from the stomach back into the esophagus, increase gastrointestinal motility, or make the refluxed material less irritating to the lining of the esophagus by neutralizing the pH of the gastric acid.

Gastroesophageal reflux disease (GERD) is a common disorder that can be associated with serious complications, such as esophageal ulcerations, strictures, and adenocarcinoma. Pharmacists are often the first health care professionals approached for advice by patients experiencing symptoms of GERD.

Although proton pump inhibitors (PPIs) are the most expensive acid-reducing agents, it is important to assess all direct and indirect costs, such as loss of work productivity and impact on quality of life associated with the treatment of gastroesophageal reflux disease (GERD). Multiple pharmacoeconomic analyses have attempted to identify the best treatment strategy among step-down, step-up, intermittent, and on-demand treatment approaches.

Gastroesophageal reflux refers to the retrograde movement of gastric contents from the stomach into the esophagus. Gastroesophageal reflux disease refers to any symptomatic clinical condition or histologic alteration that results from episodes of gastroesophageal reflux. When the esophagus is repeatedly exposed to refluxed material for prolonged periods, inflammation of the esophagus (reflux esophagitis) can occur and in some cases it progresses to erosion of the esophagus (erosive esophagitis).

Gastroesophageal reflux disease (GERD) is often a chronic disease, with 80% of patients having a relapse of symptoms within one year after treatment withdrawal despite initial healing. The difficulty in maintaining remission is directly related to the extent of the damage before the initial treatment commenced. Due to the preponderance of complications associated with GERD, maintenance therapy with a minimal dose of a drug capable of relieving symptoms and healing the mucosa is an important issue.

When you think about someone with heartburn or gastroesophageal reflux, chances are you picture an adult. But some researchers now believe that as many as half of the infants born today have gastroesophageal reflux or GERD. D. moderated a panel discussion on pediatric gastroesophageal reflux at Digestive Disease Week in San Diego.