GERD

 
Key points to know :
 
This is a condition when the normal acid produced in the stomach refluxes up to the feeding tube (known as?esophagus) and causes a lot of symptoms.
 
Symptoms include heartburn (burning sensation starting from the pit of the stomach and going up to the chest or neck), difficulty swallowing, gas, bloating. These symptoms often get worse with certain kinds of food, lying down, heavy meals.
 
Some patients may also present with other symptoms include a sticking sensation in the throat, asthma, hoarseness of the voice or bad breath.
 
The disease can lead to a condition called?Barretts esophagus. This is a pre-cancerous condition which can lead to esophageal cancer.
 
Other complications that can occur include ulceration, bleeding, stricture (narrowing of the esophagus).
 
Patients often need a test called?upper endoscopy, or 24 hour pH and / or X ray investigation.
 
Treatment involves dietary changes and life style changes. Often times patients need medications.
 
Dietary changes include avoiding soda or pop, eating small more frequent meals, avoiding fried fatty meals, avoiding tomatoes, caffeinated products, mints, chocolate
 
Life style changes include elevation of the head end of the bed, not eating meals 3 hours prior to sleeping.
 

Treatment includes using antacids, over the counter medicines such as?Zantac, Pepcid, Axid or Tagamet, prescription medicines including?H 2 blockers and?proton pump inhibitors. (See section of medicine).

 

Heartburn:

            Avoid irritants such as tomato sauce, spicy and fatty foods, fried foods, citrus fruits, chocolates, alcohol, coffee, caffeine, and cigarettes. Eat small frequent meals. Do not lie down immediately after meals. Avoid tight fitting clothes. Medicines work best if taken 30 mins. before a meal.

Bloating:

Avoid milk, cheese, fruits, potatoes, broccoli, cabbage, asparagus, cauliflower, beans, potatoes and corn.

Avoid artificial sweeteners (like that present in sugar free candies, chewing gum) soda and high fructose corn syrup.

            Avoid mouth breathing.

            Soluble fibers like that present in oats, barley, legumes, etc can cause more bloating.

            Peppermint Tablet (To be swallowed not sucked on – available at GNC stores)           

            Align or VSL #3 (probiotics)

         Iberogast    Iberogast 20 drops tid.  It is available online from amazon and other web pages.  This has been shown to be helpful by anecodatal reports and is not FDA approved.  I have discussedthis with the patient.  It has been helpful for bloating.  The side effects of Iberogast include allergic reaction to Chamomile (including anaphylaxis) and side effects of Liquorice which includes myocardial infarction, water retention, pseudohypoaldosternoism, headaches, fatigue and hypertension.  Moreover it contains some alcohol. 

Side effect of medications used for GERD / Heartburn treatment.

This is far from complete. Please contact your pharmacist or physician for additional information.

PPI: The drugs included in this is Nexium, Prevacid (Lansoprazole), Prilosec, Omeprazole, Protonix, and Aciphex. The new concerns with these medications include: increased incidence of wrist and hip fractures from osteoporosis (thinning of the bone), increased chance of pneumonias, bowel infection called C-Diff and low magnesium levels. Anyone on the medication for more than one year should get their magnesium level checked. Please contact your primary care for evaluation of osteoporosis.

 

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