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.

Causes? Irritants: tomato sauce, spicy and fatty foods, fried foods, citrus fruits, chocolates, alcohol, caffeine, cigarettes

Treatment?

  • Lifestyle
  • Exercise and weight loss
  • Control diet (limit intake of irritants listed above)
  • Avoid tight fitting clothes
  • DO NOT lie down immediately after meals

Medications:

PPI: a class of medications used to treat GERD/heartburn

How to take? Take 30 minutes prior to breakfast

Types of PPI:

  • Nexium (Esomeprazole)
  • Prevacid (Lansoprazole)
  • Prilosec (Omeprazole)
  • Protonix (Pantoprazole)
  • Dexilant (Dexlansoprazole)
  • Aciphex (Rabeprazole)

Drug Interactions: DO NOT TAKE OMEPRAZOLE AND NEXIUM WITH PLAVIX

Side effects of PPI:

  • Increased incidence of wrist, spine, and hip fractures from osteoporosis (thinning of the bone). Contact your primary care physician for evaluation of bone density.
  • Increased chance of infections such as pneumonia and a bowel infection called C.diff.
  • Nephritis (kidney inflammation)
  • Questionable risk of coronary events and memory loss / dementia
  • Low magnesium levels. Anyone taking these medications for more than one year should get their magnesium levels checked.
  • Contact your pharmacist for a complete list of risks.

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.