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pharmacy

Treating GERD
Treating GERD If looking for relief of mild, occasional heartburn, the first available treatment option is the antacids.

Frequently pharmacists are approached for help in treating heartburn. Heartburn, a symptom of Gastresophageal Reflux Disease or GERD, allows stomach acid to splash back up into the esophagus. The acid causes a burning sensation and can result in some inflammation to the esophagus as well. Some patients detect a sour taste in the back of their mouths lending to the term “sour stomach.”

Acid reflux, heartburn, and sour stomach may be due to one of several factors including diet, obesity, stress, smoking, and medications. Decreased muscle tone of the lower esophageal sphincter, or valve at the opening to the stomach, may also be the cause. But for the most part, patients know what the causative factor of their heartburn is, and lifestyle modifications to help relieve the symptoms such as diet change, weight loss, and smoking cessation have already been attempted. If looking for relief of mild, occasional heartburn, the first and oldest available treatment option is the antacids. Antacids neutralize stomach acid on contact and the effect is almost immediate. Chewable and liquid formulations are the quickest acting and can easily be found in your local drugstore. The most common products include: Tums® or Rolaids®, (calcium carbonate), and Maalox® or Mylanta® (magnesium hydroxide and aluminum hydroxide). As stated above, the effect of these products is fast, but unfortunately, it is short lived and patients may find themselves needing a dose every one or two hours to obtain relief. This repeated dosing may lead to other problems with side effects such as constipation associated with calcium carbonate or diarrhea with magnesium formulations. Therefore, a longer acting product may be sought to attain sufficient acid control.

Alginates are also effective over-the-counter acid reflux relievers. Alginates work by forming a protective barrier over the stomach contents that helps to block the acid from being splashed back into the esophagus. These medications relieve heartburn for a bit longer than the traditional antacids. An example of an alginate is Gaviscon®.

Next in line for the treatment of mild to moderate heartburn are the histamine 2 receptor antagonists (H2RA). These drugs inhibit acid secretion in the stomach. Their action is reversible, yet very effective, for the treatment of heartburn and relief may last as long as twelve hours. They can be taken for symptomatic relief, on an “as needed” basis, or they can be taken thirty to sixty minutes prior to a meal to prevent acid reflux or heartburn. These products have had over-the-counter status for a while, but higher dosages are also available by prescription. They are typically taken twice daily. Examples of H2RA’s include: Tagamet® (cimetidine), Zantac® (ranitidine), Pepcid® (famotidine), and Axid® (nizatidine).

Finally, the newest class of medications available for acid reflux relief is the proton pump inhibitors (PPI’s). PPI’s directly and irreversibly block the pathway for acid secretion into the stomach and therefore are considered the most efficacious products for treating acid reflux. These compounds have even been shown to heal the lining of the stomach and esophagus. Unlike the antacids, relief is not obtained immediately, yet they are the longest-acting medications used for this purpose. Commonly, once daily dosing at least thirty minutes before breakfast is sufficient. There are two PPI’s available over-the-counter. Those are Prilosec® and Prevacid®. All other PPI’s are available only by prescription. These include: Protonix® (pantoprazole), Nexium® (esomeprazole), Aciphex® (rabeprazole), and Zegerid® (omeprazole/sodium bicarbonate).

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"Treating GERD"
   authored by:
PHARMACY
Tamara Dulin, R.Ph., is a registered pharmacist with Nightingale Home Health Care in Carmel, Indiana. A 1991 graduate of Butler University College of Pharmacy, she has spent the majority of her career in consulting. She is a past president of the Ind...



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