November 21-27 is GERD Awareness Week. By Our Student Pharmacist, Khoi Dang.

November 21st, 2021

The upcoming week, November 21 to 27, is GERD Awareness Week, so I want to give you some information about GERD.

GERD (gastroesophageal reflux disease, or chronic reflux disease) is a condition where acid in your stomach leaks back to the esophagus (the tube in your throat) causing a burning sensation (heart burn). If this happens for a long period of time, the esophagus will be damaged.

GERD is usually caused by the damaged esophageal sphincter, which can not close as it is supposed to, creating a back flow of stomach acid.

Keep in mind that having heart burn or acid reflux does not mean that you have GERD, since everybody will experience heart burn now and then. However, if you experience heart burn more than twice weekly, discuss with your doctor since that may be a sign for GERD.

GERD is very common. About 20% of the US population has GERD.

Some risk factors of getting GERD are:

Age: >40 years
Obese or overweight
Pregnant
Smoking (including secondhand smoke)
Medications that cause GERD:
- Iron supplements
- Potassium
- Antibiotics: especially tetracyclines and clindamycin
- Bisphosphonates (osteoporosis medications) which include:
  - alendronate (Fosamax)
  - ibandronate (Boniva)
  - risedronate (Actonel, Atelvia)

Symptoms of GERD include:

Heart burn
Regurgitation (food comes back into your mouth from the esophagus)
The feeling of food caught in your throat
Coughing
Chest pain
Problems swallowing
Vomiting
Sore throat and hoarseness

***Keep in mind that people often confuse the chest pain from a heart attack with that from heart burn. The image above from the University of Washington Medicine does a very good job of comparing the symptoms of heart burn and heart attack.

Treatment options:

Lifestyle modification:
- Lose weight if you’re overweight or obese.
- Elevate your head during sleep by placing a foam wedge or extra pillows under your head and upper back to incline your body and raise your head off your bed 6 to 8 inches.
- Have the last meal of the day about two hours before bedtime.
- Quit smoking, if you smoke.
- Reduce consumption of foods that can cause GERD including:
  - acidic foods, such as citrus fruits and tomatoes
  - alcoholic drinks
  - chocolate
  - coffee and other sources of caffeine
  - high-fat foods
  - mint
  - spicy foods
- Take medications that help with heart burn and reduce acid:
  - Antacids: mild heart burn can be relieved by taking antacids; however, antacids should not be used on a regular basis without the advice of doctors. Antacids could decrease the absorption of some medications such as levothyroxine, ciprofloxacin, etc…, so they should be taken about two hours apart from these medications.
  - H2 blockers: famotidine (Pepcid) is preferred over cimetidine (Tagamet) because it has fewer drug interactions. These medications could help lower the amount of acid in your stomach.
  - Proton Pump Inhibitors (PPI) including pantoprazole (Protonix), omeprazole (Prilosec), lansoprazole (Prevacid): These medications could lower the acid in your stomach much better than H2 blockers; however, they need about 2-3 days until you feel the difference. PPIs should not be taken for more than 14 days unless instructed otherwise by your doctor. Studies have shown that taking PPIs for a long period of time could increase the risk of fracture and clostridium difficile (C. diff ) infections.