US Pharm. 2020;45(12):15-16.


When Heartburn Persists

Gastroesophageal reflux is a condition in which acid from the stomach flows back up (refluxes) into the esophagus and causes heartburn. Although everyone has experienced heartburn occasionally after eating a large meal or spicy foods, when these symptoms continue over a long period of time, it is known as gastroesophageal reflux disease (GERD). The condition can affect people of all ages and is often overlooked in infants and children as a primary cause of chronic cough, hoarseness, feeding problems, and asthma. GERD can lead to inflammation of the esophageal tissue, precancerous changes in the esophageal lining, and even esophageal cancer if left untreated.

Some Food and Medications Can Exacerbate GERD

GERD’s most common physical causes include a weakened lower esophageal sphincter (LES) muscle, hiatal hernia, slow stomach emptying, and problems with contractions (motility) of the esophagus. Factors that increase the risk of GERD or make it worse include obesity, pregnancy, and smoking. Some foods exacerbate symptoms, including spicy foods, acidic foods (tomatoes or orange juice), caffeine, carbonated beverages, fatty foods, alcohol, and peppermint. Many medications can worsen GERD symptoms as well.

Common symptoms of GERD include heartburn, nausea after eating, or a feeling that food is trapped behind the breastbone after swallowing. Less common symptoms include hoarseness, asthma or chronic cough, sore throat, and postnasal drip. Chest pain from GERD can be sharp and stabbing, mimicking a heart attack. Difficulty in swallowing or painful swallowing, vomiting with or without blood, weight loss, hoarseness, coughing, and wheezing are all symptoms that signal a more serious problem and require evaluation by a physician.

A Combination of Lifestyle Changes and Medications

A definitive diagnosis of GERD can be made with specific testing—such as endoscopy—but invasive tests are unnecessary if symptoms are not severe. For some people with GERD, lifestyle changes can have a significant impact on symptoms. Since everyone has different triggers for symptoms of GERD, it is important to keep a 1- or 2-week diary of symptoms and their severity. Many people can identify the foods that worsen symptoms and successfully avoid those foods. Eating smaller, more frequent meals may help. Weight loss is an important lifestyle change that can improve GERD, since abdominal obesity or tight-fitting clothes can cause the stomach contents to push upward and reflux into the esophagus. For nighttime symptoms, it is recommended not to eat for 2 to 3 hours before bedtime. Smoking cessation is also recommended for people with GERD because smoking relaxes the LES muscle and increases reflux.

Management With OTC and Prescription Medication

Medications used to treat GERD symptoms include antacids, histamine-2 (H2) blockers, and proton pump inhibitors (PPIs). Antacids such as Maalox and Mylanta work quickly to relieve pain by neutralizing acid in the stomach. However, they are short-acting, so they must be taken frequently. H2 blockers, such as Tagamet and Pepcid, work more slowly but last longer by reducing acid production. They are available in nonprescription and prescription strengths. Recently, the OTC H2 blocker Zantac was removed from the market because it was found to contain cancer-causing agents. PPIs block acid formation in the stomach, and examples include Nexium, Prilosec, Protonix, Aciphex, Prevacid, and Dexilant. These drugs are the most effective for treating the symptoms of GERD, and some are available without a prescription. Prescription-strength PPIs are the only medications proven to heal esophagitis, an inflammation of the esophageal lining. In some people, a combination of agents is effective for symptom relief.

Surgery as a Last Resort

If symptoms do not improve, physicians may recommend surgery to improve GERD symptoms and esophageal damage. The most commonly performed minimally invasive surgery for GERD is fundoplication, where the surgeon sews around the area where the stomach and esophagus meet. Surgery may have more complications than the medications used to treat GERD.

If you have questions about GERD or the medications used to treat it, reach out to your local pharmacist or another healthcare practitioner.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.