Do you have GERD?

Roughly 18 to 26% of Americans have GERD, and the majority are adults between the ages of 30 to 60 years. GERD is a short for gastroesophageal reflux disease, a condition where stomach fluid (acid) backs up into the esophagus (the tube connecting the mouth and the stomach) and causes aggravating symptoms.

Other names that you may have heard for GERD are acid reflux or heartburn. Often acid reflux is caused by muscle weakness of the lower esophageal sphincter, a valve that lets food and drinks into the stomach. ^[1,2,6]

What are the symptoms of GERD?

Symptoms are typically present after eating and can be different from person to person. The most common ones are: ^[1,6]

• Heartburn or burning in the chest
• Sour taste or burning feeling in the throat
• Stomach pain
• Difficulty swallowing food or choking
• Sore throat or hoarse voice
• Cough that is not relived by anything
• Spitting up
• Frequent burping
• Asthma

How is GERD treated?

Treatment of acid reflux include lifestyle changes, antacids such as Tums, or stronger stomach acid suppressants like histamine 2 receptor antagonists (H₂RAs) or proton pump inhibitors (PPIs). ^[2,3]

Changes to diet or lifestyle can help control symptoms of heartburn and the following changes can be helpful: ^[2,3,4]

• Stay away from foods and beverages that can lead to acid reflux or heartburn. Foods and beverages like: coffee, alcohol, chocolate, fatty foods, spicy foods, and citrus fruits/juices
• Raise the head of your bed 6 to 8 inches
• Try eating smaller portions and avoid sleeping or lying down within 3 hours of eating a meal
• Lose weight. Being overweight can contribute to GERD
• Stop cigarette smoking
• Wear loose fitting clothes

Do Antacids Treat GERD?

Antacids work by neutralizing or reducing the acidity of the stomach. They are used for milder symptoms and are taken as symptoms occur to relieve heartburn symptoms.  These drugs can affect the absorption of other drugs. Always ask your pharmacist to check for interactions with your current medications as well as how and when to take them.^[4]

What Other Drugs Can Treat GERD?

Histamine 2 receptor antagonists (H₂RAs) work by suppressing acid secretion in the stomach. They are stronger than antacids in controlling heartburn symptoms. Overall, they are very well tolerated.^[3]

Proton pump inhibitors (PPIs) also work by suppressing acid secretion in the stomach. They are used when heartburn symptoms are not well controlled by H₂Ras or when symptoms are troublesome affecting quality of life.

PPIs work best when taken on empty stomach half an hour before the first meal of the day. PPIs may alter the way some drugs work. Ask your pharmacist or doctor to check for interactions with your current medications before taking them.^[5]

Medicine Type	Generic Name	Regulatory Status	Brand Name
Antacids	Calcium Carbonate	OTC	Tums
	Aluminum hydroxide, magnesium oxide and simethicone	OTC	Maalox
Histamine 2 receptor antagonists	Cimetidine	OTC	Tagamet
	Famotidine	OTC	Pepcid
	Nizatidine	OTC	Axid
	Ranitidine	OTC	Zantac
Proton Pump Inhibitors (PPIs)	Esomeprazole	Rx	Nexium
	Dexlansoprazole	Rx	Dexilant
	Lansoprazole	15mg – OTC	Prevacid
	Omeprazole	OTC	Prilosec
	Omeprazole + sodium bicarbonate	OTC	Zegerid
	Pantoprazole	Rx	Protonix
	Rabeprazole	Rx	Aciphex

OTC = over the counter (without prescription); Rx = prescription only; * Regulatory status obtained from FDA website [7]

All antacids and H₂RAs are available over the counter whereas this would only apply to some PPIs. Sometimes these medicines are cheaper without a prescription. If cost is a concern for you ask your pharmacist to help you find ways to reduce your medication cost.^[7]

References:

1. Gastroesophageal Reflux Disease (GERD). In DynaMed Plus [database online]. EBSCO Information Services. http://www.dynamed.com.proxy.hsl.ucdenver.edu/topics/dmp~AN~T116914/Gastroesophageal-reflux-disease-GERD. Updated April 26, 2019. Accessed on 8/8/10/2019
2. Patient education: Acid reflux (Gastroesophageal Reflux Disease) in adults. The Basics. In: UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited date unknown). Available from  https://www-uptodate-com. Accessed on 8/10/2019
3. Kahrilas PJ. Medical management of gastroesophageal reflux disease in adults. In: Talley NJ & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 28, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
4. Vakil NB. Antiulcer medications: Mechanism of action, pharmacology, and side effects. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited March 22, 2018]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
5. Wolfe MM. Proton pump inhibitors: Overview of use and adverse effects in the treatment of acid related disorders. In: Feldman M & Grover S (Editors). UpToDate. [Internet]. Published place unknown: UpToDate; 2019 [cited Nov 29, 2017]. Available from: https://www-uptodate-com. Accessed on 9/10/2019
6. Kahrilas PJ, Shaheen NJ, Vaezi MF, et al. American Gastroenterological Association Medical Position Statement on the Management of Gastroesophageal Reflux Disease. Gastroenterology. 2008 Oct;135(4):1383-1391
7. Over-The-Counter (OTC) Heartburn Treatment. U.S. Food & Drug Admiration. https://www.fda.gov/drugs/drug-information-consumers/over-counter-otc-heartburn-treatment. Published date unknown. Updated on March 5, 2018. Accessed 8/10/2019