Gastroesophageal Reflux Disease (GERD) Quiz

Gastroesophageal Reflux Disease (GERD)

• GERD is the reflux of stomach contents, including hydrochloric acid (HCl), into the esophagus due to relaxation of the lower esophageal sphincter.
• Common symptoms of GERD include heartburn, chest pain, and a burning sensation due to acid exposure, as the esophagus cannot withstand acidity like the stomach lining.

Causes of Lower Esophageal Sphincter Relaxation

• Large, fatty meals can trigger relaxation of the sphincter.
• Obesity contributes to increased pressure on the stomach.
• Pregnancy leads to hormonal changes (elevated estrogen and progesterone) affecting sphincter tone, alongside pressure from the growing fetus.
• Smoking and alcohol consumption are also significant risk factors.

Symptoms Presentation

• Patients often report symptoms such as burning in the chest or feelings of acidity.
• Specific symptoms created by GERD can vary among individuals, requiring knowledge of these signs for effective identification.

Gastric Ulcer

• Gastric ulcers are characterized by a breakdown of the protective mucus layer in the stomach lining.
• Common causes include:
  • Infection with Helicobacter pylori.
  • Chronic use of non-steroidal anti-inflammatory drugs (NSAIDs).
  • Excess production of gastric acid.

Medication Classes for GERD

• Antacids: Neutralize stomach acid; careful usage needed due to potential interactions with other medications.
• H2 receptor antagonists: Reduce acid production.
• Proton Pump Inhibitors (PPIs): Block acid production effectively.
• Prostaglandin mucosal protective agents: Help protect the stomach lining.

Antacids

• Formulated to neutralize stomach acidity rather than inhibit acid production.
• Side effects include varying bowel effects depending on the metal element: aluminum (constipation), magnesium (diarrhea).
• Avoid Antacids containing sodium in patients with heart failure or hypertension.

Drug Interactions

• Antacids can affect the absorption of other medications (e.g., tetracycline) since they form complexes with multivalent ions.
• Time intervals (2-3 hours apart) are recommended when administering antacids with other drugs to avoid interactions.

Recommendations for Patients

• Encourage lifestyle modifications:
  • Avoid smoking, alcohol, caffeine, and spicy foods.
  • Maintain a healthy weight and avoid lying down immediately after meals.
• Antacids are generally safe for pregnant and nursing women; however, those containing sodium should be avoided for pregnant women.

Dosage Information

• Antacid tablets generally prescribed: 2-4 after meals and at bedtime, with a maximum of 12 per day.
• Gaviscon liquid: typically administered in doses of 10-15 mL after meals and at bedtime.
• The combination of antacids with simethicone provides dual action against both acidity and gas.

Miscellaneous

• Various formulations available, including effervescent tablets and powders, which should be taken immediately after preparation.
• Recommendations include monitoring for any adverse effects, especially in patients with renal issues, and avoiding combination therapies without a prescription.

Differentiating GERD from Atypical Angina

• Atypical angina presents with pain that may radiate to the neck, shoulder, or arm, distinguishing it from GERD.
• If antacid administration alleviates the chest pain, it is likely GERD; if not, further medical evaluation is necessary.

Summary

• Understanding GERD and related symptoms, treatment regimens, and medication interactions is crucial for effective pharmacy practice and patient care. Providing detailed patient education can significantly enhance treatment outcomes and minimize complications.