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36 WWW.UNWLA.ORG “НАШЕ ЖИТТЯ”, ЛЮТИЙ 2017 GERD: What It Is and What to Do About It by IHOR MAGUN, M.D., F.A.C.P. These days you simply cannot get away from hearing about indigestion, heartburn, and the term GERD. It shows up everywhere—television, magazines, huge billboards, and even in those annoying pop up ads on computers. So what exactly is this GERD and why is it so often being brought to our attention? Let’s begin with the basics. GERD is an acronym for Gastro Esophageal Reflux Disease. It is defined as a reflux of stomach contents into the esophagus, or larynx or lungs with or without a resultant irritation of the esophagus (the so-called food pipe). The mere fact that an estimate of more than sixty million indi- viduals in the United States have this condition at some point in their lives underscores the need to educate people about GERD and provide information about treatment. The good news is that many over-the-coun- ter (OTC) products are now found in prescription strength, permitting easy access and relief. So who gets GERD and why? The most common risk factors for GERD are obesity, excessive alco- hol use, excessive caffeine intake, smoking, the presence of a hiatal hernia, pregnancy, use of certain pre- scription medications, and consuming certain foods. The most common of these are citrus, spicy food, peppermint, onions, chocolate, or foods with high fat content. In some individuals, GERD can be triggered by a specific food or food type. Diagnosing GERD is fairly simple—a medical history with evidence of heartburn discomfort man- ifested as a burning feeling and/or regurgitation accompanied by an acid taste in the mouth. Symptoms can appear while someone is lying down and/or bending down. Nonsmokers who have a chronic cough lasting more than three weeks where no infectious source can be documented may also be suffering from GERD. There is no need for endoscopic visualization unless there are “red flag” signs. These red flags in- clude anemia, some form of bleeding, vomiting, a palpable mass, progressive difficulty swallowing, unin- tentional weight loss, or an abnormality that appears on an imaging study. The go-to medications to combat and alleviate GERD fall into three classes: antacids, proton pump inhibitors (PPIs), and histamine receptor blockers: Antacids are primarily used as rescue medications; their main ingredient is calcium carbonate. Com- monly used antacids are Tums, Rolaids as well as other calcium containing tablets. The PPIs (which include Nexium, Omerpazole, and Pantoprazole) offer similar relief from GERD symp- toms. They suppress gastric acid secretion. Most take 24-48 hours to be effective. Histamine receptor blockers include Tagamet, Zantac and Pepcid. They enable potent inhibition of gas- tric acid secretion. Histamine receptor blockers work much faster than the PPIs, but the medical profession does not consider them the drug of choice for GERD. In fact, clinical studies demonstrate that PPIs are the medica- tions of choice recommended by most physicians. All the PPIs offer similar relief, but you should always consult your physician for verification for any treatment that you consider. You do not want to mask symp- toms that may be much more serious. In general, PPI treatment should be daily and last for at least four to eight weeks. For maximum benefit, the PPI should be taken on an empty stomach at least 30 to 60 minutes prior to eating. (This applies to over-the-counter PPIs; a prescription-only medication that has no restriction with time of in- gestion is also available). If one PPI is not helpful in relieving symptoms, your physician may recommend changing to another PPI or consider twice a day dosing. One major point to note is that if the medication is not helping, the presence of a different disease should be considered. Use of medications currently available over the counter requires proper judgment. The “no pre- scription” status, does not give anyone carte blanche to use such medications indiscriminately, so always consult your physician for proper guidance and advice. In general, the lowest dose and duration for PPIs is always warranted. Patients who need extended periods of treatment with PPIs should be periodically checked for deficiency in magnesium levels, vitamin B12 levels; they should also be aware that hip fractures are more common in individuals using PPIs. Lifestyle modifications are just as important as medication in the fight against GERD. These in- clude weight loss, smoking cessation, avoiding excessive consumption of alcohol, decreasing caffeine in- take, elevating the head of the bed, refraining from lying down after a heavy meal, and avoiding known food triggers. .
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