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Senior Life: Gastroesophageal Reflux Disease

Senior Life: Gastroesophageal Reflux Disease

Senior Spotlight March 2022 Article

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease, also known as GERD, is one of the most common chronic gastrointestinal diseases, It is thought that up to 20% of Americans have GERD. While almost everyone will experience heartburn at some point (especially after a large meal), there is a difference between GERD and occasional heartburn. GERD is defined as frequent heartburn symptoms, occurring two or more times per week, or when the esophagus suffers damage from reflux. This damage could be caused by issues such as narrowing, erosion, or precancerous changes. GERD is most common in those who are elderly, obese, or pregenant.

Causes

GERD is caused by the flow of stomach acid and bile upwards from the stomach into the esophagus. While the stomach is designed to deal with these types of fluids, the esophagus is not. The fluids are toxic to the esophagus and cause symptoms, including heartburn and regurgitation. The fluids can also cause damage to the esophagus, including ulcers and precancerous changes. Thankfully, the body has certain mechanisms in place to help prevent these fluids from entering the esophagus. These protective barriers include the diaphragm (breathing muscle), a valve covering the bottom of the esophagus, and gravity.

Symptoms

  • Heartburn
    • A burning sensation that is felt in the chest, typically behind the breastbone
  • Regurgitation
    • Happens when a mixture of gastric juices, and sometimes undigested food, rises back up the esophagus and mouth
    • Leaves a bitter, acidic taste in the mouth
  • Epigastric pain
    • Pain in the upper abdomen area, right below the ribacage
  • Increased saliva production
  • Cough
  • Nausea
  • Sore throat and hoarseness

Risk Factors

  • Increasing age
  • Family history of GERD
  • Obesity
  • Pregnancy
  • Regular use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDS)
  • Loss of mobility
  • Reduced functioning of the valve between the stomach and esophagus (called the Lower Esophageal Sphincter or LES)

GERD and Advancing Age

According to the American College of Gastroenterology, about 8% of men and 15% of women over the age of 65 have GERD. Developing this condition becomes more likely as we age due to a number of factors. These factors include worsening functioning of the valve between the stomach and esophagus, reduced physical mobility, and weight gain.

Treatment

Step 1

Lifestyle Changes

There are many changes you can make to your everyday routine to reduce GERD symptoms.

  • Weight loss, if overweight
  • Stop smoking
  • Avoid triggering foods and beverages
    • Caffine, chocolate, citrus fruit, spicy foods, peppermint, carbonated drinks, greasy foods, tomato products
  • Wait two to three hours after eating before laying down to sleep
  • Elevate the head of the bed with foam wedges or blocks

Step 2

Over-The-Counter (OTC) Treatment Options

If you only have mild heartburn symptoms, less than two times per week, you could use one of the medications listed below. However, these medications can interact with some prescription drugs, so always consult your pharmacist or provider before starting a new medication.

  • Antacids
    • Provide relief within minutes
    • Relief only lasts for 30 to 60 minutes
  • Histamine-2 Receptor Antagonists (H2 Blockers)
    • Provides relief within 60 minutes
    • Can be taken to relieve or prevent symptoms
      • To prevent symptoms, take 30 to 60 minutes before eating or drinking food that causes heartburn.

If you have GERD symptoms more than two times per week, you could try a two-week course of another class of acid-reducing medications, called proton pump inhibitors (PPIs).

  • Proton Pump Inhibitors
    • Treat frequent heartburn
    • Do not provide immediate relief (takes one to four days for full effect)
    • Some PPIs are available as a prescription only
    • If you still have symptoms after a two-week course of a PPI, you should let your provider know

Step 3

Prescription/Long-Term Treatment Options

If your symptoms do not improve with the OTC products or you find yourself needing to use the product more than frequently, you should let your provider know. Your provider can make a diagnosis and then work with you to develop a treatment plan that is specific for your needs, which may include long-term prescription medication therapy.

If you are experiencing heartburn or think you may have GERD, stop by your local Lewis Drug pharmacy to talk with one of our pharmacists about your symptoms. Our pharmacists can help you determine if an over-the-counter product may be right for you or if it is time to make an appointment with your provider.

Brooke Nibbelink, PharmD

Lewis Drug

References

ACG-American College of Gastroenterology. Acid Reflux. https://gi.org/topics/acid-reflux/. January 6, 2022

FDA. Over-The-Counter (OTC) Heartburn Treatment. https://www.fda.gov/drugs/information-consumers-and-patients-drugs/over-the-counter-otc-heartburn-treatment. January 6, 2022

RxPrep, Inc. RxPrep 2020 NAPLEX Course Book. Gastrointestinal Conditions. Chapter 72: Gastroesophageal Reflux Disease & Peptic Ulcer Disease. Pages 956-961. January 6, 2022

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