User:JoeGabriell/Gastroesophageal Reflux Disease (GERD)

Summary (Treatment)

Nortriptyline, Amitriptyline, Melatonin (, 18616070, 17622703), Proton pump inhibitors, Gastric H2 receptor blockers, Antacids, Alginic acid, Prokinetics, Sucralfate, Mosapride citrate.

Epidemiology:

H pylori, Hiatus hernia, Achlorhydria (low stomach acid production), Hyperchlorhydria (high stomach acid production), Gluten intolerance, bad posture, anecdotal evidence linking Ibuprofen and NSAID's to causing GERD www.earthclinic.com/CURES/acid_reflux_and_painkillers.html

Gastroesophageal Reflux Disease (GERD)

-Proton pump inhibitors (such as omeprazole, esomeprazole, pantoprazole, lansoprazole, and rabeprazole) are the most effective in reducing gastric acid secretion. These drugs stop acid secretion at the source of acid production, i.e., the proton pump.

-Gastric H2 receptor blockers (such as ranitidine, famotidine and cimetidine) can reduce gastric secretion of acid. These drugs are technically antihistamines. They relieve complaints in about 50% of all GERD patients. Compared to placebo (which also is associated with symptom improvement), they have a number needed to treat (NNT) of eight (8)

-Antacids before meals or symptomatically after symptoms begin can reduce gastric acidity (increase pH).

-Alginic acid (Gaviscon) may coat the mucosa as well as increase pH and decrease reflux. A meta-analysis of randomized controlled trials suggests alginic acid may be the most effective of non-prescription treatments with a NNT of four

-Prokinetics strengthen the lower esophageal sphincter (LES) and speed up gastric emptying. Cisapride, a member of this class, was withdrawn from the market for causing long QT syndrome. Reglan (metoclopramide) is a prokinetic with a better side-effect profile.

-Sucralfate (Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications.

-Mosapride citrate is a 5-HT4 receptor agonist used outside the United States largely as a therapy for GERD and dyspepsia.[26]

-Baclofen is an agonist of GABAB receptor. In addition to its skeletal muscle relaxant properties, it has also been shown to decrease transient lower esophageal sphincter relaxations at a dose of 10mg given four times daily. Reductions in esophageal relaxation clinically reduce episodes of reflux.

-(Carafate) is also useful as an adjunct in helping to heal and prevent esophageal damage caused by GERD, however it must be taken several times daily and at least two (2) hours apart from meals and medications. is a 5-HT4 receptor agonist used outside the United States largely as a therapy for GERD and dyspepsia.

The following may exacerbate the symptoms of GERD:

Antacids based on calcium carbonate (but not aluminium hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive. Smoking reduces lower esophageal sphincter competence.

Drugs And Supplements That Might Improve GERD

Glutamine may inhibit transient lower esophageal sphincter relaxations, Manuka honey, mastic gum, DGL licorice, D-Limonene, Betaine HCL if the cause is Achlorhydria.

Barrett's Esophagus/Esophageal Cancer:

Protective association of aspirin and esophageal cancer (, 10868686, 16336399)

Caveats

Stomach acid suppression from proton pump inhibitors and H2 blockers linked to food allergies: http://www.ukmicentral.nhs.uk/headline/database/viewnewssearch.asp?offset=4160&NewsID=2626

Suppression of gastric acid increases the risk of developing Immunoglobulin E-mediated drug hypersensitivity: human diclofenac sensitization and a murine sensitization model.