GERD
medicines
become extremely popular nowadays, as gastro
esophageal reflux disease prevalence grows
rapidly. If left untreated, GERD may be quite
debilitating and if left untreated can lead to
very serious complications.
There
are several ways to manage GERD. For occasional
heartburn, lifestyle changes and an occasional
antacid may be all that is necessary. For more
frequent heartburn, an OTC H2 receptor antagonist
may be taken. Patients with debilitating symptoms
usually require sustained acid-suppressive
therapy. The doctor may then choose between the
"step up" approach beginning with lifestyle and
dietary modifications and increasing medical
intervention till symptoms are controlled or the
"step down" approach beginning with potent acid
blockers agents to achieve rapid relief of
symptoms and then gradually decreasing till
symptoms subside.
There
are five main types of GERD
medicines -Antacids, histamine
antagonists, proton pump inhibitors, foam
barriers, pro-motility drugs.
1)
Antacids. They remain the mainstay of treatment.
They neutralize acid in the stomach so that there
is no acid left to reflux. Their action is brief
so they are best taken an hour after meal. They
may be calcium, magnesium, or aluminum based.
Prolonged use may lead to side effects such as
constipation, diarrhea, dizziness, nausea, and
vomiting. They are contraindicated in renal and
liver diseases.
2)
Histamine antagonists. Histamine stimulates acid
production by the stomach. Released within the
wall of the stomach, the histamine attaches to the
stomach's acid-producing cells and stimulates them
to produce acid. Histamine antagonists block the
histamine from attaching to the acid-producing
cells. They relieve symptoms but they are not good
at healing the inflammation caused by the acid.
Four different histamine antagonists are available
- cimetidine (Tagamet), ranitidine (Zantac),
nizatidine (Axid), and famotidine (Pepcid). Side
effects generally include dizziness, headache,
gastrointestinal disturbances, acute pancreatitis,
and hypersensitive
reactions.
3)
Proton pump inhibitors. They block the secretion
of acid by the stomach cells more completely and
for a longer period of time as compared to the
histamine antagonists. They also protect the
esophagus from the acid and helps in healing the
inflamed esophagus. Five different PPI are
approved for use: omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). They cannot be used for more than 8 weeks and have serious side
effects like diarrhea and hypersensitivity
reactions, osteoporosis, pneumonia, and increased
incidence of enteric
infections.
4)
Pro-motility drugs. Primary effect of pro-motility
agent, metoclopramide, is to speed up emptying of
the stomach, which also would be expected to
reduce reflux. Side effects include insomnia,
confusion, dizziness, anxiety, depression
etc.
5)
Foam barriers. The combination of the alginic acid
and bicarbonate creates a foam barrier which
floats on the stomach acid. This barrier may help
reduce the number of reflux episodes and offers
longer lasting action against heartburn. There is
only one foam barrier, which is a combination of
aluminum hydroxide gel, magnesium trisilicate, and
alginate (Gaviscon). Side effects
include upset stomach, constipation, metallic
taste, loss of appetite and dry
mouth.
All
these drugs though useful in short term help only
in relieving the symptoms and that too at a great
risk of developing side effects. For complete
cure, it is best to adopt a holistic approach to
rid the body of factors leading to GERD. This is
natural, safe, cost-effective, and permanent.
