Medications Found Effective for GERD
There is good news for the estimated 60 million Americans with gastroesophageal reflux disease (GERD): medications can be just as effective as surgery in managing disease symptoms.
GERD occurs when stomach acid backs up into the esophagus, triggering heartburn and sometimes causing esophageal damage.
"For many people who have health problems, there are often two or more options to make a choice about," says Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), which conducted the new study.
With GERD, says Dr. Clancy, the main question is "Should I take pills or should I have surgery?"
The new report should help many patients resolve that question.
Aimed at physicians and patients, the AHRQ report on GERD lists the various treatments available and the evidence for their safety and effectiveness.
The goal of these reports is to give the public and health workers the latest evidence-based treatment recommendations.
The report is the first Comparative Effectiveness Review from a new AHRQ program that compares alternative treatments for health conditions.
With the report, AHRQ also released plain-language summaries to help consumers and others review the findings quickly and understand them.
In creating the program, Congress emphasized the need for conveying the information at different levels of detail for different audiences, with special attention to making the findings useful for consumers.
"We are trying to make the information as transparent and as accessible as possible about what we know from the latest science," notes Dr. Clancy.
Among the findings: for chronic GERD, over-the-counter H2 receptor antagonist medications are not as effective as Proton Pump Inhibitors (PPIs), although PPIs have more side effects.
H2 receptor antagonists include Axid®, Pepcid®, Tagamet®, and Zantac®.
PPIs appear to have similar clinical effectiveness when compared to each another. PPIs include AcipHex®, Nexium®, Prevacid®, Prilosec OTC®, and Protonix.
And compared with surgery, PPIs appear to be similarly effective in relieving symptoms and improving quality of life.
"However, somewhere between 10 and 65 percent of people end up having to take medications after surgery," Dr. Clancy explains. "So, if you were going into surgery thinking 'Wow when I recover, I'm done, no more pills,' that might be misguided.
"What we are saying to the public is, 'Here's the information we've organized in a way that you can make an informed decision,'" says Dr. Clancy.
As data changes, the report will be updated, she adds.
Future reports will focus on breast cancer screening, medications for depression, and managing diabetes, Dr. Clancy says.
An expert on GERD, Dr. Gerald Berke, a professor of surgery at UCLA, says that the report is missing some important facts about the disease.
"In general, patients with GERD do respond to both surgical and medical treatment," says Dr. Berke. "However, the mainstay of therapy - which is not addressed - is alteration of diet and eating and sleeping habits."
Without alteration of lifestyle, most patients experience only limited improvement in signs and symptoms of GERD despite aggressive medical and/or surgical intervention, notes Dr. Berke.
"In addition, a small, but significant group of patients do not seem to respond to either medical, surgical management, or lifestyle modification, and the reason for their failure rate is currently unknown," adds Dr. Berke.
Dr. Mary Maish, an assistant professor of surgery and surgical director of the UCLA Center for Esophageal Disorders, says, "The recommendations fall in the realm of what is recommended in the medical literature. The report might be too technical for most patients."
Dr. Maish believes the report will be helpful for highly educated patients.
"For people who have an understanding of how scientific-based medicine actually works, it is great," she says. "For the average patient with reflux disease, it's probably a little too technical to follow and too long."
For physicians who do not treat GERD often, the report is a good summary, says Dr. Maish. "For people who treat GERD a lot, there isn't enough information," she says.
Always consult your physician for more information. |
Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.
Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return.
Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.
Heartburn, also called acid indigestion, is the most common symptom of GERD.
Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn.
Heartburn pain is less likely to be associated with physical activity.
Heartburn pain can be mistaken for the pain associated with heart disease or a heart attack. Seek immediate medical care if you suffer sudden, severe chest pain or pain is accompanied by sweating, light-headedness, and nausea.
Severe heartburn may be due to a serious medical condition, such as a ruptured abdominal organ or heart attack.
See a physician when heartburn persists and an over-the-counter antacid or acid-reducer does not relieve the burning feeling within a short amount of time (from a few seconds to five minutes).
The symptoms of GERD may resemble other medical conditions or problems.
GERD is believed to be the result of a condition called hiatal hernia, which affects the lower esophageal sphincter (LES).
A hiatal hernia occurs when the upper part of the stomach pushes up into the chest through a small opening in the diaphragm, the muscle that separates the stomach from the chest. A hiatal hernia results in retention of acid and other contents above this opening.
The typical cause of heartburn is when acid from the stomach backs up into the esophagus.
The LES, a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.
Other lifestyle contributors to GERD may include the following:
- being overweight
- overeating
- consuming certain foods, such as citrus, peppermint, chocolate, fatty, and spicy foods
- caffeine
- alcohol
- smoking
- use of nonsteroidal anti-inflammatory (NSAIDs) medications such as aspirin and ibuprofen
Other medical causes of heartburn may include gastritis, an inflammation of the stomach lining, or ulcer disease.
Always consult your physician for more information.
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