GERD Watch

Pharmacy Times
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Use Antacids First for Indigestion

Treating indigestion with antacids first,then moving up to more sophisticateddrugs if needed, is less expensive thanstarting with more powerful drugs, accordingto study findings reported in theJanuary 17, 2009, issue of The Lancet.

Proton pump inhibitors (PPIs), histaminetype 2 (H2)-receptor antagonists,and antacids are all used to treat indigestionin its various forms. The guidelineson how to use these drugs, however, areinconsistent, said the authors. For thestudy, 664 patients with newly occurringindigestion were randomly assigned to1 of 2 treatment groups. The ?step-up?therapy group was initially treated withantacids, then H2-receptor antagonists,and finally PPIs.

The ?step-down? group started withPPIs and worked down to antacids. Eachtreatment lasted 4 weeks, and patientsonly moved to the next tier of treatmentif they continued to have symptoms. Thestudy?s findings showed treatment successwas similar in both groups: 72% ofpatients doing the step-up approach and70% of patients doing the step-down.The average medical costs were $299for those in the step-up group and $322in the step-down group.

COPD May Cause Acid Reflux

A new study found that heartburn or gastroesophageal refluxdisease (GERD) may be a problem for individuals with chronicobstructive pulmonary disease (COPD). The opposite, however,does not seem to be the case.

One analysis involved patients initially free of chronic heartburnor GERD; 1628 patients had COPD, and 14,243 did not havethe condition. In the 5 years of follow-up, the occurrence ofGERD was 46% greater among patients with COPD, comparedwith patients without breathing problems. The incidence ofCOPD was not any more frequent among 4391 patients withGERD and 5118 patients without GERD.

The findings showed that ?COPD appears to predisposepatients to GERD rather than vice versa,? concluded the researchersin the December 2008 issue of Chest.

Nonsurgical Options Relieve Acid Reflux

Individuals experiencing acid reflux disease who do not respondto medications may find relief from nonsurgical procedures.

The study, published in the January 2009 issue of the Archivesof Surgery, indicated that endoluminal therapies reduced heartburn,swallowing difficulties, and voice hoarseness in manypatients. The 2 procedures are done with an endoscope. Thefull-thickness plication uses the endoscope to tighten the junctionbetween the esophagus and the stomach with sutures. Radiofrequency therapy uses heat to improve the function ofthe valve between the esophagus and stomach.

?I think medication is still the first thing that people should tryfor reflux,? said researcher Louis Jeansonne IV, MD. ?Surgery isstill the most effective treatment.... But this study shows that thistherapy without surgery is a viable option.?

GERD Severity Raises Cancer Risk

Researchers found that individuals with specific mutations inthe epidermal growth factor (EGF) gene and gastroesophagealreflux disease (GERD) face greater risk of cancer of the esophagus,according to study findings presented recently at theGastrointestinal Cancers Symposium.

The study showed that a variant of the EGF gene known asG/G was linked to nearly 2 times the risk of developing esophagealcancer, compared with the A/A ?wild type??or normalform?of the gene, but only in individuals with GERD. The riskwas magnified when GERD was more severe. Overall, thepatients without GERD had a lower risk, and those with moreGERD had almost 10 times the risk. The researchers also foundthat the patients who had GERD more than once a week or whohad GERD for >15 years had almost 22 times the risk.

Obesity Ups Risk of Digestive Health Issues

Studies reported recently in The American Journal of Gastroenterologylooked at the association between obesity andthe risk of colorectal cancer and gastroesophageal reflux disease(GERD). The studies highlighted the correlation betweenincreasing body mass index and the frequency and severity ofacid reflux symptoms.

One study indicated that the accumulation of abdominal fatmay be the most critical risk factor for the development of acidreflux and related complications such as esophageal adenocarcinoma.

The researchers also examined data on the effects of weightloss through diet or surgical methods on acid reflux disease.Several studies suggested weight loss through caloric restrictionwas helpful in reducing GERD symptoms.

F A S T F A C T: Chronic GERD affects approximately 20 million individuals.

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