GERD Watch

Pharmacy TimesOctober 2009
Volume 75
Issue 10

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Losing Sleep Over GERD

New research has shown that gastroesophageal reflux disease (GERD) patients face several sleep-related issues. In 2 studies published in Clinical Gastroenterology and Hepatology, investigators discovered that GERD, along with some of its patients, never sleeps.

One study pointed to a sort of catch-22 between GERD and sleep problems— trouble sleeping can cause or worsen GERD, and GERD can cause or worsen sleep problems. The researchers pointed out that a previous clinical trial showed sleep issues being resolved after GERD therapy, underlining the connection.

A second study explored the effect of nighttime GERD symptoms on sleep, and the resulting significant economic burden on the health care system caused by increased visits to clinicians, in addition to a reduction in healthrelated quality of life. By surveying 11,685 GERD patients, the researchers found that 88.9% experienced symptoms at night; 68.3% had sleep difficulties; 49.1% had a hard time falling asleep; and 58.3% had difficulty remaining asleep.

Receptor-Mimic Probiotics May Block Disease

Newly developed bacteria could help prevent intestinal infections from escalating to disease. Called receptor-mimic probiotics, these bacteria were first designed by scientists from the University at Adelaide in Australia in order to halt diseases brought on by various strains of Escherichia coli. From there, they went on to develop comparable receptor-mimic probiotics to combat cholera and travelers’ diarrhea. The bacteria that cause infections in the gut also manufacture toxins that cause damage to tissue by binding to intestinal receptors. Receptor-mimic probiotics have the potential to bind toxins in the intestine, which would stop the toxins from attaching to the receptors and causing disease. The scientists’ project is ongoing, but they presented their data thus far at the Society for General Microbiology’s meeting at Heriot-Watt University in Edinburgh, Scotland.

Altered Microbiome Found in GERD Patients

Communities of microbial cells, or microbiomes, remain mostly uncharted territory in terms of research, but investigators at New York University’s Langone Medical Center have uncovered a link between an altered esophageal microbiome and gastroesophageal reflux disease (GERD). Examining bacteria from the esophagi of 34 GERD and healthy patients, the researchers discovered a high concentration of Streptococcus in healthy patients, and a high level of Gram-negative bacteria making up an altered microbiome in GERD patients, especially those with Barrett’s esophagus or esophagitis. The findings were published in the August 1, 2009, issue of Gastroenterology.

Go with Your Gut and Your Heart: PPIs Okay with Thienopyridines

Recent research has revealed that proton pump inhibitors (PPIs) do not interfere with the efficacy of thienopyridines. The news comes from an analysis of 2 randomized trials that sought to determine whether PPIs indeed thwarted the effectiveness of thienopyridines like clopidogrel or prasugrel, as reported in a March study that left some alarm in its wake, due to the high incidence of PPIs being prescribed in combination with thienopyridines. The research was published in the September 1, 2009, online edition of The Lancet.

FAST FACT: Patients with a history of sexual abuse are more likely to experience gastrointestinal disorders than those in the general population.

Mind or Matter for Care-Seeking Upper GI Patients?Patients with upper gastrointestinal (GI) symptoms have a higher rate of psychological symptoms than others, but it remains unclear whether these are associated with GI symptoms or were simply the impetus to seek out health care. A recent study, published in BMC Family Practice (September 9, 2009), explored a potential link between psychosocial problems and GI symptoms and found that patients with upper GI symptoms visited their primary care physicians twice as frequently as those in a control group (8.6 vs 4.4 times per year). In addition, patients with upper GI symptoms also complained more of other types of health problems than controls and took more medications. The researchers concluded that an equivocal relationship existed between upper GI symptoms and psychological problems, possibly pointing to general increased health care demands.

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