Gastroesophageal Reflux (GERD) / Acid Reflux
What is Reflux?
Gastroesophageal reflux disease (GERD) is a condition in which the stomach's juices (acid and digestive enzymes) flow backwards, or reflux, into the esophagus (swallowing tube). Because the lining of the esophagus is not equipped to handle these caustic substances, the esophagus becomes inflamed. This produces the sensation we call heartburn as well as other symptoms of esophageal irritation. Over time, untreated GERD may even lead to permanent esophageal damage.
The underlying problem in GERD almost always involves the esophageal sphincter (LES). The LES is a high pressure zone at the lower end of the esophagus near the entrance to the stomach. Under normal circumstances, the LES keeps the stomach's contents from flowing backwards into the esophagus by opening only when you are eating or swallowing. The rest of the time, the LES acts like a protective valve and remains tightly shut.
In patients with GERD, the LES either does not squeeze tightly or opens at the wrong time, allowing digestive juices to reflux into the esophagus and irritate the esophageal lining. Prolonged exposure to acid can cause esophagitis (inflammation of the esophagus), narrowing of the esophagus or an esophageal ulcer. Chronic acid exposure can also lead to Barrett's esophagus, a condition in which the normal lining of the esophagus is replaced by inflamed tissue. Barrett's esophagus is considered a potentially precancerous condition; 2 percent to 5 percent of patients with Barrett's esophagus eventually develop cancer of the esophagus.
About 40% of the US population has heartburn at least once a month. An estimated 17 million Americans (7%) currently suffer from heartburn and other symptoms of GERD every day.
Symptoms
Symptoms of GERD may include:
- Heartburn (the most characteristic symptom), a burning type pain radiating into the chest or throat which may be worse when you eat, bend over or lie down
- Regurgitation (back flow of stomach fluids into your mouth) especially when bending over or straining
- Belching, especially belching an acidic or sour-tasting fluid
- Chest Pain
- Chronic sour or bitter taste in the mouth
- Difficulty swallowing
- Hoarseness, especially in the morning
- Sore throat
- Coughing
- Wheezing
- Globus (repeatedly needing to clear your throat)
Diagnosis
GERD is diagnosed mostly by a careful interview of your symptoms. This includes the frequency and characteristics of your symptoms, and what makes your symptoms worse or better. Because heartburn like pain can also be a symptom of coronary artery disease, your doctor may ask whether you have any cardiac symptoms (shortness of breath, palpitations, dizziness) or do additional testing to help rule out this problem. Depending on your symptoms, lifestyle changes (see Prevention) and a trial of over-the-counter medications may be recommend prior to beginning any specialized diagnostic testing.
If you have more serious symptoms (such as severe heartburn, difficulty swallowing, painful swallowing, or weight loss) or if your heartburn is not relieved by medications, then further testing is required. The best way to visualize the esophagus is with esophagoscopy, a form of endoscopy (visual inspection with an instrument called an endoscope). Esophagoscopy allows the doctor to inspect the inside of your esophagus and, if necessary, to take a biopsy (a tissue sample for laboratory analysis). During esophagoscopy, your doctor looks for evidence of esophageal inflammation, erosions, ulcers, strictures or the color changes of Barrett's esophagus. To eliminate other possible causes of your symptoms, the scope may be used to visualize the stomach and first part of the small intestines. The following tests may be ordered in addition to esophagoscopy:
- Barium swallow — This is an X-ray test that outlines the esophagus.
- Cardiac evaluation — Patients who have chest pain as a GERD symptom may also need an electrocardiogram (called ECG or EKG) and an exercise stress test to rule out heart disease.
- Esophageal manometry or motility studies — These studies can measure how tightly the LES shuts, and they can also check for abnormalities in esophageal pressure and movement.
- Esophageal pH monitoring — This test uses electrodes to measure the pH (acid level) in the esophagus, usually over a 24-hour period.
- Abdominal ultrasound — Uses sound waves to image the abdominal organs to look for other abnormalities that account for your symptoms including gallbladder problems.
- Gastric emptying study — Used to check the function of the stomach
When Should I See a Doctor?
Without treatment, GERD is typically a long-term problem that relapses and recurs over many years. In fact, studies have shown that the average GERD patient endures symptoms for one to three years before seeing a doctor. This is unfortunate, because medical and surgical treatments are very effective in treating this condition. You should see your doctor immediately if you have any of the following symptoms:
- Heartburn more often than twice a week
- Pain or difficulty swallowing
- Feeling full after eating only a small amount
- Frequent vomiting
- Unexplained weight loss
- Severe hoarseness or wheezing
- Chest pain
- Blood in your stool or black tarry stools
- Vomiting blood
Prevention
There is much that you can do to prevent the symptoms of GERD. Some simple lifestyle changes include: At night, elevate the head of your bed at least six inches. If possible, put wooden blocks under the legs at the head of the bed or use a solid foam wedge under the head portion of the mattress. Simply using extra pillows may not help. Avoid foods that promote acid reflux, especially coffee, chocolate, fatty foods, spicy foods, carbonated beverages, peppermint, spearmint, citrus fruits, tomatoes, whole milk and onions. Eat smaller, more frequent meals. Do not lie down after eating. Do not eat for three to four hours before going to bed. Quit smoking, this includes all nicotine containing products. Avoid drinking alcohol. Lose weight if you are obese. Obesity can make it harder for the LES to stay closed. Avoid wearing tight-fitting garments. These increase pressure on the abdomen, opening the LES when it should be shut.
Treatment
For many people, the first step is lifestyle modification as described above. Drug therapy includes over-the-counter antacids and acid-blocking drugs and prescription-strength drugs that target symptoms in different ways. Procedural treatments such as the laparoscopic Nissen fundoplication and the Esophyx procedure attempt to decrease the amount of fluid that refluxes into the esophagus.
Over-the-counter antacids — These include Mylanta, Maalox, Tums, Rolaids, Gaviscon and others. The liquid forms of these medications work faster, but the tablets are more convenient. Because the magnesium-containing antacids may cause diarrhea and the aluminum-containing antacids may cause constipation, your doctor may advise you to alternate antacids to avoid these problems. Although these drugs neutralize acid, they do not heal the inflammation of the esophagus. Note: If you are pregnant, always check with your doctor before you take antacids or any other medication.
Over-the-counter H2 blockers — These drugs work by causing the stomach to make less acid, and they are effective in patients with mild to moderate symptoms. They include famotidine (Pepcid-AC), cimetidine (Tagamet HB), ranitidine (Zantac 75) and Prilosec OTC. Because of a phenomenon called "up regulation", after prolonged regular use these drugs often will no longer suppress acid adequately.
Prescription medications — Prescription medications include:
- H2 blockers — These are prescribed at higher doses than those available in over-the-counter forms.
- Proton pump inhibitors — These drugs selectively block the pump mechanism in the stomach's acid-making cells, shutting off the stomach's acid production. The proton pump inhibitors, including:
Omeprazol (Prilosec)
Lansoprazole (Prevacid)
omeprazole
Generic Name
omeprazole (oh MEP ra zohl)
Trade Name
Prilosec(10 mg, 20 mg, 40 mg)
This drug is available in a generic form.
What is omeprazole?
This medicine belongs to a group of drugs called proton pump inhibitors (PPI). The proton pump is the site within the stomach cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs block the formation of acid in the stomach from 80% to over 90% if enough of the drug is taken.
What is it used for?
The drug is used for almost any condition where stomach acid is causing a problem or tissue injury. These include peptic ulcers in the stomach and duodenum and gastroesophageal reflux disease where acid splashes back into the food pipe causing injury. An uncommon disease, called Zollinger-Ellison Syndrome, results in the production of huge amounts of stomach acid because of uncontrolled stimulation of the stomach by a hormone called gastrin. Severe ulcers can then occur. Omeprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. Finally, some physicians will use the drug for simple hyperacidity although the FDA has not approved it for this purpose.
How do I take it?
Follow your physician's instructions carefully. Omeprazole is usually taken once or twice a day before a meal. The capsule should not be crushed or opened. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose in the morning but remember in the afternoon, take it for that day. Otherwise, continue the next day as before and don't double up. The drug is most effective if taken right before eating.
Are there interactions with food or beverages?
There are no known interactions with omeprazole and food or beverages. However, nicotine, caffeine and alcohol can stimulate stomach acid or delay ulcer healing. In all honesty, this drug is so potent that many of the previous recommendations about dietary and other precautions with ulcer healing are no longer as important as they once were. Still, listen to your physician's recommendations.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.
Interactions with this drug may occur with the following:
- diazepam (Valium)
- phenytoin (Dilantin)
- blood thinners (Coumadin)
- Plavix
Certain other drugs require stomach acid to be changed into their active form to be absorbed. Since omeprazole eliminates stomach acid so effectively, the absorption of the following drugs may be adversely affected:
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- iron preparations
- ketoconazole (Nizoral)
If you take any of the above medications, ask your physician. It is okay to take antacids.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Severe advanced liver and kidney disease may result in higher blood levels of the drug since these organs help to metabolize the drug. If you have an infection of the stomach caused by Helicobacter pylori bacteria, the drug by itself will reduce the number of bacteria in the stomach, but will not cure the infection. It is possible that the use of the drug long-term while this infection is present could seriously damage the stomach. There is a simple blood test available to see if you have ever been infected with this bacteria. Ask your physician.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are hives or skin rash. Of course, a person should not take omeprazole if there has been a previous reaction to this or a similar drug called lansoprazole (trade name, Prevacid).
What if I'm pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Omeprazole is ranked C. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are no known adverse effects of omeprazole on sexual function.
Are there other precautions?
Persons of Asian descent may need a reduced dose. Check with your physician. Of course, this and all medicines should be stored in a tight container and away from children.
How long is it safe to take omeprazole?
The FDA has no restrictions on length of use. Physicians from around the world have been prescribing it for well over 15 years and no serious long-term side effects have been described. It looks like it is a very safe drug even though some minor changes in the stomach cells can be seen when biopsies are reviewed under the microscope.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For omeprazole, the following are the observed side effects:
Minor:
- headache
- abdominal pain
- nausea
- diarrhea
- rash
- dizziness
Major:
- severe skin rash
Rabeprazole (AcipHex)Prevacid
Generic Name
lansoprazole (lan SOAP ra zol)
Trade Name
Prevacid(15 mg, 30 mg)
This drug is not available in a generic form.
What is lansoprazole?
This medicine belongs to a group of drugs called proton pump inhibitors (PPI). The proton pump is the site within the stomach cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs, therefore, block the formation of acid in the stomach from 80% to almost 90% if enough of the drug is taken.
What is it used for?
The drug is used for almost any condition where stomach acid is causing a problem or tissue injury. These include peptic ulcers in the stomach and duodenum and gastroesophageal reflux disease where acid splashes back into the food pipe and causes injury. An uncommon disease called Zollinger-Ellison Syndrome is where huge amounts of stomach acid and injury occur because of uncontrolled stimulation of the stomach by a hormone called gastrin. It is also used along with antibiotics to cure or eradicate a stomach bacteria infection called Helicobacter pylori which has been shown to cause peptic ulcers. Finally, some physicians will use the drug for simple hyperacidity although the FDA has not approved it for this purpose.
How do I take it?
Follow your physician's instructions carefully. Lansoprazole is usually taken once or twice a day before a meal. The capsule can be opened and the pellets sprinkled on a tablespoon of applesauce or similar food. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose in the morning but remember in the afternoon, take it for that day. Otherwise, continue the next day as before and don't double up.
Are there interactions with food or beverages?
There are no known interactions. However, nicotine, caffeine and alcohol can stimulate stomach acid production or delay ulcer healing. In all honesty, this drug is so potent that many of the previous recommendations about dietary precautions with ulcers are no longer as important.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction.
Interactions with this drug may occur with the following:
- theophylline (Theo-Dur)
- sucralfate (Carafate)
Certain other drugs require stomach acid to be changed into their active form or to be absorbed. Since lansoprazole eliminates stomach acid so effectively, the absorption of the following drugs may be affected:
- certain iron pills
- ketoconazole (Nizoral)
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- If you take any of the above medications, ask your physician. It is okay to take antacids at the same time as lansoprazole.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Severe advanced liver disease may result in higher blood levels of the drug since the liver helps to metabolize it. Again, discuss with your physician. A disease to be concerned about is H. pylori bacteria infection of the stomach. By itself, the drug reduces the number of bacteria in the stomach but does not cure it. It is possible that the use of the drug long-term, while this infection is present, could seriously damage the stomach. There is a simple blood test available to see if you have ever been infected with this bacteria. Ask your physician.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are skin rash, hives and itching. Of course, a person should not take lansoprazole if there has been a previous reaction to this or a similar drug.
What if I'm pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Lansoprazole is ranked B. Always consult the physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are no known adverse effects of lansoprazole on sexual function.
Are there other precautions?
There are only a few precautions. The safety in children has not been established. Persons of Asian descent may need a lower dose. And, of course, this and all medicines should be stored in a tight container and away from children.
How long is it safe to take lansoprazole?
The FDA has now approved it for a year. However, physicians from around the world have been prescribing it for much longer and no serious side effects have been noted. It looks like it is a very safe drug even though some minor changes in the stomach cells can be seen when biopsies are reviewed under the microscope.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild, such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For lansoprazole, the following are the observed side effects:
Minor:
- diarrhea
- headache
- change in taste
- abdominal pain
- dizziness
- nausea
- rash
×Pantoprazole (Protonix)AcipHex
Generic Name
rabeprazole (ra BEP ra zol)
Trade Name
AcipHex
What is rabeprazole?
This medicine belongs to a group of drugs called proton pump inhibitors (PPIs). The proton pump is the site within the stomach cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs block the formation of acid in the stomach from 80% to over 90% if enough of the drug is taken.
What is it used for?
The drug is used for almost any condition where stomach acid is causing a problem or tissue injury. These include peptic ulcers in the stomach and duodenum and especially gastroesophageal reflux disease where acid splashes back into the food pipe causing injury. Rabeprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. Some physicians will use the drug for simple hyperacidity. An uncommon disease, called Zollinger-Ellison Syndrome, results in the production of huge amounts of stomach acid because of uncontrolled stimulation of the stomach by a hormone called gastrin. Severe ulcers can then occur.
How do I take it?
Follow your physician's instructions carefully. This medication is usually taken once or twice a day 60 minutes before a meal. Swallow the capsule whole do not crush or chew the pellets. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose in the morning but remember in the afternoon, take it for that day. Otherwise, continue the next day as before and don't double up. The drug is most effective if taken right before eating.
Are there interactions with food or beverages?
There are no known interactions with rabeprazole and food or beverages. However, nicotine, caffeine (coffee, tea, chocolate, cola) and alcohol can stimulate stomach acid or delay ulcer healing. This drug is so potent that many of the previous recommendations about dietary and other precautions for ulcer healing are no longer as important as they once were. Still, listen to your physician's recommendations.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Always inform the physician of all drugs being taken.
Interactions with this drug may occur with the following:
- diazepam (Valium) or similar sedating drugs
Certain other drugs require the presence of stomach acid to be effective. Since rabeprazole eliminates stomach acid so effectively, the absorption of the following drugs may be adversely affected:
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- iron preparations
- zidovudine (Retrovir)
Consult your physician if you take any of the above medications. It is okay to take antacids.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Check with your physician if you have severe liver or kidney disease. Rabeprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. While rabeprazole does not act directly on these bacteria, it does help the antibiotics to be more effective. It is possible that the use of the drug long-term while this infection is present could seriously damage the stomach. There is a simple blood test available to see if you have ever been infected with this bacteria. Ask your physician.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are skin rash, hives or itching. Of course, a person should not take rabeprazole if there has been a previous reaction to any PPI drug (Prilosec, Prevacid, Protonix, Nexium).
What if I'm pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Rabeprazole is ranked B. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are no known effects of acetaminophen on sexual function.
Are there other precautions?
The safety of this medication in children has not been established. Some persons, especially those of Asian descent, may need a reduced dose. Check with your physician. Of course, this and all medicines should be stored in a tight container and away from children.
How long is it safe to take rabeprazole?
This drug is likely to be safe long-term. However, patients should stay in touch with their physician.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For rabeprazole, the following are the observed side effects:
Minor:
- headache
- diarrhea
Esomebrazole (Nexium)Protonix
Generic Name
pantoprazole (pan TOP ra zol)
Trade Name
Protonix(40 mg)
This drug is not available in a generic form.
What is pantoprazole?
This medicine belongs to a group of drugs called proton pump inhibitors (PPIs). The proton pump is the site within the stomach cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs block the formation of acid in the stomach from 80% to over 90% if enough of the drug is taken.
What is it used for?
The drug is used for almost any condition where stomach acid is causing a problem or tissue injury. These include peptic ulcers in the stomach and duodenum and especially gastroesophageal reflux disease where acid splashes back into the food pipe causing injury. Pantoprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. Some physicians will use the drug for simple hyperacidity. An uncommon disease, called Zollinger-Ellison Syndrome, results in the production of huge amounts of stomach acid because of uncontrolled stimulation of the stomach by a hormone called gastrin. Severe ulcers can then occur.
How do I take it?
Follow your physician's instructions carefully. This medication may be taken with or without food. Swallow the capsule whole. The capsule should not be crushed or opened. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose in the morning but remember in the afternoon, take it for that day. Otherwise, continue the next day as before and don't double up. The drug is most effective if taken right before eating.
Are there interactions with food or beverages?
There are no known interactions with pantoprazole and food or beverages. However, nicotine, caffeine (coffee, tea, chocolate, cola) and alcohol can stimulate stomach acid or delay ulcer healing. This drug is so potent that many of the previous recommendations about dietary and other precautions with ulcer healing are no longer as important as they once were. Still, listen to your physician's recommendations.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Always inform the physician of all drugs being taken.
Certain other drugs require the presence of stomach acid to be effective. Since pantoprazole eliminates stomach acid so effectively, the absorption of the following drugs may be adversely affected:
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- iron preparations
- ketoconazole (Nizoral)
Consult your physician if you take any of the above medications. It is okay to take antacids.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Check with your physician if you have severe liver or kidney disease. Pantoprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. While pantoprazole does not act directly on these bacteria, it does help the antibiotics to be more effective. It is possible that the use of the drug long-term while this infection is present could seriously damage the stomach. There is a simple blood test available to see if you have ever been infected with this bacteria. Ask your physician.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are hives or skin rash. Of course, a person should not take pantoprazole if there has been a previous reaction to any PPI drug (Prilosec, Prevacid, Aciphex, Nexium).
What if I'm pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Pantoprazole is ranked B. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are no known adverse effects of pantoprazole on sexual function.
Are there other precautions?
The safety of this medication in children has not been established. Some persons, especially those of Asian descent, may need a reduced dose. Check with your physician. Of course, this and all medicines should be stored in a tight container and away from children.
How long is it safe to take pantoprazole?
This drug is likely to be safe long-term. However, patients should stay in touch with their physician.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For pantoprazole, the following are the observed side effects:
Minor:
- headache
- abdominal pain
- diarrhea
are very effective medications that can be especially helpful in patients who do not respond to H2 blockers and antacids. Although these drugs are considered very safe, there are potential side effects such as headache, bloating, and diarrhea. There are also some recent studies that indicate that long term use of these drugs may lead to osteoporosis. These drugs are best taken 30 minutes prior to your first meal of the day.Nexium
Generic Name
esomeprazole(es oh MEP ra zohl)
Trade Name
Nexium(20mg., 40 mg.)
This drug is not available in a generic form.
What is esomeprazole?
This medicine belongs to a group of drugs called proton pump inhibitors (PPIs). The proton pump is the site within the stomach cell where hydrochloric acid is actually made and pumped out into the stomach. The PPIs block the formation of acid in the stomach from 80% to over 90% if enough of the drug is taken.
What is it used for?
The drug is used for almost any condition where stomach acid is causing a problem or tissue injury. These include peptic ulcers in the stomach and duodenum and especially gastroesophageal reflux disease where acid splashes back into the food pipe causing injury. Esomeprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. Some physicians will use the drug for simple hyperacidity. An uncommon disease, called Zollinger-Ellison Syndrome, results in the production of huge amounts of stomach acid because of uncontrolled stimulation of the stomach by a hormone called gastrin. Severe ulcers can then occur.
How do I take it?
Follow your physician's instructions carefully. Esomeprazole is usually taken once or twice a day 60 minutes before a meal. The capsule may be opened and the pellets mixed with cold applesauce and swallowed. Do not crush or chew the pellets. Keep all medications away from children. Never share your medications with anyone else.
What do I do for a missed dose?
If you miss a dose in the morning but remember in the afternoon, take it for that day. Otherwise, continue the next day as before and don't double up. The drug is most effective if taken 60 minutes before eating.
Are there interactions with food or beverages?
There are no known interactions with esomeprazole and food or beverages. However, nicotine, caffeine (coffee, tea, chocolate, cola) and alcohol can stimulate stomach acid or delay ulcer healing. This drug is so potent that many of the previous recommendations about dietary and other precautions for ulcer healing are no longer as important as they once were. Still, listen to your physician's recommendations.
Are there interactions with other drugs?
An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Always inform the physician of all drugs being taken. Interactions with this drug may occur with the following:
- diazepam (Valium) or similar sedating drugs
Certain other drugs require the presence of stomach acid to be effective. Since esomeprazole eliminates stomach acid so effectively, the absorption of the following drugs may be adversely affected:
- ampicillin (Polycillin, Omnipen)
- digoxin (Lanoxin)
- iron preparations
- ketoconazole (Nizoral)
If you take any of the above medications, ask your physician. It is okay to take antacids.
Is there a problem if I have another disorder or disease?
At times, a drug may have a different or enhanced effect when other diseases are present. At other times, the drug may worsen or effect another disease. Check with your physician if you have severe liver or kidney disease. Esomeprazole is also used along with antibiotics to cure or eradicate a stomach infection caused by Helicobacter pylori. These bacteria have been shown to cause peptic ulcers. While esomeprazole does not act directly on these bacteria, it does help the antibiotics to be more effective. It is possible that the use of the drug long-term while this infection is present could seriously damage the stomach. There is a simple blood test available to see if you have ever been infected with this bacteria. Ask your physician.
What about allergies?
People who have known allergies or asthma may be at an increased risk for a reaction from any new medication. The physician should always know a patient's allergy history. Signs of an allergic reaction are skin rash, hives or itching. Of course, a person should not take esomeprazole if there has been a previous reaction to this or any PPI drug (Prilosec, Prevacid, Aciphex, Protonix).
What if I'm pregnant, considering pregnancy or breast-feeding?
Most females now know that, if possible, no drug, including alcohol, should be taken during pregnancy or lactation. The potential danger, of course, is an injury to the baby. However, some drugs are much safer than others in this regard. So, the FDA has a grading system for each drug which reflects what is known medically. It ranks drugs from A, where medical studies show no evidence for danger to the fetus or mother, to B, C, D and X, where the medical evidence indicates that the risk to the fetus outweighs any benefit to the mother. Esomeprazole is ranked B. Always consult your physician before taking any drug during or when planning pregnancy.
What are the effects on sexual function?
There are no known adverse effects of esomeprazole on sexual function.
Are there other precautions?
Check with your physician if you have severe liver disease (cirrhosis). This and all medications should be stored in a tight container and away from children.
How long is it safe to take esomeprazole?
This drug is likely to be safe long-term. However, patients should stay in touch with their physicians.
How about side effects?
Adverse reactions can occur with any drug, even over-the-counter medications. Some of these are mild such as a stomach upset, which may be avoided by taking the medication with food. Minor reactions may go away on their own but if they persist, contact the physician. For major reactions, the patient should contact the physician immediately.
For esomeprazole, the following are the observed side effects:
Minor :
- headache
- abdominal pain
- nausea
- diarrhea
- constipation
- dry mouth
Major :
- severe skin rash
× - Prokinetic drugs — These medications may help decrease esophageal reflux, but are not usually used as the sole treatment medication for GERD. They work in a variety of ways. Some prevent reflux by strengthening the muscle tone of the LES, whereas others cause the stomach to empty faster (this narrows the window of time during which reflux can occur). The prokinetic drugs include metoclopramide and bethanechol, and they are commonly used in combination with an H2 blocker or a proton pump inhibitor.
- Mucosal protectors — These medications coat, soothe and protect the irritated esophageal lining. They include sucralfate (Carafate).
Procedural treatments
Usually reserved for patients who have frequent symptoms who can not be weaned off medication and for a variety of reasons do not wish to or can not tolerate long term medical therapy. In the majority of patients the procedures are safe, well tolerated, highly effective in relieving symptoms, and have a high degree of patient satisfaction. The two procedures Dr. Fusco offers for Acid Reflux are: the Laparoscopic Nissen Fundoplication, and the Esophyx procedure.
The Esophyx procedure is a type of Natural Orifice Surgery or Incisionless Surgery. The procedure is done by altering the LES area by placing stitches from the inside of the stomach. This is done using an instrument that is placed via the mouth.
Prognosis
GERD has an excellent prognosis. Eighty to 90 percent of patients improve after treatment with medication. Laparoscopic Nissen fundoplication, even though it is typically used in patients with the most severe cases of reflux, will cure heartburn in over 90% of cases without the need for continued medication in two thirds of case.
Additional Info (links)
- Society of American Gastrointestinal Endoscopic Surgeons: General info about GERD
- Society of American Gastrointestinal Endoscopic Surgeons: Guidelines for the treatment of GERD
- Jackson Gastroenterology: Good illustration
- GERD diet
- American Gastroenterological Association : General info about GERD
- GERD and Heartburn info sponsored by Ethicon
- Info about Barrett's esophagus and the Halo procedure
- www.endogastricsolutions.com : makers of the Esophyx device
- Open as a PDF file for more accurate printing.