Burning Love: Treating GERD and Peptic Ulcer Disease

Always consult with your healthcare provider before initiating any new treatment regimen.

Background Information

Peptic Ulcer Disease (PUD) and Gastroesophageal Reflux Disease (GERD) are common gastrointestinal disorders that affect millions of people worldwide. Despite their prevalence, many patients remain unaware of the underlying mechanisms, symptoms, and pharmacologic/nonpharmacologic treatment options available. This blog post aims to provide an overview of PUD and GERD from a pharmaceutical perspective, shedding light on their respective pathophysiologies and the various treatment options available to patients in the USA.

Pathophysiology of Peptic Ulcer Disease (PUD)

Common symptoms include burning stomach pain, bloating, heartburn, nausea, and in severe cases, vomiting blood or having black stools.

Peptic Ulcer Disease occurs when open sores, or ulcers, develop on the inner lining of the stomach, upper small intestine, or esophagus. The most common causes of PUD include infection with Helicobacter pylori (H. pylori) bacteria and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.

1. H. pylori Infection: This bacterium damages the mucous coating that protects the stomach and duodenum, allowing stomach acid to create an ulcer.

2. NSAIDs: These drugs inhibit the production of prostaglandins, which protect the stomach lining by promoting mucus and bicarbonate production and maintaining blood flow.

Other risk factors include smoking, excessive alcohol consumption, stress, and spicy foods, although these factors are less directly involved in ulcer formation.

Pathophysiology of Gastroesophageal Reflux Disorder (GERD)

Symptoms include heartburn, regurgitation of food or sour liquid, difficulty swallowing, chronic cough, and a sensation of a lump in the throat.

Gastroesophageal Reflux Disease is a chronic condition where stomach acid frequently flows back into the tube connecting the mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of the esophagus. GERD is primarily caused by a malfunction of the lower esophageal sphincter (LES), a ring of muscle that acts as a valve between the esophagus and stomach.

1. LES Dysfunction: When the LES is weak or relaxes inappropriately, stomach acid can flow back into the esophagus, causing symptoms.

2. Hiatal Hernia: A condition where a part of the stomach pushes up through the diaphragm, can also contribute to GERD by affecting the LES's function.

Other contributing factors include obesity, pregnancy, smoking, and certain foods and drinks that relax the LES, such as chocolate, caffeine, and fatty foods.

Available Treatment Options

Over-the-Counter (OTC) Medications:

1. Antacids: These provide quick relief by neutralizing stomach acid. Examples include Tums, Rolaids, and Maalox.

2. H2 Blockers: These reduce acid production. Common OTC options include famotidine (Pepcid) and ranitidine (Zantac).

3. Proton Pump Inhibitors (PPIs): Stronger acid reducers than H2 blockers, OTC options include omeprazole (Prilosec OTC) and lansoprazole (Prevacid 24HR).

Prescription Medications:

1. Stronger H2 Blockers and PPIs: Prescription-strength versions of these drugs are available for more severe cases.

2. Antibiotics: For PUD caused by H. pylori, a combination of antibiotics (such as amoxicillin and clarithromycin) and a PPI is typically prescribed.

3. Prokinetics: These medications, such as metoclopramide (Reglan), help strengthen the LES and improve stomach emptying, useful in GERD management.

4. Cytoprotective Agents: Drugs like sucralfate (Carafate) and misoprostol (Cytotec) help protect the stomach lining and are used in PUD treatment.

Lifestyle and Dietary Changes:

In addition to medication, lifestyle and dietary changes play a crucial role in managing both PUD and GERD.

• Eating smaller, more frequent meals

• Avoiding trigger foods and beverages (spicy, acidic, caffeinated, and fatty foods)

• Quitting smoking

• Reducing alcohol consumption

• Maintaining a healthy weight

• Elevating the head of the bed to prevent nighttime symptoms

Conclusion

Peptic Ulcer Disease and GERD are manageable with a combination of medication, lifestyle changes, and, when necessary, medical intervention. Understanding the underlying causes and symptoms can help individuals seek appropriate treatment and improve their quality of life. If you experience persistent symptoms of PUD or GERD, consult with a healthcare professional for a proper diagnosis and tailored treatment plan.

Resources:

1. Ramakrishnan K, Salinas RC. Peptic Ulcer Disease. Am Fam Physician. 2007;76(7):1005-1012.

2. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal Definition and Classification of Gastroesophageal Reflux Disease (GERD) - a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900-1920.

3. Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102(8):1808-1825.

4. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108(3):308-328.

5. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Peptic Ulcers (Stomach Ulcers). National Institute of Health website. https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment. Updated May 2017. Accessed June 13, 2024.

6. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for GER & GERD. National Institute of Health website. https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults/definition-facts. Updated November 2014. Accessed June 13, 2024.