Question

Many individuals take antacids to decrease the symptoms of Gastroesophageal Reflux Disease (GERD). Discuss possible dangers or interactions that may occur when taking one of the drugs. What herbal supplements can be used to treat the symptoms of GERD

Answer 1

GASTROESOPHAGEAL REFLUX DISEASE

It is a chronic symptom of mucosal damage caused by reflux of stomach acid into the lower esophagus.

Clinical manifestations

• Heart burn
• Dyspepsia
• Regurgitation
• Respiratory symptoms, including wheezing, coughing and dyspnea
• Chest pain in older adults

Collaborative therapy

• ​​​​​​Head of the bed is elevated
• Avoid foods that are reflux inducing
• Avoid alcohol
• Drug therapy; proton pump inhibitors, antacids, H_{​​​​​​2} receptor blockers, cholinergic drugs etc.
• Surgical management :Ninson fundoplication
• Endoscopic management : Intraluminal valvuloplasty, Radiofrequency therapy.

Let's see the drug therapy of GERD

1 - Proton pump inhibitors

Eg : Omeprazole

2 - Histamine receptor blockers

Eg : cimetidine

3 - Prokinetic agents

Eg : Metoclopramide

4 - Antiulcer, protectants

Eg : Sucralfate

5 - cholinergic

Eg : Bethanechol

6 - Antacids

Eg : Sodium bicarbonate

7 - Prostaglandin (synthetic)

Eg : Misoprostol

​​​​​​Now, dangers or interaction when taking antacid

ANTACID

They decrease the amount of HCL acid in stomach. It creates a alkaline environment and it neutralize acid and protects the mucosa, thereby relieving pain and symptoms of GERD.

sodium bicarbonate is one of the antacids.

Therapeutic Action : Neutralises hydrogen ion, raises blood, urinary pH.

Dangers or interactions of sodium bicarbonate are given below;

• It may increase the concentration, toxicity of quinidine, quinine.
• Decrease effects of lithium

Remeber : patient should be cautioned not to overuse sodium bicarbonate due to its systemic effect, and they should be informed that changing gastric acid P^H may affect absorption of other medications.

• Milk, other diary products may result in milk - alkali syndrome.
• It may increase serum, urinary P^H

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Adverse effects / toxic reactions

• Excessive use may produce metabolic alkalosis
• Fluid overload and related symptoms
• Tachypnea
• Bradycardia
• Wheezing
• Cough
• Distrended neck veins

Herbal supplements to reduce symptoms of GERD :

Some natural remedies are there. Always check with the doctor before using herbal supplements.

1 - peppermint oil.

Never take it and antacid at the same time, it will results in increase of heart burn.

2 - Ginger.

It has anti inflammatory effect, so may reduce irritation of esophagus.

Taking too much of it can actually cause heartburn.

Some others are :

Lemon balm, milk thistle, german chamomile flower, turmeric etc.

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