5. GERD is short for gastroesophageal reflux disease, which
some people also call acid reflux , is the most common disease
encountered by the gastroenterologists..
The primary care providers will find that complaints related to
reflux disease constitute a large proportion of their practice.
6.
7.
8.
9. Gasstroesophageal reflux or GER , refers to reflux of gastric
contents into the esophagus , is a physiological phenomenon,
occurring in everybody, especially after large and fat
meals.
Under physiological conditions, efficient esophageal clearing
mechanisms return most of the refluxed material to the stomach
and symptoms do not occur .
10. Gastroesophageal reflux or GER is generally associated with
transient relaxations of the lower esophageal sphincter (LES)
independent of swallowing, which permits gastric contents to
enter the esophagus.
Episodes of GER in healthy adults tend to occur after eating (large
meals, fatty foods, spicy foods, and acidic fruits and juices), last less
than 3 min, and cause few or no symptoms.
11.
12.
13.
14.
15. GER is fairly common in infants who haven’t yet fully
matured, as their LES muscle needs more time to develop.
This is why babies typically spit up and burp after
eating .
Regurgitation is the most visible symptom of GER .
GER Occurs daily in 50% of infants < 3 months of age
resolves spontaneously in most by 12–14 months, Reflux that
continues past 1 year of age may be GERD .
16. When the reflux of gastric contents is large or aggressive enough,
it causes troublesome symptoms and/or complications and adversely
affects health-related quality of life, giving rise to
Gastroesophageal reflux disease (GERD) .
Occasional Gastroesophageal reflux (GER) is common and does
not necessarily mean one has GERD.
17.
18.
19. Symptoms OR mucosal damage produced by
the abnormal reflux of gastric contents into
the esophagus .
Often chronic and relapsing .
May see complications of GERD in patients who lack
typical symptoms .
GERD Definition
22. Pathophysiology of GERD
Primary barrier to gastroesophageal reflux is the lower
esophageal sphincter (LES)
If barrier disrupted, acid goes from stomach to esophagus
23.
24. Normally, the connection between the esophagus and
the stomach is controlled by a one-way valve (LES) .
If that valve becomes too weak, or if the pressure from
the stomach becomes too great, acid will flow in the
wrong direction AND in the wrong place (i.e.,in contact with
the esophageal mucosa) .
25.
26.
27. Once reflux occurs, the duration of resultant esophageal acid
exposure is determined by the effectiveness of esophageal
acid clearance, the dominant determinants of which are
peristalsis, salivation, and, the anatomic integrity of the EGJ.
Approximately half of patients who have GERD have
abnormal acid clearance and the major contributor to this is
hiatus hernia.
28. GERD is primarily a motility disorder & its pathogenesis
is multifactorial.
The main motility abnormalities include an impaired function of
the lower esophageal sphincter, an abnormal esophageal
clearance and a delayed gastric emptying in up to 40 % of
cases.
The presence of hiatal hernia favors reflux, but this association
is not mandatory.
33. • When refluxed stomach acid touches the lining of the esophagus
it may cause a burning sensation in the chest or throat
called heartburn or acid indigestion.
• Symptoms are due to abnormal esophageal exposure to acid, not
secondary to gastric acid hypersecretion, which has been
documented in only a small subset of GERD patients .
34. The most common symptom of GERD - is heartburn, an
uncomfortable burning sensation behind the breastbone,
usually occurring after a meal.
Everyone has the occasional episode of acid reflux, but when
it happens more than twice a week every week, you
probably have GERD.
35. Everybody experiences gastro-oesophageal reflux at
some time, many people may experience reflux but may
not have GERD.
Occasional GER is common and does not necessarily
mean one has GERD.
36. Classic GERD symptoms
– Heartburn (pyrosis): substernal burning discomfort
– Regurgitation: bitter, acidic fluid in the mouth when lying down
or bending over .
People who have heartburn at least two times a week may have
gastroesophageal reflux disease .
37.
38.
39.
40.
41. GERD that is not well-controlled can cause serious complications
42.
43.
44. The diagnosis of GERD can be established based upon
clinical symptoms alone.
In patients presenting with the typical heartburn or
regurgitation, a presumptive diagnosis of GERD can be
made.
If you are experiencing heartburn two or more times a week,
you may have acid reflux disease, also known as GERD,
which, if left untreated, is potentially serious .
45. Most experts agree that it is not necessary to initiate a
diagnostic evaluation in every patient with heartburn.
However in some patients, diagnostic testing is required to
confirm the diagnosis of GERD, especially in patients who are
refractory to therapy, to assess for complications of GERD, or
to establish alternative diagnosis .
49. In 1892, Sir William Osler noticed for the
first time that worsening asthma was
associated with a distended stomach, but
awareness of an association specifically
between GERD and asthma occurred
only during the past two decades
51. GERD is highly prevalent in adult asthmatics
It is estimated that more than 75 percent of patients
with asthma also experience gastroesophageal reflux disease
(GERD) .
People with asthma are twice as likely to have GERD as
those people who do not have asthma.
Of those people with asthma, those who have a severe,
chronic form that is resistant to treatment (refractorty asthma
) are most likely to also have GERD .
52. People with asthma are more likely to get GERD and vice
versa.
Both GERD and asthma can exacerbate and potentially trigger
one another.
The causal relationship between asthma and GERD is difficult
to establish because either condition can induce the other .
53. Asthma &GERD are common diseases that often appear to co-
exist .
This does not mean that everyone with GERD is going to
develop asthma, But it may mean that people with GERD may
be more likely to develop asthma .
54. The association of GERD with asthma may indicate either
that GER causes or triggers asthma or that asthma
aggravates GER in a certain proportion of patients.
It is conceivable that both possibilities may operate i.e. GERD
triggers asthma, which in due course lead to more reflux, thus
resulting in a vicious cycle.
Fortunately, both conditions can be controlled with medication
and lifestyle changes .
55. Which came first, Asthma or GERD?
Does GERD cause Asthma ? Does asthma cause GERD?
60. Does GERD Trigger Asthma?
Am J Med 2001; 111: 37S
Reflux Theory
Direct contact between
gastric refluxate and lung
tissues
Inflammation of the airway
Bronchial smooth
muscle reactivity
61. Does Asthma Trigger GERD?
Proposed Mechanisms
Coughing
Increase Intra-
abdominal Pressure
Increasing
Pressure Gradient
Across The LES
Asthma
Medications
Lower LES
PressureGERD
62.
63. 1. Mechanical causes
Asthmatics may develop GER symptoms only during acute asthma
exacerbations .
During periods of increased respiratory effort, as in acute asthma
attacks, bronchoconstriction results in an increase in negative
pleural pressure and as a result an increased pressure gradient
between the thorax and the abdomen that overcoming ( overrides )
LES pressure.
In other words, negative pressure in your chest actually draws(
reflux) gastric contents up into the esophagus .
Does Asthma cause GERD ?
64. As the lungs become over-inflated during an asthma attack,
added pressure on the stomach may cause the muscles that
usually discourage acid reflux to become lax,allowing acid to
move up into the esophagus .
Hyperinflation leads to shortening of the lower esophageal
sphincter particularly the intra-abdominal segment, which plays
an important role in the antireflux effectiveness of the LES .
65.
66. Pulmonary hyperinflation associated with bronchospasm
contributes to the diaphragmatic dysfunction (can lead to
flattening of the diaphragm and possibly weakening the
antireflux barrier).
It places the diaphragmatic crura, which normally supplement
LES , at a functional disadvantage because of the geometric
flattening.
Altered crural diaphragmatic function can lead to GER
episodes.
67. 2. Asthma medications
Theophylline, increases gastric acid secretion& decreases LES
pressure.
Albuterol , systemic or repeated Inhaled beta2-agonists caused
dose-dependent decreases in LES pressure and in the
amplitude of esophageal contractions.
Oral corticosteroids, (prednisone 60 mg daily) increased
esophageal acid contact times at both the proximal and distal
esophagus.
Anticholinergic agents are known to relax the lower esophageal
sphincter .
68. Recent studies indicate that frequent use of bronchodilators may
contribute to a decrease in lower esophageal sphincter tone and
promote gastric reflux .
These effects raise the possibility that gastroesophageal reflux
may occur after bronchodilator therapy .
Still, many patients who use those asthma medications regularly
will not necessarily develop GERD or experience worsened
symptoms.
69. Predisposing Factors for GERD Development in Asthmatic
Individuals:
The high prevalence of obesity and hiatal hernia in patients with
asthma also predisposes them to GER development.
Several other theories have been advanced to explain why
GERD and asthma seem to be linked. It remains possible that a
third factor, such as obesity or smoking, increases the risk of
both diseases.
70. Not only is the asthmatic patient more likely to have GERD as
compared to the general population, but also GERD is
recognized as a potential trigger in many cases of severe
asthma.
GERD may worsen asthma symptoms, however, asthma and
some asthma medications may worsen GERD symptoms.
71. You can see that GERD and asthma work together
to worsen symptoms in both directions .
74. Signs and symptoms suggestive of GERD ?
The following are of special importance:
You get a burning sensation — heartburn — in your lower mid-
chest after eating a meal, especially a large meal that leaves
you feeling really full. The burning sensation is worse when you
lie down after the meal.
You experience regurgitation after meals or awaken from sleep
with sour liquid in your mouth.
You have bad breath regularly.
You have frequent hiccupping or burping.
Using antacid medications often relieves your heartburn feeling.
75. When asthma symptoms are related to a problem with
gastroesophageal reflux, one or more of the following are
common:
Your asthma symptoms often follow a large meal
Your asthma seems to get worse during sleep
Your asthma symptoms worsen in mid-life and do not appear
to be related to allergy or seasonal infections
You are hoarse on a regular basis
You have frequent coughing
Your asthma does not respond well to the usual asthma
medications
76. Certain clinical clues can be helpful in identifying GERD-
related asthma:
1. Patients' symptoms suggesting reflux include nocturnal
cough, worsening of asthma symptoms after eating large
meal, drinking alcohol, after lying down or being in the
supine position.
2. GERD should be considered in asthmatics who initially
present in adulthood.
3. Asthma doesn't respond to the standard asthma treatments
(medically refractory asthma) .
4. An additional clue may be the development of reflux
symptoms before the onset of asthma, or heartburn
heralding an asthma attack.
77. Points to remember:
If asthmatic individuals are obese, they are at increased risk
for developing GERD.
Some asthmatic individuals may develop GER symptoms only
during acute asthma exacerbations
Use of rescue inhalers when patients are experiencing GER
symptoms should also alert physicians.
Some asthmatic individuals with GER do not have typical
GER symptoms and their GER is clinically silent.
78. A well-taken history is essential in establishing a diagnosis of
GERD .
If the classic symptoms of heartburn and acid regurgitation
clearly dominate a patient’s history, they can help establish the
diagnosis of GERD with sufficiently high specificity .
The presence of atypical symptoms although common, cannot
sufficiently support the clinical diagnosis of GERD .
79. What are the diagnostic tests for
GERD- induced asthma
80. Currently, no diagnostic test or biomarker can reliably identify
asthmatic individuals with GER-triggered asthma or confirm
the diagnosis .
Based on clinical impression, thorough history and physical
examination, the clinician should consider the “empiric trial
test” as one of the potential optimal means of diagnosis
confirmation .
81. The patient's history is an extremely important part of the
diagnosis of GERD-associated asthma .
The diagnosis of GERD is easily made if the patient
complains of typical symptoms such as heartburn and
regurgitation .
However, in the case of GERD-related respiratory symptoms
the typical digestive syndrome is frequently absent, the
situation corresponding to the so-called 'silent GERD' .
82. Because GERD is a potential asthma trigger, all asthmatics
should be questioned about the possibility of esophageal GERD
symptoms .
Because GERD therapy has the potential to improve asthma
outcomes in selected asthmatics, all asthmatics should be
screened for the presence of GERD symptoms.
83. Health care providers should be aware that GERD is a
potential trigger of asthma, although not all asthma patients
with GERD experience reflux symptoms.
All patients with asthma should be questioned about reflux
symptoms, and an initial trial of empiric therapy , in particular
high-dose PPI therapy, should be initiated , in patients with a
history typical for uncomplicated GERD
84. Can GERD be cured ?
Unfortunately, GERD, in general, cannot be cured at present.
In some cases, it may be a temporary condition associated
with a specific aggravating factor such as pregnancy .
In most cases GERD is a chronic condition. However, it can
be effectively managed with medications and lifestyle
modifications in almost everybody .
85. Since asthmatic individuals have multiple asthma triggers
&asthma is a complex inflammatory disorder, elimination of one
comorbid condition or trigger would not be expected to
eliminate the disease .
GERD may also be more difficult to treat in asthmatic
individuals compared with GER subjects without asthma.
86.
87.
88.
89. Foods & Beverages known to cause an increase in symptoms:
Alcohol
Creamed foods or soups
Caffeine
Carbonated beverages
Chocolate
Citrus fruits and juices (grapefruit, orange, lime, etc.)
Onions and garlic
Tomatoes and tomato sauce
Spicy or fatty foods
Full-fat dairy products
Fried foods
Fast foods
Peppermint
Spearmint
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105. Elevate the head of the bed about 6 inches with a wedge or
by tilting the entire bed, do not use extra
pillows to raise your head
Positional modifications
117. Positional modifications
Elevate the head of the bed 4-8 inches to allow gravity to help
keep the stomach's contents in the stomach..
Patients should avoid sleeping on additional pillows, this puts
your body into a bent position that actually aggravates the
condition by increasing pressure on the abdomen and lead to
increased reflux.
Avoid lying supine (laying on the back) for 2 to 3 hours after a
meal .
Sleep left side down , Right side lying allows the acid to flow into
the esophagus more easily .
125. The symptoms of heartburn and regurgitation are the most
reliable for making a presumptive diagnosis based on history
alone.
Empiric PPI therapy (a PPI trial) is a reasonable approach to
confirm GERD when it is suspected in patients with typical
symptoms.
A response to therapy would ideally confirm the diagnosis.
126. An 8-week course of PPIs is the therapy of choice for
symptom relief and healing of erosive esophagitis. (Strong
recommendation, moderate level of of evidence)
There are no major differences in efficacy between the
different PPIs. (Strong recommendation, high level of
evidence)
Traditional delayed release PPIs should be administered 30 –
60 min before meal for maximal pH control.
127. A PPI trial is recommended to treat extraesophageal symptoms
in patients who also have typical symptoms of GERD. (Strong
recommendation, low level of evidence) .
Non-responders to PPI should be referred for evaluation , as
refractory GERD. (Conditional recommendation, low level
of evidence).
128. Proton pump inhibitors (PPIs)
Omeprazole (Losec®)
Lansoprazole (lanzor®)
Pantoprazole (Controloc®)
Rabeprazole (Pariet®)
Esomeprazole (Nexium®)
The currently available 3 PPIs which have an IV formulation:
lansoprazole, Pantoprazole, Esomeprazole .
137. The current recommendation in patients with asthma (with
concomitant heartburn or regurgitation) is initial empiric trial
of twice daily PPI’s for 2–3 months.
In those responsive to therapy for both heartburn and/or
asthma symptoms, PPI’s should be tapered to the minimal
dose necessary to control symptoms.
138.
139. Guidelines for the treatment of asthma recommend that
patients who have asthma that is difficult to control be
evaluated for the presence of coexisting conditions such as
gastroesophageal reflux disease .
If typical GERD symptoms are present, a trial of pharmaco-
therapy is warranted.
The PPIs are the most potent inhibitors of gastric secretion
available and the recommended therapy when treating GERD-
induced asthma .
140. Patients with asthma with GERD symptoms should undergo
an empiric trial 2-3 month GERD therapy in particular high-
dose PPI therapy with lifestyle modification.
GERD therapy along with twice-daily PPI therapy 30 min
before breakfast and dinner.
Once symptoms are controlled, it is appropriate to try to "step
down" in order to find the least amount of medication needed
to control the patient's symptoms.
141. During the empiric GER therapy trial, asthma symptoms and
PEF should be monitored. If asthma improves, then continue
GER therapy and consider tapering the PPI to once daily.
If symptoms are not improved after 2 months of empiric
therapy, then either reflux is inadequately controlled or
GERD-induced asthma is not present. Referral to a
gastroenterologist may be warranted .
142. In general, benefits of proton pump inhibitors in asthma appear
to be limited to patients with both symptomatic reflux and night-
time respiratory symptoms
In summary, patients with poorly controlled asthma should not
be treated with anti-reflux therapy unless they also have
symptomatic reflux (Evidence A)
Asymptomatic gastroesophageal reflux ‘‘silent’’GERD is not a
likely to be a cause of poorly controlled asthma.
143. Since GERD is more common in people with asthma than in non-
asthmatics, treatment guidelines have recommended that doctors
ask asthma sufferers about heartburn.
This is all fine and good, but—and here's the problem -many
physicians have rather routinely used heartburn medications as
part of their routine treatment of asthma, whether the patient
has symptoms of GERD or not .
144. Should patients with poorly controlled asthma be treated
empirically for gastroesphageal reflux disease (GERD)?
National Asthma Education and Prevention Program - Expert
Panel Report 3 (EPR-3): Guidelines for the Diagnosis and
Management of Asthma (2007):
Recommend trying GERD treatment with PPIs in patients with
poorly controlled asthma, even if they do not have classic GERD
symptoms.
145. the Study of Acid Reflux in Asthma (SARA)
C L E V E L A N D C L I N I C J O U R N A L O F ME D I C I N E MA R C H 2 0 1 0
146. Physicians refer to GERD without heartburn as "silent GERD.“
It's not really silent, [but it is] presenting atypically."
Not all asthmatic individuals with GERD have esophageal
symptoms, so GERD can be “clinically silent.”
Silent’ GERD is likely not the cause of poorly controlled asthma,
and treatment with proton pump inhibitors does not improve
control or provide any benefit to the patients.”
147. Patients with poorly controlled asthma and symptomatic
GERD are treated with anti-reflux medications with some
associated improvement in their asthma.
For asthma patients with "silent GERD" there appears to be
no benefit in taking GERD medications,Treating silent reflux
disease does not improve poorly controlled asthma .
Implications for management
148. Potential Predictors of Asthma Response :
Difficult-to-control asthma
Nonallergic intrinsic asthma
Nocturnal asthma
Obesity (BMI > 29.7 kg/m2)
Treatment of GER does not improve asthma outcomes in the
general asthma population, but may improve asthma outcomes
in selected patients.
Asthma symptoms are more likely than pulmonary function to
improve with GERD therapy .
149. Because GERD is a potential asthma trigger, ,all asthmatics
should be questioned about the possibility of esophageal GER
symptoms .
Although GERD may be a trigger in an individual asthmatic ,
GERD therapy does not “cure “ asthma,therefore treatment of
GERD in asthmatics treats a potential contributing condition , not
asthma itself .
150.
151.
152.
153. Long-term PPI Use: Cautions
Proton pump inhibitors rank among the top 10 prescribed
classes of drugs .
The first PPI was approved by the US Food and Drug
Administration in 1989, and, in general, PPIs are safe.
However, their long-term use is associated with potential
hazards.
154.
155. Acid reflux medications “not the benign
drugs the public thinks they are” –
Dr. Shoshana Herzig, Harvard Medical School
156.
157. 2016: PPIs was independently associated with a 20% to 50% higher
risk of incident CKD
2016: Confirmed association PPIs with…CKD, Progression of ESRD,
Doubling of Serum creatinine.
2015: PPI Therapy had increased risk of acute kidney injury and acute
interstitial nephritis
2015 PLOS - General Population
• PPI consumption increases chances of MI In general population also.
2014 Japan - Hypomagnesemia
• Log term PPI intake induces hypomagnesemia
2013 & 2016 AHA – Circulation
THE ADMA PATHWAY & PPI induced Endothelial aging.
2011 PPI Interaction with Clopidogrel
• PPI & Clopidogrel: similar CYP2 pathway, PPI reduces clopidogrel
action by almost 45%
more…. Many
178. It was recommended that H-2 receptor blockers, and not PPIs, should be the choice of
treatment for prolonged use as they were relatively safer and have fewer
chances of developing CKD and ESRD
179.
180.
181.
182.
183.
184. Rebound acid hypersecretion syndrome.
Is defined as an increase in gastric acid secretion above pre-
treatment levels following discontinuation of acid suppressive
therapy (AST).
Particularly in patients who have been treated with a PPI for
longer duration and who previously experienced a rapid
recurrence of symptoms after withdrawal of PPI treatment .
On discontinuing the proton-pump inhibitor there is rebound
acid hypersecretion which persists for at least 2 months.
185. Rebound acid hypersecretion syndrome.
If you stop your PPI all at once, you might have “rebound”
heartburn symptoms.
186.
187. Please don't try to quit PPIs cold turkey, as this can lead to a
relapse , to minimize this risk, you can gradually decrease the
dose you're taking, and once you get down to the lowest dose of
the PPI, you can start substituting with an OTC H2 blocker like
Tagamet (Cimetidine), Zantac (Ranitidine).
Then gradually wean off the H2 blocker over the next several
weeks. While weaning yourself off these drugs, continue
implementing the lifestyle modifications .
192. The idea that heartburn is caused by too much stomach acid
is still popular in the media and the public.
Heartburn and GERD are not considered to be diseases of
excess stomach acid.
Instead, the prevailing scientific theory is that GERD is
caused by a dysfunction of the muscular valve , the lower
esophageal sphincter or LES .
193. If the LES is working properly, it doesn’t matter how much acid
we have in our stomachs. It’s not going to make it back up into
the esophagus.
But if the LES is malfunctioning, as it is in GERD, acid from the
stomach gets back into the esophagus and damages its delicate
lining (Unlike the stomach, the lining of the esophagus has no
protection against acid)..
Here’s the key point. It doesn’t matter how much acid there is
in the stomach. Even a small amount can cause serious
damage.
194. We must understand that GERD is not caused by too much acid,
but by acid being refluxed into the esophagus where it does not
belong. Stomach acid can reflux when the LES doesn’t close
properly.
In most cases, acid reflux is not due to having too much acid in
your stomach , Heartburn May Be Due to Too Little Stomach
Acid .
195. What’s crucial to understand is that any amount of acid in
the esophagus is going to cause problems. That’s because its
delicate lining isn’t protected against acid like the stomach
lining is.
You don’t have to have excess acid in your stomach to have
heartburn .
196. For decades the medical establishment has been directing its
attention at how to reduce stomach acid secretion in people
suffering from heartburn and GERD .
Treating gastroesophageal reflux disease with profound acid
inhibition will never be ideal because acid secretion is not the
primary underlying defect.
197. PPIs Don’t Address Underlying Cause of Heartburn, Acid
Reflux
Currently available medical therapy only suppresses acid and
does not control GER episodes , Which is mainly due to
transient relaxations of lower esophageal sphincter .
Heartburn Drugs Only Treat the Symptoms, Not the Cause
(PPIs only mask symptoms; they do not stop regurgitation)
198. Curing a disease means eliminating its cause. When a
disease is cured, the symptoms don’t return once the
treatment is removed.
This of course is not the case with drugs for heartburn and
GERD. As soon as the patient stops taking them, the
symptoms return. And often they’re worse than they were
before the patient started the drug
Evidence That Proton-Pump Inhibitor Therapy Induces the
Symptoms it Is Used to Treat
199. Most of us tend to think of heartburn medications as pills that
just “take the edge off” and leave us with normal acid levels.
Unfortunately, that’s not really the case. Not only do they
reduce levels that may already be too low, sometimes they
almost completely eliminate it
Although eliminating stomach acid will relieve symptoms of
indigestion, it also prevents the stomach from doing its job .
200. Acid is actually needed, It just needs to be in the stomach
where it belongs:
1. Acid triggers the LES to close , keeping the acid out of
the esophagus.
2. This acid plays an essential role in helping us to break down
food so that nutrients can be absorbed, and also kills a
variety of bacteria, parasites, and other pathogens . .
201.
202. So how does not enough stomach acid cause reflux?
So when we don’t have enough stomach acid, the food sits in
the stomach for too long and ferments instead of digesting
and moving on into the small intestine.
As the bacteria work on the food in the stomach, it bubbles
up like lava into the esophagus and causes symptoms of
heartburn.
203. Bacterial overgrowth + maldigested carbohydrates =
GAS!
The resulting gas increases intra-abdominal pressure, which
is the driving force behind acid reflux and GERD
204.
205.
206. Lack of medications that adequately control GER as a motility
disorder.
Only We can control the acidity of gastric contents, but we
cannot prevent the occurrence of GER events.
PPIs do not cure acid-related conditions — they simply
manage the symptoms. Thus, experts say these medications
should not be viewed as a long-term solution.
207. While PPIs provide relief, they do not cure GERD. They only
mask the problem by removing the pain associated with
heartburn, If the medication is removed, the symptoms
are likely to recur.
The only way to cure GERD is for the sufferer to take an active
role in managing the disease through a lifestyle change.
Long term or large dosage use of PPIs for GERD, acid reflux, or
heartburn is a poor choice for those without severe symptoms
208.
209. PPIs have revolutionized the therapy of numerous upper GI
tract disorders. However, PPI therapy is not without risk of
adverse effects.
The overall benefits of therapy and improvement in quality of
life significantly outweigh potential risks in most patients .
210.
211. “Up to 60 to 70 percent of people taking proton pump
inhibitors have mild heartburn and shouldn’t be on them.”
Besides being overprescribed to patients who don’t need the
drugs, some people who take PPIs for heartburn or acid reflux
actually experience worsened symptoms after discontinuing
treatment, which can create a long-term dependence on the
potentially harmful drugs.
