FEATURE


Gastro-oesophageal reflux disease (GORD) is defined as the regurgitation of stomach contents into the oesophagus, causing symptoms such as heartburn1


important that we are familiar with how to manage this condition effectively.


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One of the main causes of GORD is thought to be a problem with the lower oesophageal sphincter (LOS), a ring of muscle found at the base of the oesophagus2


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This sphincter acts as a valve, allowing food to pass down into the stomach whilst retaining stomach acid within the stomach.


In many patients with GORD, this sphincter has become weak, allowing stomach contents back up into the oesophagus.


Risk factors thought to be involved in the weakening of the lower oesophageal sphincter include:


• Obesity or being overweight – this can put increased pressure on the stomach and hence can weaken the sphincter


DRUG


Calcium channel Blockers Bisphosphonates Benzodiazepines Anticholinergics Nitrates


harmacists are often the first point of contact for patients with GORD and so it is


• Eating large quantities of fatty foods- it takes longer for stomach acid to digest fatty meals


• Tobacco, alcohol, coffee, chocolate – All of these consumables relax the sphincter muscle


• Hormone changes in pregnancy – can weaken the sphincter muscle and increase pressure on the stomach


• A hiatus hernia • Stress


Table one outlines some of the medicines implicated in GORD.


The prevalence of GORD is difficult to establish as there are various definitions of GORD in existence. It is however thought to be more common in older aged patients3


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Patients normally present with symptoms of heartburn, acid regurgitation and dysphagia.


Dysphagia occurs when acid reflux leads to scarring and narrowing of the oesophagus, making swallowing more


EFFECT Lower oesophageal sphincter pressure


Can lead to the development of oesophagitis Lowers oesophageal sphincter pressure Lowers oesophageal sphincter pressure Lowers oesophageal sphincter pressure


Selective serotonin reuptake inhibitors Can lead to the development of oesophagitis Non- steroidal antinflammatories Corticosteroids Theophylline


Table 1: Drugs implicated in the development of GORD and their effect in doing so2, 3


18 pharmacyinfocus.co.uk


Can lead to the development of oesophagitis Can lead to the development of oesophagitis Lower oesophageal sphincter pressure


difficult. It affects approximately a third of patients with GORD.


Pharmacists can advise on simple measures to reduce symptom severity. Avoidance of any identified dietary items that precipitate symptoms, such as coffee, chocolate, tomatoes, spicy foods and fatty foods, is recommended and often beneficial to patients3


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GORD is thought to be primarily caused by relaxation of the lower oesophageal sphincter, hence it is accepted that lying flat can increase acid regurgitation as gravity does not prevent it.


Patients should therefore be advised to eat smaller meals and to eat their last meal at least three to four hours before going to bed.


It is also suggested that raising the head of the bed by 4-8 inches (10- 20cm) can help improve symptoms in some patients, however there is only weak evidence supporting this.


Losing weight can help in patients who are overweight or obese, as there is good evidence indicating a strong relationship between increasing BMI and symptoms of GORD.


Helping patients to reduce their stress levels is another appropriate recommendation pharmacists can make.


There is evidence to suggest a link between ongoing stress, isolated stressful events and gastrointestinal symptoms.


GASTRO-OESOPHAGEAL REFLUX DISEASE .


Additionally, those with higher levels of anxiety, depression and related issues both find a wider range of life events more stressful and have a higher occurrence of GORD or functional dyspepsia3


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Symptoms can recur annually in as many as 50% of those with GORD. Those with severe oesophagitis tend to have a faster rate of GORD recurrence.


Unfortunately, 10-15% of those with GORD will develop Barrett’s oesophagus, and 5-10% will develop adenocarcinoma within ten to twenty years3


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Pharmacists should refer immediately anyone presenting with alarm features of dyspepsia to rule out any serious underlying pathology.


• Alarm features of dyspepsia • Chronic gastrointestinal bleeding. • Progressive unintentional weight loss.


• Progressive difficulty swallowing. • Persistent vomiting. • Iron deficiency anaemia. • Epigastric mass. • Suspicious barium meal. • Aged over 55 years of age with unexplained and persistent recent onset dyspepsia.


Complications of gastro-oesophageal reflux disease include: • Oesophageal ulcers. • Oesophageal haemorrhage. • Anaemia due to chronic blood loss. • Oesophageal stricture. • Aspiration pneumonia. • Oesophageal adenocarcinoma.


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