Gastroesophageal Reflux Disease

(GERD)

Shinta Mayasari, S.Farm, M.Farm,Klin., Apt

Divisi Farmasi Klinik dan Komunitas
Program Studi Sarjana Farmasi
STIKES dr Soebandi Jember
 Overview
• Introduction
– Symptoms
• Causes
– Peptic Ulcer Disease
• H. pylori
• NSAIDs
• Treatments
 Who is Affected?

Gastric acidity and GERD affects

people of all ages, races, and gender
 Symptoms
• Heartburn • Regurgitation
• Acid Indigestion • Nausea
 Symptoms Continued
• Hoarseness
• Sore Throat
• Chest Pain
• Bad Breath
• Dry Cough
• Asthma*
 Symptoms in Children

• Vomiting
• Coughing
• Breathing
Problems
 Acid-Peptic Disorders
• Peptic Ulcer Disease
–Occurs when there
is an imbalance
between the
mucosal defense
factors and the
acid and pepsin.
Helicobacter pylori Infection
• Causes 80% of peptic ulcers
• Survives the acid environment by attaching to
the sugar molecules that line the stomach wall
• Uses the mucus
layer as protection
 H. pylori
• Produce large amounts of
urease
Urease
3 NH3 + CO2
H20
Urea
 H. pylori
• Secret proteins and toxins that interact
with the stomach’s epithelial cells
• Leads to inflammation and damage
 NSAIDs
• Aspirin, Ibuprofen,
Naproxen
• Can have an affect at very
low doses
• Suppresses
cylooxygenase-1
• Decrease production of
prostaglandins
 What is GERD?
• Condition where the stomach
acid/content is pushed back or
“refluxed” into the esophagus
• Affects 10 million Americans
• Approximately 7% have daily
 GERD vs. NERD
• Patients suffering symptoms are placed
in two groups
–Non-erosive reflux disease, or NERD
–Erosive esophagitis
• Erosive esophagitis is characterized by
swelling and Inflammation
–Barrett’s Esophagus
–Precursor to Esophageal Cancer
 Causes of GERD
• Abnormalities with the
Lower Esophageal
Sphincter, or LES
• Stomach Abnormalities
–Hiatal hernia
–Link
 Causes
• Medications
–NSAIDs
–Calcium Channel Blockers (high
blood pressure, angina)
 Medications
–Anticholinergics (urinary tract
disorders)
–Beta Adrenergic Agonists (asthma)
–Dopamine (Parkinson’s disease)
 Causes
• Food and Drinks
– Carbonated beverages
– Chocolate 
– Alcohol
– Citrus Fruits
– Coffee or Tea
– Fatty foods
– Containing tomatoes
– Mint
– Spicy Food
 Causes
• Smoking
– Damages mucus
membranes
– Impairs muscle
reflexes in the throat
– Increases acid
secretion
– Reduces LES function
and salivation
 Causes
• Obesity
• Laying down after
a large meal
• Eating close to
bed time
• Exercise
Release of Gastric Acid
 Release of Gastric acid
• Histamine stimulates
acid release by
interacting with the
histamine receptor, H2
• Acetylcholine activates
the cholinergic
receptors
• Gastrin is released
when food is present in
the stomach
 Treatments
• Antacids
• Alginates
• Sucralfate
• Proton Pump Inhibitors
• Histamine H2-Recptor Antagonists
• Prokinetics
• New Treatments
 References
• Bak, Young-Tae. Management Strategies for Gastroesophageal
Reflux Disease. Journal of Gastroenterology and Hepatology
(2004), 19, S49-S53.
• Horn, J. Understanding the Pharmacodynamic and Pharmacokinetic
Differences between proton pump inhibitors- focus on pKa and
metabolism. AP&T (2006), 2, 340-350.
• Pettit, M. Treatment of Gastroesophageal Reflux Disease. Pharm
World Sci (2005) 27, 432-435.
• Vakil, N., New Pharmacological Agents for the Treatment of
Gastroesophageal Reflux Disease. AP&T (2006), 19, 1041-1049.
• Vesper, J.B. et all, Gastroesophageal Reflux Diesease, Is there More
to the Story?, ChemMedChem (2008), 3, 552-559.
• Goodman and Gilman pg 967-980.
• Patrick pg 643-671.