The need for lifestyle modifications for management of gastroesophageal reflux disease (GERD) should be assessed at each encounter with the patient.
Medication therapy management (MTM) providers should evaluate medications for GERD at each encounter, specifically assessing efficacy, need for continued therapy (ie, the patient should be taking the lowest effective dose for symptom relief), and potential adverse effects.
MTM providers should educate patients on the importance of watching for alarm symptoms of GERD and when to seek medical attention.
Approximately 18% to 28% of adults in the United States experience symptoms of heartburn or regurgitation at least once weekly.1 While most cases are not serious, these symptoms are referred to as “gastroesophageal reflux disease” or GERD.2 GERD is a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Furthermore, symptoms are considered “troublesome” if they adversely impact well-being and/or quality of life. Episodic heartburn that occurs infrequently or is not painful enough to be considered bothersome by the patient is not included in the definition of GERD.3,4 Table 23-1 highlights the definitions and common abbreviations associated with the discussion of GERD.
TABLE 23-1GERD: Common Definitions and Abbreviations |Favorite Table|Download (.pdf) TABLE 23-1 GERD: Common Definitions and Abbreviations
|Definitions || |
Barrett esophagus: Complication of GERD when tissue lining the esophagus is replaced by tissue similar to the lining of the intestine
Erosive esophagitis: Erosion of the squamous epithelium of the esophagus
Esophagitis: Inflammation of the lining of the esophagus
Gastroesophageal reflux disease: A condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications
Nonerosive reflux disease: GERD symptoms without esophagitis
Refluxate: Material that rises from the stomach into the esophagus; contains food, acid, pepsin, and bile
|Abbreviations || |
GERD: Gastroesophageal reflux disease
H2RAs: Histamine type 2 receptor antagonists
LES: Lower esophageal sphincter
NERD: Nonerosive reflux disease
PPI: Proton pump inhibitor
A key feature in the development of GERD is abnormal reflux. Gastric contents from the stomach enter the esophagus, irritate the lining of the esophagus, and cause symptoms. Some patients also have other factors that contribute to presentation of symptoms, including defective lower esophageal sphincter (LES) pressure or function. Other secondary causes can contribute to presentation of GERD symptoms; these and other factors are highlighted in Table 23-2.3 Additionally, endogenous substances produced by the body may promote esophageal damage on reflux into the esophagus. These include gastric acid, pepsin, bile acids, and pancreatic enzymes. Therefore, the composition and volume of the refluxate, as well as duration of exposure, are all aggravating factors that play a role in damaging the lining of the esophagus and causing symptoms and complications of GERD and the associated syndromes (Table 23-3)....