During high school, my older brother came home complaining
of chest pain and a severe burning sensation to the back of his throat after he
ate. Later that week, after a trip to his primary care physician, he was
diagnosed with gastroesophageal reflux disease (GERD) also known in layman’s
terms as heartburn. GERD symptoms (esophageal irritation, a burning sensation
in the chest, chest pain and difficulty swallowing) are extremely common in
today’s population (Vakil et al., 2006). Approximately 20% of adults in the
United States experience GERD symptoms at least once a week (Locke et al., 1997).
GERD is defined as a condition in which the acidic stomach contents flow back
through the lower esophageal sphincter irritating the lining of the esophagus (Vakil
et al., 2006). Chronic GERD symptoms are known to cause the squamous mucosa lining
the esophagus to be replaced by columnar epithelium similarly seen lining the
stomach and intestines, which is a condition called Barrett’s esophagus
(Spechler et al., 1986). Both chronic GERD and Barrett’s esophagus are risk
factors for developing esophageal adenocarcinoma, a cancer that’s frequency has
quadrupled over the past twenty years (Spechler et al., 2001).
With this information provided to my parents and brother,
they were also informed of the possible treatment methods for GERD. The most
popular and effective medication to treat GERD are proton pump inhibitors
(PPIs) that block the production of acid in the parietal cells of the stomach (Richardson
et al., 1998). Some examples that are commonly advertised are Prilosec, Nexium,
Prevacid and Protonix. My parents and brother decided to make the autonomous
decision, after receiving this information, to have my brother begin taking Prilosec.
He took his first dose in the morning before school and came home during his
first period because he was not feeling well. He described his symptoms as dizziness,
shortness of breath and paresthesia (tingling sensation). My parents rushed him
to the hospital and were told that he was having an allergic reaction to the
medication. He was then prescribed the next best treatment for GERD, histamine-receptor
antagonists (H2RAs) (Badillo 2014). Due to the severity of his GERD, this new
medication did not improve his symptoms even slightly. His only other options
were food and drink consumption changes to monitor acid intake (with continued
use of H2RAs) or an invasive endoscopic surgery. This surgery is known as sphincter augmentation using the LINX Reflux Management System but it has only been 80% effective at relieving
symptoms entirely with a high rate of severity re-occurrence (Badillo 2014).
My brother elected to not have surgery but continues to deal with his symptoms
to this day. Watching him struggle with the burning pain after eating and
having to limit certain foods and drinks that he loves is upsetting for me. This
is a situation similar to ones we have discussed in class in which he has
chosen to make the autonomous decision to not have surgery that, in my eyes,
may end up benefiting him in the long term.
Citations:
Badillo, R., &
Francis, D. (2014). Diagnosis and treatment of gastroesophageal reflux disease. World journal of gastrointestinal pharmacology
and therapeutics, 5(3), 105.
Locke 3rd, G. R.,
Talley, N. J., Fett, S. L., Zinsmeister, A. R., & Melton 3rd, L. J. (1997).
Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in
Olmsted County, Minnesota. Gastroenterology, 112(5), 1448-1456.
Richardson, P., Hawkey,
C. J., & Stack, W. A. (1998). Proton pump inhibitors. Drugs, 56(3), 307-335.
Spechler, S. J., &
Goyal, R. K. (1986). Barrett's esophagus. New England Journal of
Medicine, 315(6), 362-371.
Spechler, S. J., Lee,
E., Ahnen, D., Goyal, R. K., Hirano, I., Ramirez, F., ... & Vlahcevic, Z.
R. (2001). Long-term outcome of medical and surgical therapies for gastroesophageal reflux
disease: follow-up of a
randomized controlled trial. Jama, 285(18), 2331-2338.
Vakil, N., Van Zanten,
S. V., Kahrilas, P., Dent, J., & Jones, R. (2006). The Montreal definition
and classification of gastroesophageal reflux disease: a global evidence-based
consensus. The American journal of gastroenterology, 101(8), 1900.
Holly,
ReplyDeleteHas your brother ever considered the treatment of salivary stimulation? According to an article written by J. Burgess in 2018, increasing salivation during sleep can help improve symptoms caused by GERD. This can improve symptoms because saliva has been shown to neutralize stomach acid that is refluxed into the esophagus by buffering and diluting the acid (Burgess, 2018).
This study was a randomized controlled trial involving a placebo, two traditional over the counter medications (gel dry mouth remedies) and OraCoat XyliMelts (Burgess, 2018). OraCoat XyliMelts is an over the counter dissolvable disc that is made with all-natural ingredients including xylitol and mint and adheres to the mouth during sleep (Burgess,2018). It slowly releases flavor throughout the night causing an increased production of saliva (Burgess, 2018). Data from this study shows participants using the OraCoat XyliMelts reported a significant reduction in the pain of their heartburn, a reduction in their GERD severity, hoarseness and a 60% reduction in antacid use (Burgess, 2018).
While this study showed improvement in symptoms of GERD, more studies still need to be completed in order to validate this data. A prospective study should be completed in order to determine if there are negative health outcomes associated with this product. However, given the severity of your brothers GERD, coupled with is allergy to Prilosec and lack of symptom improvements from other medications, it is worth a shot. You can purchase OraCoat XyliMelts on Amazon or at grocery stores including Walmart and King Soopers.
Burgess, J. (2018). Salivary stimulation-could it play a role in GERD management. J Otolaryngol ENT Res, 10(3), 127-130.
Holly,
ReplyDeleteAfter reading your post I was surprised to find in my research of just how quickly the number of individuals suffering from GERD is increasing! According to a study done by Casale et al. GERD has been increasing by approximately 4% each year worldwide and has been linked to not only dietary changes over the years but also weight lifting. Regardless of whether one or the other (or both) applies to your brother I think that you might also find this study very interesting as it provides a possible supplementary treatment for GERD that has been shown to alleviate the symptoms.
According to the study reflux arises as a result of the failing of the muscular barrier called the lower esophageal sphincter (LES) which, in conjunction with the diaphragm comprise the esophagogastric junction (EGJ) (Casale et al. 2016). In more basic terms these muscles lose their tone and so they are less effective at stopping stomach acid from making its way into the esophagus. The part that I think might be most useful to you is that a physical therapist might be able to help your brother! Inspiratory muscle training (IMT) overseen by a DPT, along with consistency on the patients part, led to a reduction of GERD symptoms after just a few weeks (Casale et al. 2016). The "how" of this therapy is this: by increasing the muscle tone of those associated with GEJ we increase pressure within the GEJ to the point of overcoming the pressure within the stomach that allows for acid to enter the esophagus (Casale et al. 2016). This kind of therapy might allow your brother to rely less on PPIs and H2RAs in the future and might even divert him away from the possibility of surgery in the future considering that invasive surgeries are not ideal and very expensive.
M. Casale, L. Sabatino, A. Moffa, F. Capuano, V. Luccarelli, M. Vitali, M. Ribolsi, M. Cicala, F. Salvinelli (2016). Breathing training on lower esophageal sphincter as a complementary treatment of gastroesophageal reflux disease (GERD): a systematic review, 20(N.21), 4547-4552.