By gastroesophageal reflux disease (GERD, acidic reflux disease) content from the stomach is frequently pushed up into the esophagus and sometimes all the way into the mouth. The content can also sometimes be aspirated down into the throat and the windpipe.

Since there is a high concentration of acid (HCl) and digestive enzymes in the stomach content, it will irritate or hurt the esophagus, mouth or throat. It will give acute burning pain and can cause chronic inflammation and eventually also structural damages in these organs.

THE MECHANISMS OF THE DISEASE

Several mechanisms can cause acid reflux and thereby heartburn, either solely or in combination:

– The sphincter (a circular muscle) that normally closes the entrance from the esophagus into the stomach can be too lax or it can be be abnormally shaped so that stomach content leaks upwards.

– Hiatal hernia can cause GERD. By this condition the upper part of the stomach has been pressed up through the passage in the diaphragm into the thoracic cavity.

– The digestion of food in the ventricle may be too slow, causing the ventricle to empty too late and eventually get over-filled.

– The ventricle can contract too much or have cramps, like when one throws up.

– The portal muscle between the stomach ventricle and the duodenum (upper part of the small intestine) can be too narrow or constrict too strongly so that content fills up in the ventricle and makes an over- pressure here.

– Any situation that increases the pressure in the abdominal cavity can contribute to GERD.

– The heartburn and other symptoms of GERD can be associated with a too high production of salty acid (HCl) in the ventricle.

– Also people with normal stomach function seem to have some degree of reflux. In many sufferers of GERD increased production of acid therefore seems to be the only component of the disease.

PRIMARY CAUSES OF GERD

The primary causes of these mechanisms and thereby GERD can also be many:

– Anomalies in the gastroesophageal sphincter or other places in the stomach region causing reflux can be congenital.

– Consuming too much coffee, tea, alcoholic beverages, citrus juices, tomato juice, carbonated beverages, chocolate, peppermint and other spices can cause GERD. But a more moderate consume of coffee, tea and spices may have a good effect on the digestion.

– People that consume great amounts of fatty food, refined sugar and refined floor will often acquire acid reflux.

– Acidic reflux is sometimes associated with smoking and with use of certain drugs, like cocaine.

– Frequent physical strain of certain kind, like heavy lifting when bending down, frequent coughing or labor during delivery can increase the pressure in the stomach and cause reflux.

– A history of stomach ulcers or inflammations can give the kind of abnormalities in the stomach that cause GERD.

– Nervous problems caused by stress or physical neurological anomalies can affect the nervous control of the stomach and the sphincter and lead to frequent regurgitation of stomach content

TREATMENT OF GERD

Lifestyle measures are often the first treatment one tries to help against GERD. If these are not enough, drugs of various kind can be used, and as a last resort surgery is sometimes performed. Possible measures against GERD are:

– It can be useful to reduce the consume of coffee, tea, alcoholic beverages, citrus juices, tomato juice, carbonated beverages, chocolate, peppermint and other spices. It is however not necessarily wise to avoid consume of coffee, tea and spices totally

– Stopping or reducing smoking may help against GERD.

– Reducing the consume of food with much added sugar or of sweet snacks and cookies may help. It may also help to eat full corn bread and cereals instead of products based on refined flour.

– Lying with the upper body and head high can often hinder reflux during night or rest. Reducing the meals before bedtime can also help..

– Relaxing measures like meditation or measures to avoid stress can often alleviate the problem.

– Chewing gum after meals may alleviate GERD, because this action stimulates the production of acid-neutralizing saliva and the swallowing down of the regurgitated stomach content

– Acute symptoms of GERD can be alleviated with drugs containing acid-neutralizing substances. Most of these are based on salts of aluminium, magnesium or calcium.

– Sometimes drugs that modify the acid secretion are used. A class of these drugs blocks the action of the tissue hormone histamine that commands the release of acid – the so-called H2 receptor blockers (cimetidine, famotidine, nizatidine, ranitidine). Another class, proton pump inhibitors, blocks the production of acid directly (esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole) These.last drugs also help against the inflammation and damages done by the reflux.

– There are also drugs than can stimulate the function of the muscles in the upper digestive system, so that the gastroesophageal sphincter contracts better and the stomach empties itself faster (metoclopramide).

– One drug (Gaviscon) works partly by producing a foam that will lie upon the top of the stomach content and block the regurgitation, and partly by neutralizing the acid.

– Substances that can improve the digestion chemically can sometimes help, like supplements of gastric enzymes.

– There also exist herbs or natural substances with the ability to reduce acid reflux and help heal damages from acid reflux, like Aloe vera, Picrorhiza, orange peel, and licorice. Often such substances are blended to give the wanted effects.

– When hiatal hernia causes severe reflux, a surgical procedure called Nissen fundoplication is sometimes performed.

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Most people will experience occasional heartburn but millions experience a more serious condition often referred to as GERD, an acronym for gastro esophageal reflux disease. What is GERD and is it the same as Acid Reflux? The answer is “yes”. Typically GERD and Acid Reflux refer to the same problem where liquid contents in the stomach regurgitate (or refluxes upward into the esophagus).

The most common symptom of GERD is a burning sensation that radiates up from the stomach and into the chest and throat. Other symptoms may include cramps, difficulty or pain when swallowing. A patient may experience pain behind or below the breastbone. They may have vomiting at night and liquid may be inhaled into the lungs. Excess saliva, bad breath, sore throat, hoarseness, coughing (sometimes excessively), shortness of breath or any combination of these symptoms may occur. Acid in the mouth can also cause erosion of tooth enamel on the surface of teeth.

One study revealed that nearly three-quarters of patients with frequent GERD problems experience their worst symptoms at night. To fully understand GERD one must realize that the main problem stems from eating too much in the evening. To solve the problem, diet can be adjusted to substitute a lighter meal at dinner and a small snack later, as opposed to one large meal in the evening. Typically one should not eat two to three hours before bedtime and it’s best not to lie down immediately after eating.

Additional factors that may contribute to GERD include smoking, being overweight, pregnant, use of certain medications and eating foods that aggravate the condition but that varies with each individual. Certain types of foods are bad for GERD. It’s best to avoid high-fat meals and to eat foods high in complex carbohydrates instead. One should also avoid clothing that fits too tight across the midsection of the body.

How are symptoms of GERD diagnosed? A physician can take a complete medical history and review symptoms. A visit with a specialist may be recommended to evaluate symptoms in greater depth and likely order test. To determine a GERD diagnosis one test includes x-rays after the patient drinks a solution of barium. In addition an Esophagoscopy may be ordered. An Esophagoscopy is a test where a flexible tube is inserted so the Gastroenterologist can have a better view of the esophagus. If a problem is detected the physician will determine the best form of treatment for symptoms of Acid Reflux.

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ZEGERID’s effectiveness in controlling nocturnal gastric acidity when dosed at bedtime is intriguing and worthy of further study,” said Donald Castell, MD,

“The goal of PPI use in the evening is to reduce nocturnal gastric acidity, which reduces the possibility of acid reflux in patients with GERD,” Dr. Castell added.

Dr. Castell is professor of medicine and director, Esophageal Disorders Program at the Medical University of South Carolina, and is past president of the American Gastroenterological Association.

In this study, 36 patients with nighttime symptoms of GERD participated in an open-label, randomized crossover trial. The patients received repeated evening doses of either ZEGERID or Protonix for one week, followed by twice-daily dosing for one day. After a washout period, patients were treated with the alternative drug, following the same schedule.

During once-daily dosing, ZEGERID was administered at bedtime; however, reflecting current practice for evening dosing of delayed-release PPIs, Protonix was administered before dinner. During twice-daily dosing, both drugs were administered before breakfast and at bedtime. The protocol allowed 18 patients to return for additional once-daily dosing of ZEGERID 40 mg on six consecutive days, with 24-hour pH monitoring beginning at the last dose. Gastric acidity was calculated separately over an 8-hour nighttime interval and over 24 hours.

Measurements included median gastric pH, percentage of time gastric pH was greater than 4 and percentage of patients with nocturnal acid breakthrough (NAB), defined as the occurrence of continuous gastric pH of less than 4 for more than one hour during the night while receiving PPI therapy. The amount of time that pH is greater than 4 is a parameter frequently used to evaluate the clinical effects of treatment with PPIs in patients with acid-related diseases.

Data from 32 patients were available for analysis. After repeated once-daily dosing, ZEGERID 40 mg produced significantly better nocturnal gastric acid control than Protonix 40 mg: median gastric pH was 4.7 vs. 2.0; the time with gastric pH greater than 4 was 55 percent vs. 27 percent; and patients with NAB totaled 53 percent vs. 78 percent (P less than or equal to 0.005 for all comparisons). After twice-daily dosing of ZEGERID 40 mg and Protonix 40 mg, respectively: median gastric pH was 6.5 vs. 1.5; the time with gastric pH greater than 4 was 92 percent vs. 37 percent; and patients with NAB totaled 12 percent vs. 71 percent (P less than or equal to 0.002 for all comparisons).

Once-daily bedtime dosing of ZEGERID 40 mg also achieved better nocturnal gastric acid control than twice-daily dosing of Protonix 40 mg: median gastric pH was 4.7 vs. 1.7 (P less than 0.001); the time with gastric pH greater than 4 was 55 percent vs. 34 percent (P less than 0.001); and patients with NAB totaled 53 percent vs. 75 percent (P = 0.035). In addition, ZEGERID 40 mg dosed once-daily achieved similar 24-hour pH control as Protonix 40 mg dosed twice-daily.

Important Safety Information

ZEGERID Powder for Oral Suspension 40 mg is indicated for reduction of risk of upper GI bleeding in critically ill patients and short-term treatment (four to eight weeks) of active benign gastric ulcers. ZEGERID Powder for Oral Suspension 20 mg is indicated for short-term treatment of active duodenal ulcers, for heartburn and other symptoms associated with GERD, for short-term treatment (four to eight weeks) of erosive esophagitis diagnosed by endoscopy, and for maintenance of healing of erosive esophagitis (controlled studies do not extend beyond 12 months). ZEGERID is contraindicated in patients with known hypersensitivity to any components of the formulation.

The most frequently reported adverse events with ZEGERID are headache, diarrhea and abdominal pain. Symptomatic response to therapy does not preclude the presence of gastric malignancy. Atrophic gastritis has been noted occasionally in gastric corpus biopsies from patients treated long term with omeprazole. In critically ill patients treated with ZEGERID, adverse events generally reflected the serious, underlying medical condition of the patients, and were similar for patients treated with ZEGERID and with the comparator (acid-controlling) drug.

ZEGERID contains 460 mg sodium per dose in the form of sodium bicarbonate (1680 mg/20 mEq), which should be considered for patients on a sodium-restricted diet. Sodium bicarbonate is contraindicated in patients with metabolic alkalosis and hypocalcemia.