Gastroesophageal Reflux Disease (GERD)
The oesophagus is the tube that moves the food you eat from the mouth to the stomach by muscle contractions. Disorders affecting the oesophagus affect the way it works and can cause difficulty in eating/drinking and swallowing (dysphagia), heartburn, indigestion, regurgitation/vomiting, chronic cough, sore throat, hoarseness, a feeling of food stuck in the oesophagus, unexplained weight loss, and/or pain in the abdomen, chest, or back. The most common disorder of the oesophagus is Gastro-Oesophageal Reflux Disease (GERD). This usually happens when the lower oesophageal sphincter (LES), the opening separating the stomach from the oesophagus, does not close well, causing stomach contents and acid to come back up into the oesophagus. Other oesophageal disorders include oesophageal spasms, achalasia (the LES does not relax and open to allow food/drink to pass into the stomach), oesophageal strictures (narrowing of the oesophagus), oesophagitis, oesophageal ulcers and erosion, oesophageal cancer, infections of the oesophagus (ex.- candida/yeast infection), eosinophilic oesophagitis (a large number of white blood cells in the oesophagus cause inflammation and swelling), and Barrett’s oesophagus (a complication of GERD that can increase the risk of oesophageal cancer). In many oesophageal disorders, surgery may be required. However, there are several medication treatments available to help control symptoms and slow disease progression.
Antacids are available over the counter (OTC) and contain stomach acid-neutralizing chemicals to help decrease heartburn symptoms. Active ingredients found in antacids include sodium bicarbonate, sodium alginate, magnesium hydroxide, aluminium hydroxide, and calcium carbonate. These are meant to treat mild symptoms and you should seek medical advice if you need to use them every day.
H2 Blockers block receptors called histamine-2 receptors in the stomach to decrease stomach acid secreted and reduce heartburn and GERD. These can be used daily or as needed for short-term symptom relief. Examples are famotidine, cimetidine, and ranitidine.
Proton Pump Inhibitors (PPIs) reduce the creation of acid in the stomach blocking a hydrogen pump in the stomach lining cells and can help heal the oesophageal lining. These medications are to be taken every day. Examples include pantoprazole, omeprazole, esomeprazole, and lansoprazole.
Antiemetics treat nausea and vomiting associated with oesophageal disorders. Examples include ondansetron, promethazine, and aprepitant. It is important that these are only used for temporary relief, and that the underlying cause is diagnosed and treated.
Pro-motility agents, also called prokinetic agents, help increase peristalsis (the muscle movements that move food down the oesophagus to the stomach) by targeting receptors involved in the process. Examples include erythromycin, mosapride, and bethanechol. A popular prokinetic agent that is commonly used to treat other digestive disorders, metoclopramide, is not recommended for oesophagus disorders due to side effects and poor effectiveness.
Corticosteroids are used to treat inflammation in eosinophilic oesophagitis. These are usually inhaled medications that are swallowed for topical, local treatment of oesophageal tissue. Examples include budesonide and fluticasone.
Monoclonal Antibodies block proteins that cause inflammation. Dupilumab is an injected monoclonal antibody used to treat eosinophilic esophagitis.
Botulinum Toxin (aka Botox®) injections temporarily paralyze the oesophagus muscle and relax it to treat oesophageal spasms and achalasia.
Calcium Channel Blockers relax smooth muscle, which can be helpful for oesophageal spasms that make it difficult for food/drink to pass into the stomach. Examples include nifedipine and diltiazem.
Anti-Infective Medications are used to treat infections that can cause oesophagitis, which often occur in people with weakened immune systems. Examples include fluconazole tablets and nystatin suspension to treat oesophageal candidiasis (yeast infection), acyclovir and valacyclovir for herpes simplex (HSV), cytomegalovirus (CMV), and human papillomavirus (HPV), and amoxicillin and clarithromycin for H. pylori infection. These are usually used in combination with H2 blockers or proton pump inhibitors.
Commonly associated with these medications include constipation, diarrhoea, dizziness, headache, and drowsiness or fatigue. Serious complications include Clostridium difficile (C. diff) infection, which can cause bloody, severe diarrhoea, which required medical attention and additional treatment. Vitamin efficiencies are possible, and you should talk to your doctor about whether you should take a multivitamin supplement regularly. Organ dysfunction such as kidney failure or liver failure, as well as electrolyte or blood count abnormalities are possible. It is important that you follow up with your healthcare provider regularly and have routine bloodwork done, which can often detect these problems before they cause severe symptoms.
There are many ways to help prevent oesophageal disorders and their symptoms (especially GERD, which can lead to more serious issues) that do not involve medication use. Dietary changes are important. This includes avoiding acidic foods such as citrus fruits and tomatoes, spicy foods, fatty foods, and caffeinated and/or carbonated drinks. Small meals throughout the day, eating slowly, and avoiding eating within 3 hours of laying down and going to bed are recommended. Limited alcohol use and avoiding smoking or tobacco use can decrease the risk of oesophageal disorders. Raising the head of the bed or elevating your head on a pillow can also help. It is also important to be physically active and have a healthy weight.
Oesophageal disorders can increase the risk of oesophageal cancer, and stomach contents may enter the trachea (windpipe) and lungs, causing pneumonia, a serious lung infection. Therefore, it is important to seek medical help when non-medication treatments and prevention strategies are not effective to eliminate symptoms of oesophageal disorders.