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HEALTH GASTRO-OESOPHAGEAL REFLUX DISEASE 45 How to keep the By Nerine Zoio. HWeartburn and indigestion are prevalent in Australia and further afield, with more of those affected than would care to admit it being liable to feel real panic if they don’t have at the very least the safety net of a chalky tablet at hand. orld Health Organisation symptoms to pharmacists, with the most history, two questions have to be asked: figures at the beginning common conditions being heartburn or what medicines the patient is taking and of 2019 showed annual GORD,” she said. whether any of these medicines could expenditure on antacids “Acid reflux is a common medical be causing or exacerbating symptoms.” exceeding $10 billion worldwide.1 condition that can range in severity Drugs that aggravate heartburn and acid reflux Ms Rigby highlights that a range of different classes of medicines – such as calcium channel blockers used for heart conditions and high blood pressure – can cause or aggravate reflux. Other drugs that can have such effects include the bisphosphonates used for treatment and prevention of osteoporosis and non-steroidal anti- inflammatory drugs. “It doesn’t stop there,” Ms Rigby said, “because there’s so much new information coming in from studies that pharmacists need to keep abreast of, with one of the biggest issues being patients taking prescriptions or over-the- counter drugs for these conditions for too long a period of time.” For example, she cites the guidelines for reflux that advise people to take such medication for four to eight weeks and no longer. TO PAGE 46 RETAIL PHARMACY • AUG 2020 Pharmacies well know how many people present for OTC or prescribed medications for relief from heartburn, spanning gastroesophageal reflux disease (GORD) and other stomach conditions. However, they also well know, as do patients, that there’s not always a quick fix, with many patients on the wrong medication for too long, often leaving a sour taste, literally and figuratively. This highlights the need to navigate such tricky terrain with care and perhaps with the help of a recently launched range of complex probiotics (discussed later in the article). Advanced practice pharmacist Debbie Rigby tells Retail Pharmacy that GORD is among the most common of conditions presented to pharmacists and GPs in Australia. “It’s difficult for consumers to differentiate between gastroesophageal reflux disease, acid reflux and heartburn, and they’ll therefore present their from mild to serious, whereas gastroesophageal reflux disease is the chronic, more severe form of acid reflux, and heartburn a symptom of acid reflux and GORD.” She attributes these conditions to the usual culprits: big meals, overeating, naps after consumption, too-tight clothes, tomatoes, spicy food and chocolate. “So, it’s all about people knowing their triggers,” Ms Rigby said, “but even this knowledge meets with resistance as people don’t necessarily want to give up certain comforts or foods.” Medicines can also cause or exacerbate GORD, she says, which is less known, with most people assuming the source of the problem is a lifestyle factor. “This is where pharmacists can really help, because medicines used would come up in MedsChecks conducted in the pharmacy and home medicine reviews,” Ms Rigby said. “For the best possible medication