Page 36 - Retail Pharmacy March 2021

34 HEALTH GORD FROM PAGE 33 Dos and don’ts of diagnosis Professor Andrews continued: “The cardinal symptom of GORD is heartburn, a feeling of warmth that rises up in the chest behind the breastbone. If it happens in that typical location, and it happens in response to large meals, rich or fatty foods, or bending over, then you can be fairly confident that it’s GORD. “When it’s typical, we can make a very reliable diagnosis, so it’s good for the pharmacist to chat to the patient and explore that element. The one thing we always worry about if someone has chest pain and they haven’t seen a doctor is the possibility of it being a heart attack.” No one dies from reflux disease, Professor Andrews says, “but if you get it wrong, and it’s a heart attack and the patient should have gone to the emergency department, that’s a very different situation”. “If the symptoms come on with exertion and go away when they patient rests, and if the pain goes up into the neck or it goes into the left arm, don’t give them PPIs \[proton pump inhibitors\],” she advised. “The patient needs to go and get some other assessments. “I think the most important thing is that safety check at the beginning: • Is it in the right location? • Does it sound typical, looking at the person and listening to their symptoms? • Could it be cardiac? “One other thing I’d like to mention is sometimes people have dysphasia, which is difficulty swallowing or finding certain foods get stuck on the way down. It’s quite common with reflux disease to have some difficulty swallowing, with some people also having pain on swallowing, which is usually associated with inflammation. “These symptoms are something that the pharmacist or pharmacy assistant need to check with the patient, because if they do have dysphasia and it’s been getting progressively worse, or the person has had to change their diet because things get stuck, or they’re losing weight, they should be referred to a doctor, who’ll likely request an endoscopy.” Professor Andrews says this is because the symptoms described could be oesophageal cancer, which, while rare, “Recognise and avoid foods causing acid reflux Maintaining a note of what you eat and the effect on your digestion helps planning ahead to avoid of those trigger items.” (unless you’re an older white male who smokes), isn’t something to be missed. “Up to 75 per cent of people with untreated reflux esophagitis will have dysphasia, and they’ll get completely better – not just a little bit better but completely better – within two weeks of treatment using a PPI,” she said. Treatments In a range of treatment options for acid reflux and GORD, the most commonly used are antacids and PPIs. Generally, antacids are used for patients experiencing occasional symptoms of heartburn, while PPIs are for more serious ongoing cases of GORD. “Antacid medication acts as a chemical buffer to neutralise acid you’ve already produced,” Professor Andrews said. “If you’re someone who gets an occasional bit of reflux when you eat the wrong food or overindulge, then buffering with an antacid is perfect because it’s going to work straight away. For those types of patients, it can simply be used as needed. “The PPIs are for more serious cases as they turn off the proton pump, which is what gives the stomach its acidity. “Someone who has very severe oesophagitis with a lot of ulceration, or who has had narrowing of the oesophagus should be on a PPI all the time.” Other products include Gaviscon, offering a combination of buffering to neutralise acids while forming a layer on the surface of the stomach’s contents that acts like a raft to limit the rising of acid into the oesophagus. In addition to medicines, it’s helpful if pharmacists can advise patients as to simple lifestyle adjustments that may alleviate the onset of GORD, even when heartburn medicine is also prescribed. These include: • Losing excess weight. For those considered medically overweight, a reduction in weight may reduce acid reflux, and in some people weight loss may eliminate GORD entirely. • Avoid large meals. Acid reflux frequently occurs when patients have overindulged by eating large meals, while not being felt when smaller amounts of the same food are consumed. • Recognise and avoid foods causing acid reflux. Foods triggering acid reflux vary a great deal but typical triggers include alcohol, spicy or fatty food, tomato, orange juice, coffee RETAIL PHARMACY • MAR 2021