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Ameen Pirasteh

on 19 April 2013

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Transcript of HeartburnAPPE

What is Heartburn? Burning sensation that usually arises from the lower chest and moves up toward the neck and throat

Symptom of GERD or “acid reflux” where stomach acid content leaks and comes back up the esophagus Objectives Identify the prevalence and incidence of heartburn
Identify the basic principles and causes of heartburn
Recognize common triggers of heartburn
Disscus treatment options available for heartburn
Identify complications related with heartburn Heartburn Types of Heartburn Common Signs and Symptoms? Difficulty swallowing (Dysphagia)
Burning in the throat
Chest pain especially after laying down or bending over
Bitter or acidic taste
Indigestion (Dyspepsia) Heartburn or Heart Attack Seek immediate Medical Attention!!
Sudden Pressure, tightening or crushing in center of chest
Pain or discomfort in neck, jaw, or arm. Especially left arm
Shortness of breath with or without chest pain
Pressure in chest during physical or emotional activity Ameen Pirasteh
Hoang Duc Huynh Vaishali Shah Heartburn Prevalance of Heartburn Ranges from 15%-25% in the Western world
About the same in both men and women
About 1 in every 4 adults in the US report experiencing dyspeptic symptoms Occurs within 2 hrs after eating large meals, trigger foods), or beverages Postprandial heartburn "Simple" Heartburn mild, infrequent, episodic heartburns related to their lifestyle Frequent Heartburn heartburn that occurs 2 or more days a week Nocturnal heartburn keeps individuals from getting restful sleep at night Pathophysiology Transient LES relaxation
Sudden increase in intra-abdominal pressure (e.g. bending over, coughing, straining)
Decrease in saliva production and esophageal motility Causes Hiatal Hernia
Trigger Foods
Bisphosphonate, iron salts, potassium salts, pain medications, some antibiotics Trigger Foods Diagnosis Symptoms Usually are enough to warrant diagnosis!
However Tests can be preformed:
Upper GI endoscopy: device with a flexible tube and mini camera.
Upper GI Series: Series of X-Rays to examine esophagus, stomach and small intestine. Barium Suspension used Esophageal Manometry: Measure motor action of the lower esophageal body.
Esophageal pH Monitoring: Measure the frequency and duration of stomach acid in the esophagus Symptom Free
Prevent meal or exercise related symptoms
Cost Effective
Prevent recurrence of symptomatic GERD
Primary Goal
Relieving abdominal discomfort Treatment Options Lifestyle and Dietary modifications
Over the counter medications
Histamine2 – Receptor Antagonists
Proton Pump Inhibitors (PPI)
Prescription medications
Surgical Options Treatment Goals Lifestyle Modification Stop smoking
Avoid alcohol
Lose weight if needed
Eat small meals
Avoid trigger foods
Avoid tight fitting clothes
Avoid lying down for 3 hours after a meal
Raise the head of your bed 6 to 8 inches if nighttime symptoms are present. Antacids Sodium Bicarbonate, Aluminum Hydroxide, Calcium Carbonate, Magnesium Hydroxide
Buffering agent
Partially neutralizes gastric acid
Increase pH in the stomach
Used to relief mild, infrequent heartburn
Onset of Relief: <5 minutes.
Duration of Relief: 20-30 minutes
Adverse effects:
Diarrhea (Mg++), Constipation: (Al3+ & Ca++), Belching & Flatulence (Na+ & Ca++) Omeprazole and Lansoprazole
Inhibit CYP2C19
Inhibit hydrogen potassium ATPase (the proton pump) irreversibly which blocks the final step in gastric acid secretion
Used to relieve mild to moderate frequent heartburn that occurs 2 or more days a week
Onset of Relief: 2-3 hours
Duration of Relief: 12-24 hours
Adverse effects: Diarrhea, constipation, headache, increased risk of fractures with Rx PPIs Proton Pump Inhibitors (PPIs) OTC Products Available:
Omeprazole (Prilosec OTC®)
Lansoprazole (Prevacid®) PPI Products H2RA + Antacid
Famotidine + Calcium Carbonate + Magnesium Hydroxide (Pepcid Complete® or Tums Dual Action®)
Provides immediate relief and longer duration of effect
PPI + Antacid
Omeprazole + Sodium Bicarbonate (Zegerid®)
Sodium bicarbonate raises intragastric pH causing rapid absorption of omeprazole Combination Products Antacids
For children ages 2 years and older
For mild, infrequent heartburn
For patients ages 12 years and older
For mild to moderate, infrequent, and episodic heartburn when a longer effect is needed
For patients ages 18 years and older
For mild to moderate frequent heartburn that occurs 2 or more days a week Product Selection Vomiting blood or passing black tarry stool
Unexplained weight loss
Nursing mothers
Children younger than 2 years (for antacids), 12 years (for H2RA), or 18 years (PPI) Frequent heartburn >3months
Heartburn that persists after 2 weeks of treatment with OTC H2RA or PPI
Painful swallowing of solid foods
Severe heartburn and dyspepsia
Chest pain with sweating and pain radiating down shoulder, arm, neck, or jaw, and shortness of breath Exclusion for Self-Treatment Questions?  Berardi, Rosemary; Krinsky, Daniel; “Handbook of Non-Prescription Drugs: An Interactive Approach to Self-Care”; 17th edition; APhA, 2012.
Kenneth R. DeVault. Donald O. Castell. Updated Guidelines for the Diagnosis and Treatment of Gastroesophogeal Reflux Disease. American Journal of Gastroenterology. 2005
Williams DB, Schade RR. Chapter 39. Gastroesophageal Reflux Disease. In: Talbert RL, DiPiro JT, Matzke GR, Posey LM, Wells BG, Yee GC, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7977509. Accessed March 7, 2013.
http://www.ucsfhealth.org/conditions/heartburn/diagnosis.html References Also known as H2 Blockers
Cimetidine, Ranitidine, Famotidine, Nizatidine
Decrease fasting and food-stimulated gastric acid secretion and gastric volume by inhibiting histamine on the histamine receptor of the parietal cell
Used to relieve mild to moderate, infrequent, and episodic heartburn when a longer effect is needed
Onset of Relief: 30-45 minutes
Duration of Relief: 4-10 hours
Adverse effects: Headache, diarrhea, constipation, dizziness, and drowsiness OTC Products Available:
Cimetidine (Tagamet®)
Ranitidine (Zantac®)
Famotidine (Pepcid®)
Nizatidine (Axid®) H2RA Products Histamine2-Receptor Antagonists Case Presentation JK is a 45 yo white male who presents to your pharmacy with complaints of "burning sensation in his chest, and bitter taste after eating."
Upon further questioning you discover he has these symptoms 3-4 times per week and eats fast food along with 3-4 alcoholic beverages a week.
He wants to know what he can take over the counter for his symptoms.
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