Diabetes and GERD: Diagnosis and Treatments

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Gastroesophageal reflux disease (GERD) is no picnic, as many of you have attested to. Finding out that you have the condition is the first step; the second step is treating it. Constantly popping antacids is, at best, a Band-Aid, and it may not help.

As I mentioned last week, if you have been bothered by symptoms of GERD (heartburn, feeling acid backing up into your throat, tightness in your throat, hoarseness, shortness of breath, or a bitter taste in your mouth), don’t delay: Talk with your health-care provider. Treating this condition promptly and effectively is important.

I also mentioned that GERD seems to be more common in people with Type 2 diabetes. This may be, in part, due to being overweight, but it may also stem from having neuropathy, or nerve damage. Gastroparesis, a type of neuropathy, can contribute to GERD. All the more reason to report any symptoms to your provider.

Diagnosis of GERD
If you report any of the above symptoms to your health-care provider, he may start you right away on some form of treatment. Or, depending on the severity of your symptoms, you may be sent to a gastroenterologist for certain tests to confirm GERD and rule out other conditions.

Typical tests include an upper GI series, which are x-rays of your esophagus, stomach, and part of your intestines. You may have an endoscopy, in which a tube with a little camera at the end is passed down your throat to look for signs of damage from acid reflux. Or you might have a test called esophageal manometry, which measures how well the esophagus and the lower esophageal sphincter are working. Finally, you might also be given a 24-hour pH probe study, which measures how often you have acid reflux over the course of a day.

Medical Treatments
GERD is similar to diabetes in that it’s a chronic condition. It may not ever go away, but it can be managed successfully. Milder symptoms of GERD can usually be treated with medicines, of which there are several types.

Antacids. People with heartburn or GERD will often first reach for antacids, such as Tums, Rolaids, or Mylanta. These may contain calcium, magnesium, or aluminum. As the name implies, antacids neutralize stomach acids and can help relieve reflux. Antacids are short-lived, however, in that they leave the stomach quickly, which means that acid reaccumulates. For this reason, it’s probably best to take antacids about one hour after a meal. Calcium-based antacids are probably only good for occasional symptoms because they may stimulate even more acid build-up if used regularly. Also, aluminum-based antacids may cause constipation, while magnesium-based ones may trigger diarrhea.

Foam barriers. Part antacid and part foaming agent, foam barriers are tablets that dissolve in the stomach, forming foam that acts like a barrier to prevent stomach acid from flowing back into the esophagus. They’re best taken after a meal and, ideally, before lying down, as these are both times when reflux is likely to occur. Also, they’re usually given along with other GERD medicines. Gaviscon is an example of a foam barrier.

H2-blockers (histamine H2-receptor antagonists). The next tier of anti-reflux drugs is the H2-blockers, such as cimetidine (brand name Tagamet), ranitidine (Zantac), and famotidine (Pepcid). These drugs are available by prescription as well as over-the-counter (but in a less potent dose). H2-blockers work by literally blocking histamine receptors in the stomach, which means that histamine is unable to stimulate acid production.

H2-blockers should be taken 30 minutes before meals so that peak levels will be in the stomach when acid production is usually at its highest. Finally, H2-blockers can help relieve GERD symptoms, but they don’t really work to improve related complications, like inflammation, strictures (narrow areas in the esophagus), or ulcers, for example.

Proton pump inhibitors (PPIs). PPIs work to prevent acid-producing cells in the stomach from pumping out acid. These drugs work a little better than H2-blockers because they work for a longer period of time, and they can promote healing of the esophagus. They’re also recommended when there are ulcers or strictures or if someone has Barrett esophagus (a condition in which the lining of the esophagus is altered). PPIs are best taken about an hour before eating. Common PPIs include omeprazole (Prilosec, Zegerid, Dexilant), lansoprazole (Prevacid), and esomeprazole (Nexium).

Promotility drugs. These medicines work to stimulate emptying of the esophagus, stomach, and/or intestines. The thought is that increasing the emptying rate of the stomach would lessen the chances of acid reflux, but these drugs may not work that well to reduce the symptoms of GERD. They may be given if other drugs don’t work, or along with other drugs. Metoclopramide (Reglan and others), which is often prescribed to people with gastroparesis, is approved for treating GERD, and is taken 30 minutes before meals and at bedtime.

More on treatments next week!

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