A digestive ailment that occurs when acidic stomach juices, or food and fluids, flow back up into the esophagus. What is GERD? • Gastroesophageal Reflux Disease (GERD) can generally be caused by the recurrent acid reflux or nonacidic contents from the stomach reflux. Heartburn Regurgitation of sour liquid or meal Chest discomfort Dysphagia Laryngitis A persistent cough The symptoms of GERD GASTROESOPHAGEAL REFLUX DISEASE (GERD) Hiatal hernia occurs when upper region of the stomach pokes out through the diaphragm into the chest. This causes the diaphragm and LES to split. This division then interrupts the integrity of the LES. This induces the esophagus from being exposed to the stomach acid. It achieves this, among other things, by hindering the LES's ability to operate, which lowers pressure. This increases a person's risk of experiencing reflux while coughing or taking inspiration, both of which raise intra-abdominal pressure. Additionally, during esophageal acid clearance, the hernia can function as a reservoir for acid, trapping it in the hernia sac. Impaired esophageal mucosal defense against the gastric refluxate Defective esophageal motility the chosen drugs Esomeprazole (Nexium) Pantoprazole (Controloc) Baroscon Double Action Suspension Ranitidine (Zantac) causes of gerd • GERD happens when sphincter that is responsible for the smooth flow of food and water from esophagus to the stomach is not working properly • When the sphincter does not function properly by relaxing when it should, acid from the stomach flows back into the esophagus. • When this happens repeatedly, the lining of the esophagus can be inflamed from the result of acid reflux. pathophysiology Rabeprazole (Aciphex) Lansoprazole (Prevacid) Omeprazole (Prilosec) Esomeprazole (Nexium) Dexlansoprazole (Dexilant) Pantoprazole (Contoloc) List of commonly used drugs Transientlower oesophageal sphincter relaxations (TLESRs) The pathogenesis of GERD engages a combination of various factors and it is better described by multiple mechanisms that involved. These mechanisms include the effect of the lower esophageal sphincter when it is impaired, the appearance of hiatal hernia, the defense against the gastric refluxate when the esophageal mucosal is dysfunction and the motility of esophageal The Effect of lower esophageal sphincter when it is impaired Lower Esophageal Sphincter is a zone that is complex anatomically, and it is mainly located at the junction of gastroesophageal, containing two elements which is the true LES, a section of continuously contracted smooth muscle that is located in the distal oesophagus and the diaphragm in which the section is crural. In a normal situation, the when the LES is relaxed due to the contractions of oesophagus, it enables for food to pass through into the stomach. LES can maintain a high-pressure zone up to 15 -30 mmHg above the intragastric pressure when it is in the resting position. However, patients with impaired LES can cause the low pressure of LES, which allows for reflux of acid every time the pressure in the stomach reaches the limit of LES pressure. In most cases, severe oesophagitis is accompanied by a persistently reduced LES resting tone. Similar to this, many individuals with additional GERD problems, such oesophageal stricture and Barrett's oesophagus, have LES deficiencies. In GERD patients with no impaired LES or hiatal hernia, the transient LES (TLESRs) maybe the main culprit. TLESRs are short acid reflux occurrences that happen after meals or during sleep. It is triggered when the number of abnormal relaxations of the TLESRs is increased. Similar to LES resting pressure, certain meals (such fatty foods and chocolate), alcohol, and smoking can have an impact on the frequency of TLESRs. HIATAL Hernia The capability of the esophageal mucosal to resist the damage is important in the progression of GERD. It depends on a range of protective components, including the defence that acts prior to the epithelial layer and the defence within the epithelial layer. Pre-epithelial defence utilizes a limited buffering of bicarbonate-based. Cell membranes, intercellular connections, buffers, and ion transporters are used by the epithelial defence when it is overpowered to prevent acid entry and neutralise back-diffusing acid. Nevertheless, the intense components such as highly acidic reflux or certain substances can surpass these defences can lead to mucosal damage. Intercellular junctions are disrupted by the corrosive effects of acid and acid-pepsin, resulting in heightened permeability and symptoms such as heartburn. The backward diffusion of acid contributes to the formation of erosions, causing cellular harm and impairing the natural repair mechanisms. In normal instances, when the gastric contents reached the esophagus, it is typically being resolved by the repeated routine of esophageal peristalsis and the gastric contents are being neutralised by salivary bicarbonate. The GERD patients were shown to have poor esophageal peristalsis, which resulted in decreased gastric reflux clearance, which caused severe reflux symptoms and mucosal damage. A brief introduction to the chosen medications Esomeprazole and Pantoprazole are both medications from the same pharmacological class of Proton Pump Inhibitors (PPIs). They are primarily chosen as they can decrease the level of stomach acid thus facilitating the healing process of the esophageal or gastric lining. Baroscon Double Action is a combination of antacid and alginate. Antacid helps to neutralize the stomach acid. Meanwhile, alginate aids in the protection from gastric reflux as it forms a barrier on the stomach contents. Ranitidine is a H2 blocker. It aids in treating Gastroesophageal Reflux Disease by decreasing the stomach acid.
Types of drug preparation available Based on MIMS Malaysia, Nexium is not available as an Over The Counter (OTC) medication as Nexium falls under class B regulatory classification. Therefore, patients would need a prescription written by their physicians in order to obtain this medication. Dosage forms available Nexium MUPS DR-FC tablet 20 mg Nexium MUPS DR-FC tablet 40 mg Nexium powder for solution for injection (vial) 40 mg Pharmacological class Proton pump inhibitors (PPIs) mechanism of action Esomeprazole, also known as Nexium, is a proton pump inhibitor (PPI) medication. It is used to treat GERD by providing gastric protection against the recurrence of stomach ulcers or damage caused by long-term NSAID use. It is also used to treat pathological hypersecretory illnesses like Zollinger-Ellison Syndrome. Esomeprazole performs by interfering with the final stage of gastric acid production. It does so by covalently binding to the sulfhydryl groups of cysteines on the (H+, K+)- ATPase enzyme found on the secretory surface of stomach parietal cells. This action inhibits both baseline and induced stomach acid secretion. As a consequence of esomeprazole's irreversible binding to the (H+, K+)-ATPase enzyme, restoring acid secretion involves the production of new enzymes, resulting in an antisecretory activity that lasts more than 24 hours. specific side effects - (the occurrence is not known) The electrolytes is not balanced The deficiency of Vitamin B12 (parenteral route) Side effects general side effects - (Uncommon) general side effects - (Unusual or rare) specific side effects - (Unusual or rare) Encephalopathy Aggression Agitation Bronchospasm Increased risk of infection if administered through injection, Muscle weakness Renal failure may occur (parenteral route) dosage 10 mg to be taken once, daily by mouth for 8 weeks, for children aged 1 to 11 years old with the body weight of 10 to 19 kg 10 – 20 mg to be taken once, daily by mouth for 8 weeks, for children aged 1 to 11 years old with the body weight more than 20 kg To be taken initially 40 mg once daily for 4 weeks, and continue for another 4 weeks only if the symptoms are not fully healed with maintenance dose of 20 mg daily for children 12 – 17 years old. For adult, 40 mg daily, by intravenous injection or by intravenous infusion until oral administration route is possible. The injection to be given at least 3 minutes. Based on British National Formulary 81e, the dosages of Esomeprazole for the treatment of Gastroesophageal reflux disease (GERD) in the presence of oesophagitis includes; . 10 mg to be taken once, daily by mouth for 8 weeks, for children aged 1 to 11 years old with the body weight of 10 kg and above 20 mg to be taken once, daily by mouth for up to 4 weeks, for children aged 12 to 17 years old 20 mg to be taken once, daily by mouth for 4 or 8 weeks, then 20 mg daily if needed. For intravenous injection or intravenous infusion administration route, is given to an adult, 20 mg once, daily until oral administration method is possible, to be given over at least 3 minutes. Meanwhile, for the treatment of Gastroesophageal reflux disease (GERD) in the absence of oesophagitis includes; CONTRAINDICATION The information on MIMS Malaysia stated that Esomeprazole should not be given to the patients with hypersensitivity to Esomeprazole, substituted benzimidazoles or any similar constituents that is present formulation. According to MIMS Malaysia the drug interactions of esomeprazole include: Esomeprazole can enhance the absorption of Ketoconazole, Erlotinib, Itraconazole and Digoxin Drug-drug interactions Esomeprazole can decline the serum levels of nelfinavir, and atazanavir Esomeprazole disturbed CYP2C19 enzyme in which can boost the plasma concentration of CYP2C19-metabolised drug Esomeprazole can elevate International Normalized Ratio (INR) when taken with warfarin Esomeprazole can increase the half life of cisapride NEXIUM (esomeprazole)
Dosage forms available Controloc gastro-resistant (enteric-coated) tab 20 mg Controloc gastro-resistant (enteric-coated) tab 40 mg Controloc powd for inj (vial) 40 mg Pantoprazole is available as a delayed-release tablet and as delayedrelease granules to be taken orally. The delayed-release tablet releases the drug in the intestine to avoid stomach acids from breaking it down. The delayed-release granule packets must be dissolved in applesauce or apple juice and either orally or through a feeding tube. Pantoprazole is typically given once day to treat and maintain GERD. Pantoprazole is often given twice day to treat illnesses where the stomach secretes excessive amounts of acid. Granules are often taken 30 minutes before to a meal, whereas delayed-release pills are typically taken with or without meals. Drug-Drug Interaction Inform a health practitioner, if there is any allergies to pantoprazole, dexlansoprazole (Dexilant), esomeprazole (Nexium, in Vimovo), lansoprazole (Prevacid), omeprazole (Prilosec, in Zegerid), rabeprazole (AcipHex), any other drugs. Pantoprazole (Controloc) Belongs to a class called proton pump inhibitors (PPIs). Pantoprazole heals the esophagus and prevents further damage to the esophagus, especially for adults suffering from GERD. Controloc is a medication that contains the active ingredient which is pantoprazole. It functions by reducing the quantity of stomach acid production. How should this medication be used? Mechanism of Actions www.groupassignmentPHD223.com headache nausea vomiting gas joint pain diarrhea dizziness When you recall, immediately take the missing dosage. On the other hand, omit the missed dose if it is almost time for your next one and carry on with your usual dosing regimen. It is not necessary to take two doses to make up for missing ones. Pharmacological Class Controloc is available as gastroresistant tablets.The term "gastroresistant" describes a tablet whose contents pass through the stomach undamaged before entering the intestine. This avoids the active ingredient being damaged by the stomach's acid. This medication has to be prescribed by a health practitioner. TYPES OF DRUG PREPARATION AVAILABLE Pantoprazole and other proton pump inhibitors are substituted benzimidazole derivatives, which are weak bases that accumulate in the acidic area of the parietal cell before being converted into active sulfenamide derivatives in the canaliculi (little canal) of the gastric parietal cell, which is also an acidic environment. This active form forms disulfide bonds with critical cysteines on the stomach acid pump, preventing it from working properly. Pantoprazole, in particular, binds to the sulfhydryl group of the enzyme H+, K+-ATPase, which is thought to speed up the final stage of the acid secretion route. The inhibition of the enzyme inhibits gastric acid output. Pantoprazole, a proton pump inhibitor with a longer half-life than H(2) antagonists, has a greater inhibitory effect on stomach acid secretion. The proton pump ' s H(+)/K(+)-ATPase, which usually gets produced by stomach parietal cells, regulates the discharge of hydrochloric acid (HCl) into the gastric lumen. The parietal cell membrane contains an enzyme called ATPase, which aids in the exchange of hydrogen and potassium within the cell, resulting in potassium extrusion and the production of HCl (gastric acid). Abacavir: Pantoprazole may decrease the excretion rate of Abacavir which could result in a higher serum level. Acenocoumarol: Acenocoumarol's metabolism may be slowed down if taken with Pantoprazole. Acamprosate: When used with Pantoprazole, Acamprosate's excretion can be reduced. At around the same time each day, take pantoprazole. If there is anything you do not understand about the instructions on your prescription label, contact your doctor or chemist to clarify it. Just as it is prescribed, take pantoprazole. Take it just as directed by your doctor, and never in excess of that dosage, more frequently, or for a longer duration. Avoid crushing, chewing, or splitting the pills; instead, swallow them whole. In the event that the 40 mg pill your doctor has given is too large for you to swallow, ask them to substitute two 20 mg tablets. SIDE EFFECTS WHAT TO DO IF FORGOT A DOSE? PRECAUTIONS Inform the physician if experiencing low levels of magnesium, calcium, or potassium in the blood, hypoparathyroidism, osteoporosis ,low levels of vitamin B12 in the body, or an autoimmune disease Rilpivirine (Edurant, in Cabenuva, Complera, Juluca, and Odefsey) is a medication that warrants a prescription from the doctor. If this drug is on the drug regime, quickly notify the doctor to cancel it, For adults and adolescents 12 years of age and DOSAGES above, One gastro-resistant Controloc 20 mg tablet per day is the suggested oral dose. Reflux oesophagitis: For long-term care and relapse prevention, a maintenance dose of one gastroresistant Controloc tablet (20 mg) per day is advised, escalating to 40 mg pantoprazole per day if a relapse develops. This patient has access to Controloc 40 mg. The dose can once again be lowered to 20 mg pantoprazole after the recurrence has healed. STORAGE 20 mg tab: Controloc 20 mg must not be administered to patients with a history of hypersensitivity to the medication's active ingredient or to any of its other ingredients. 40 mg tab: Controloc 40 mg is used for combination treatment for patients with moderate to severe liver or kidney function disturbances Controloc 40 mg is strictly prohibited to be used in combination treatment for eradication of Helicobacter pylori. In situations, where there is a known hypersensitivity to one of the ingredients in Controloc 40 mg or one of the combination partners is present, Controloc 40 mg would typically be opted out of the drug regime. Pantoprazole medication must be kept securely closed in the container and out of the reach of children. Keep the medication at room temperature and other places with excessive heat and moisture to avoid degradation. CONTRAINDICATIONS
Antacids (sodium alginate, calcium carbonate and sodium bicarbonate) The group II and III metals' hydroxides and carbonates, as well as the alkali metals' bicarbonates, served as the foundation for the formation of antacids. All antacids contain at least one of the metals sodium, potassium, calcium, magnesium, bismuth, or aluminium. The two primary categories of antacids are absorbable and non-absorbable antacids. Pharmacological Class Mechanism Of Action Antacids reduce the quantity of acid that enters the duodenum by neutralizing the acid in the stomach. The primary treatment objectives are to alleviate pain, relax pylorospasms, and avoid acid chyme digestion and corrosion. Each salt has its own system with the ultimate goal of neutralizing acid, and the methods used by the salts to do this vary. Sodium alginate / alginic acid It is recommended to wait at least two hours before or after taking any medication while taking an antacid. Baroscon Double Action Suspension According to MIMS Malaysia, this medicine is an oral suspension (Suspensions with a pale yellow or cream tint with a peppermint flavour.) It is considered as an over-the-counter medicine and can be bought without a presciption. Types Of Drugs Preparation Antacid By neutralizing stomach acidity, calcium salts raise the pH of the gastric and duodenal bulbs. If the pH is higher than 4, they also increase the tone of the lower esophageal sphincter and inhibit pepsin's proteolytic activity. The calcium released by calcium carbonate is believed to enhance esophageal peristalsis, driving stomach acid into the stomach and alleviating heartburn symptoms. Furthermore, the calcium salts react with dietary phosphate to form insoluble compounds that prevent the latter from being absorbed. The main therapeutic effect of sodium bicarbonate treatment is an increase in plasma bicarbonate levels, which are known to buffer excess hydrogen ion concentration and elevate solution pH to combat clinical indications of acidosis. It also has the effect of increasing the pH of the urine by increasing the removal of bicarbonate ions found in urine. By maintaining alkaline urine, uric acid stones can be broken down. While acting as an antacid, sodium bicarbonate does not directly alter stomach acid production; rather, it reacts chemically to buffer or neutralize existing levels. This action raises the pH of the stomach contents, alleviating hyperacidity symptoms. Calcium carbonate Sodium bicarbonate Alginates, which are alginic acid derivatives, treat GERD in an unusual method by creating a mechanical barrier that pushes the postprandial acid pocket out of the way. When gastric acid is present, they form a raft that localizes to the acid pocket in the proximal stomach and leads them to precipitate into a gel. One or two sachets, after meals and before bed, for adults and children over the age of 12. Packaging Drug-Drug Interaction Chelators consist of antacids containing calcium, magnesium, and aluminium ions. Numerous medications, including digitoxin, tetracycline, indomethacin, aspirin, cimetidine, ranitidine, famotidine, theophylline, etc., are bound to them. Drugs including barbiturates, sulphonamides, and penicillin have their bioavailability decreased when taken with an antacid. Side effects (Calcium carbonate ingestion in excessive amounts) Alkalosis Hypercalcaemia Acid rebound Milk alkali syndrome or constipation DOSAGE CONTRAINDICATION Renal failure Heart failure Edema Low-sodium diets GI hemorrhages Hyperparathyroidism
Pharmacological class H2 Antagonists As a histamine-2 blocker, ranitidine lowers the quantity of acid produced by the stomach. Multiple uses for prescription ranitidine have been approved, including the treatment and prevention of stomach and intestinal ulcers as well as the management of gastroesophageal reflux disease. In the same drug class as cimetidine and famotidine, ranitidine is a widely used medication. This medication aids in the prevention and treatment of disorders linked to gastric acid, such as stomach ulcers, by reducing the secretion of stomach acid. There are several various ways to get ranitidine, including tablets, injections, and effervescent tablet preparations. For the short-term therapy of active duodenal ulcers, Zollinger-Ellison syndrome-related gastric acid hypersecretion, systemic mastocytosis, and other disorders that may pathologically elevate gastric acid levels, this medication is used alone or in conjunction with antacids. Additionally, it is utilised in maintenance therapy for stomach ulcers at a low dose as well as the short-term treatment of active benign gastric ulcers. In addition to the uses, ranitidine can also be used to treat GERD symptoms, endoscopically diagnosed erosive esophagitis, and to maintain gastric or duodenal ulcer healing. According to MIMS Malaysia, this medicine is an oral medication. Ranitidine is a prescription drug that must be written by physicians to obtain this medication. Ranitidine also Over the counter (OTC) medication that help prevent and treat heartburn symptoms brought on by acid reflux and a sour stomach. TYPES OF PREPARATION Dosage forms available Ranitidine 300 mg (20 tablets) Zantac Ranitidine tablets 150 mg (65 tablets) mechanism of action By inhibiting the action of histamine-on-histamine H2-receptors found on the parietal cells lining the stomach wall, ranitidine decreases the release of gastric acid in the stomach. Histamine is the chemical transmitter that stimulates the parietal cells to release gastric acid. By blocking H2 receptors, ranitidine prevents histamine from having this effect, thereby reducing gastric acid secretion. The histamine H2-receptors, which include receptors on the stomach cells, are sensitive to the competitive, reversible inhibitor ranitidine. Ranitidine is not an anticholinergic drug and does not reduce serum Cat+ in hypercalcemic conditions. This occurs as a result of the hormone gastrin, which is produced by the cells lining the stomach, stimulating the release of histamine after food consumption. Histamine then attaches to the histamine H2 receptor and releases gastric acid into the stomach. Dosage RANITIDINE (ZANTAC) Rarely Side effects Common Headache Abdominal pain Agitation Anemia Confusion Pancreatitis Reduction of all blood cells Lowered white blood cells According to MIMS Malaysia: Adult: Symptomatic relief: 150 mg twice day for two weeks; in individuals who don't respond well, it may be given for an additional two weeks. Acute reflux oesophagitis: 150 mg twice day or 300 mg before night for up to 8 weeks, or up to 12 weeks if necessary. Oesophagitis of moderate to severe severity: 150 mg four times per day for up to 12 weeks. Reflux oesophagitis longterm management: 150 mg bid. Child: 3-11 years 5–10 mg/kg each day, divided into two doses. Maximum: 600 mg per day; 12 years similar to an adult dose. Alprazolam may decreased Ranitidine's excretion rate, which could raise its serum level. Drug-drug interactions Ranitidine's sedative effects may be decreased by amphetamine. Amikacin's serum level could increase if ranitidine slows down its excretion rate. Ranitidine + Atorvastatin Chance to myopathy and myoglobinuria will develop or become more severe Ampicilin may reduce the rate of ranitidine excretion, which could lead to a greater serum level. CONTRAINDICATION Stomach cancer Porphyria Liver problems Decreased kidney function Hypersensitivity to ranitidine or components of the formulation
OTHER PHARMACOLOGICAL TREATMENTS Avoid large meals. Avoid alcoholic beverages, chocolate, onions, garlic, peppermint, citrus- and tomato-based meals, as well as alcohol. Reduce your consumption of dietary fat. After eating, wait three to four hours before resting down. Avoid using drugs including beta-agonists, theophylline, calcium channel blockers, nitrates, alpha-adrenergic agonists, and some sedatives as they may make GERD symptoms worse. Elevate the bed's head by 4 to 8 inches (10 to 20 cm). Avoid wearing tight-fitting garments around your waist. Lose weight. Quit smoking. It evolved from an open operation to a laparoscopic one, and most recently to a trans-oral incisionless fundoplication. NON-PHARMACOLOGICAL TREATMENTS As a result, impedance-pH monitoring has been found to minimize the frequency of TLESRs and all types of reflux occurrences, including acidic and mildly acidic types. However, due to its poor tolerability, which is mostly caused by neurological side effects, its clinical applicability is severely limited. It requires wrapping the LES either entirely or partially (360 degrees) around a section of the stomach, elevating LES pressure. Some advantages include less discomfort, fewer incisional hernias, a shorter hospital stay, a faster return to work, and fewer defective wraps at the follow-up endoscopy. The inability to belch and vomit, ongoing dysphagia, postprandial pain, epigastric fullness, bloating, momentary swallowing difficulty, and acute flatus are among the complications. During a trans-oral or endoluminal fundoplication, a specially customized variation of a traditional or laparoscopic fundoplication, the stomach is accessible through the mouth rather than through surgical incision. It is not currently advised as a substitute for medical or conventional surgery because there is insufficient evidence to support its function. However, recent articles have highlighted that a significant risk of symptom recurrence required ongoing antireflux medication use after a prolonged follow-up of individuals who had antireflux surgery (up to 13 years after surgery). Clinical success is heavily influenced by the surgeon's experience or expertise. Before surgery, ambulatory reflux investigations and esophageal manometry should be performed to rule out any additional conditions, such as achalasia, scleroderma, and non-reflux-induced esophageal spasms. lifestyle modifications Useful for those with mild symptoms. Assist in reducing acid reflux. Prokinetics speed up the emptying of the stomach and aid in strengthening the lower esophageal sphincter (LES). Domperidone benefits from having fewer pyramidal effects. Patients who are unresponsive to standard therapy may be given oral metoclopramide. Due to the possibility of harmful neurological and other effects, long-term usage is not advised. The length of treatment should be as minimal as possible. Medicine with Propulsive/ Prokinetic Agents www.groupassignmentPHD223.c om ANTIREFLUX SURGERY ANTIREFLUX SURGERY Example: Domperidone, Metoclopramide, Itopramide and Mosapride These innovative antisecretory medicines vary from PPIs in that they interact with K+ and provide dose-dependent selective, reversible blockage of the proton pump. Although they are not pro-drugs that must be activated in the parietal cells like PPIs, the regulation of gastric acid secretion begins after the initial dosage and within the first day of treatment. In contrast to PPIs, which are less effective at suppressing acid during the night, their rate of dissociation from the proton pump is slow. These innovative antisecretory medicines vary from PPIs in that they interact with K+ and provide dose-dependent selective, reversible blockage of the proton pump. As a result, their acid-inhibitory activity is present day and night. The most researched drug for the treatment of GERD is clearly vonoprazan. In individuals with mild to severe erosive esophagitis (EE), this medication has been demonstrated to be equally as effective as PPIs. However, the impressive acid suppression carried out by vonoprazan requires cautious management of any side effects, especially in patients receiving long-term care. In fact, this medication's short-term safety is good and equivalent to that of PPIs. Medicine with Potassium Competitive Acid-Blockers (P-CABs) Example: Veraprazan, Linaprazan, Vonoprazan and Tegoprazan Medicine with Reflux Inhibitors Example: Baclofen (Type-B GABA receptor agonist) Failed medical management: Side effects from medications, poor symptom control, and refractory GERD (persistent symptoms of GERD in cooperative patients despite regular therapy or twice-daily PPI dose for at least 8 weeks). Impacts from severe GERD, such as peptic stricture and Barrett's esophagus. Large hiatal hernia. Conditions outside the esophagus, such as a cough, asthma, chest pain, or aspiration. Young patients who need long-term care. Patients preference: Despite drug effectiveness, the patient may choose surgery because of the high expense of pharmaceuticals and the requirement to use acid-suppressing pills for the rest of their lives. However, if the patient's symptoms are effectively under control with medical treatment, surgery should be discouraged. 1. The indications Patients who report typical GERD symptoms and respond well to PPI medication have the best surgical outcomes. FUNDOPLICATION
CONCLUSION Based on the research we have done on this GERD disease, we have found a lot of information about this disease and the medicine that can treat this disease. Gastroesophageal reflux disorder (GERD) is a condition that develops when stomach acid frequently flows back into the tube that connects your mouth and stomach (the oesophagus). This backwash (acid reflux) may irritate the oesophageal lining. Therefore, there are many symptoms that can be detected if you have this disease. For example, heartburn, regurgitation of liquid or sour food, chest discomfort, dysphagia and laryngitis. Next, this disease can be treated by taking medicine that is provide for this disease. For example, Esomeprazole, Baroscon double action suspension, Pantoprazole and Ranitidine. There are two dosage forms for this medicine, among which are tablets and suspensions. Each drug used has its own mechanism of action and side effects First, the medicine that treats this GED disease is Nexium (Esomeprozole). This drug is under pharmacological class proton pump inhibitors (PPIs). Next, Esomeprazole, a pharmaceutical marketed under the brand name Nexium, is a medication categorised as a proton pump inhibitor (PPI). It is indicated for the efficient treatment of gastrosophageal reflux disease (GERD), protecting the stomach from future stomach ulcers or damage from long-term NSAID use. The Zollinger-Ellison (ZE) Syndrome and other pathological hypersecretory diseases are also treated with it. Esomeprazole demonstrates its ability in suppressing stomach acid by obstructing the final stage of gastric acid production. It achieves this by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme located on the secretory surface of gastric parietal cells. This action blocks both basal and stimulated gastric acid secretion. Because of the binding of esomeprazole to the (H+, K+)-ATPase enzyme that is irreversible, the restoration of acid secretion requires the production of new enzymes, resulting in the prolonged duration of its antisecretory effect, exceeding 24 hours. There are some side effects of this medicine such as aggression, agitation, muscle weakness and many more. Next, the second drug is Pantoprazole (Controloc). The pharmacological class for this drug is also PPIs inhibitor. The mechanism of actions of this drug are The H(+/K(+)-ATPase of the proton pump, which is highly expressed by the parietal cells of the stomach, controls the release of hydrochloric acid (HCI) into the gastric lumen. The parietal cell membrane contains an enzyme called ATPase that aids in hydrogen and potassium exchange inside the cell, which often leads to potassium extrusion and the production of HCI (gastric acid). There are some side effects of this medicine such as headache, nausea and vomiting. The third drug is Baroscon double action suspension. The pharmacological class Is Antacids (sodium alginate, calcium carbonate and sodium bicarbonate). Antacids were first synthesized from the hydroxides and carbonates of the group II and III metals and from the bicarbonates of the alkali metals. At least one of the metals sodium, potassium, calcium, magnesium, bismuth, or aluminium is present in every antacid. Antacids can be divided into two main categories: absorbable and non-absorbable. This medication ' s antacids-related mode of action is Antacids reduce the quantity of stomach acid that reaches the duodenum by neutralizing the stomach' s acid. The main treatment objectives are to lessen discomfort, ease pylorospasms, and avoid corrosion and acid chyme digestion. The eventual goal of each salt' s system is to neutralize acid, and each salt employs a different mechanism to do this. Last but not least, the side effects are hypercalcemia and acid rebound. Lastly, the drug is Ranitidine (Zantac). The pharmacological class of Ranitidine is H2 Antagonists. Ranitidine acts by preventing the release of gastric acid by inhibiting the activation of histamine-on-histamine H2-receptors found on the parietal cells lining the stomach wall. Histamine, a chemical transmitter, induces parietal cells to release stomach acid. Ranitidine inhibits H2 receptors, lowering stomach acid output and preventing histamine from exerting this effect. Additionally, if we use this medication, we may get agitation, abdominal pain, and headaches. Finally, there are numerous medications that can treat GERD.
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