PRESS RELEASE
The Philippine
Society of Gastroenterology (PSG) has completed the
development of treatment guidelines for gastroesophageal reflux disease or
GERD, a bothersome condition whose prevalence in the country is increasing. Photo shows (from left): Ivy Santos, Product Manager, Takeda Pharmaceuticals
(Philippines), Inc.; Genevive Mercurio, Franchise Manager, Takeda Pharmaceuticals
(Philippines), Inc.; Norman Zara, President and General Manager, Takeda
Pharmaceuticals (Philippines), Inc.; Dr. Peter Sy, President,
Philippine Society of Gastroenterology (PSG); Dr. Jose Sollano, PSG Past
President and Lead Convenor of the GERD
Consensus Development Group of the PSG; Dr. Sherrie de Ocampo,
PSG Accreditation Board Member; Dr.
Lexie Torres, Medical Director, Takeda
Pharmaceuticals (Philippines), Inc.; and Dr. Rio Abrenica, Medical Affairs
Manager, Takeda Pharmaceuticals (Philippines), Inc.,
Manila,
Philippines. The
Philippine Society of Gastroenterology (PSG) has completed the development
of treatment guidelines for gastroesophageal reflux disease or GERD, a
bothersome condition whose prevalence in the country is increasing.
“While the
bothersome symptoms associated with GERD are common reasons for clinic visits among
Filipino patients, there are currently no clinical practice guidelines for GERD
treatment in the Philippines. As such, we developed the Philippine Consensus Guidelines
for the Management of Gastroesophageal Reflux Disease,” said PSG President Dr.
Peter P. Sy.
“In
crafting these Consensus Guidelines, our goal was to address the need of
Filipino primary care physicians and specialists for updated, evidence-based
guidance in the management of GERD. Moreover, the government’s Universal Health
Care program may soon require country-specific guidelines for GERD diagnosis
and management,” said Dr. Jose D. Sollano, PSG Past President and Lead Convenor
of the GERD Consensus Development Group of the PSG which developed the
guidelines.
Faulty valve
After
every meal, millions of tiny pumps in the stomach—proton pumps—produce the acid
that helps digest food. At the bottom of the esophagus (the tube that carries
food from the mouth to the stomach) is a ring of muscle called the lower
esophageal sphincter (LES). The LES opens between the esophagus and stomach to
allow food and liquids to enter the stomach. If the valve doesn't close tightly,
or if it opens too often, stomach acid can move up into the esophagus. This
condition is called gastroesophageal reflux (GER). Most patients will not
complain of symptoms. However in some patients, GER can cause troublesome symptoms
like recurrent heartburn, sour taste in the mouth (acid regurgitation), chronic
sore throat, hoarseness, sensation of a lump in the throat, and chest pain,
among others.
“Occasional
GER is common and does not necessarily mean a person has GERD. However,
persistent GER that results in the annoying symptoms described above is
considered GERD,” explained Dr. Joseph Bocobo, PSG Past President and Member of
the GERD Consensus Development Group.
Diagnosis
The Consensus Guidelines
define GERD as “a condition resulting
from the recurrent backflow of gastric contents into the esophagus and adjacent
structures causing troublesome symptoms and/or tissue injury.”
Local primary care physicians can diagnose GERD in the clinic if the
typical symptoms of acid regurgitation and/or heartburn are present. In this
setting, the Consensus Guidelines do not consider an upper endoscopy as
absolutely necessary to establish a diagnosis of GERD. Upper endoscopy is a procedure that uses an endoscope
(a small, flexible tube with a light source) to see the lining of the upper
gastrointestinal tract.
For
patients who present with chest pain, even if suspected to be GERD-related, the
Consensus Guidelines recommend appropriate cardiovascular risk assessment
before starting treatment to ensure patient safety. This ensures that a heart
attack is not misdiagnosed as GERD. Such a cardiovascular risk assessment
should include, at a minimum, history and physical examination, 12-lead
electrocardiogram (ECG) and Troponin I (a blood test that indicates a heart
attack in people with chest pain).
Treatment
Untreated, GERD can cause
complications more serious than the bothersome symptoms mentioned previously. Erosive
esophagitis develops when the esophagus is damaged by continued exposure to
stomach acid. Barrett’s esophagus is a serious complication of longstanding
GERD involving profound changes in the nature of the tissue normally lining the
esophagus. Barrett’s esophagus increases the risk for cancer of the esophagus.
GERD can be managed through lifestyle modification
and drug therapy. Antireflux surgery may only be required in
patients who continue to have severe symptoms, erosive esophagitis or disease
complications despite adequate drug therapy.
Proton pump inhibitors,
also known as PPIs, are the first-line treatment for GERD. PPIs reduce the production of acid in the stomach. Less stomach
acid means less irritation of the esophagus if gastric reflux occurs thereby
allowing the esophagus to heal.
According to the
Consensus Guidelines, “Standard dose PPI once
daily for 8 weeks, taken 30 minutes before breakfast is the cornerstone of GERD
therapy.”
Even with patient compliance, inadequate symptom control especially at
night may still occur due to the failure of PPIs to provide 24-hour acid
control. Dexlansoprazole, a novel PPI with Dual Delayed Release (DDR) formulation,
was recently made available by Takeda Pharmaceutical (Philippines) Inc. to
address this gap. The once-a-day capsule provides 24-hour control of acid
production for round-the-clock symptom relief and improved sleep. Unlike other
PPIs that must be taken 30 to 60 minutes before a meal for optimal efficacy,
Dexlansoprazole can be taken anytime with or without food. This flexible dosing
increases patient compliance and enhance treatment success.
When symptoms still relapse after the recommended standard GERD
treatment, on-demand or intermittent PPI therapy is suggested for non-erosive
reflux disease (NERD) while continuous PPI treatment is recommended for
moderate to severe erosive esophagitis.
Cheryl my son used to have GERD. His vomits were 'spits in trajectory"
ReplyDeletehe used to be so thin. We did not understand why he could not absorb milk like other kids do, or that he vomits his food most of the time. But we were able to manage his GERD through his gastro pedia...Glad that doctors are putting GERD into the limelight, kasi before we had no idea what it was. It was something not heard of, in kids and grown-ups, alike.
it's bothersome indeed! a friend of mine got diagnosed with GERD before, ang daming bawal! I hope the treatment guidelines would help a lot of patients
ReplyDeleteThis is indeed a helpful article! Based on what you wrote, I think I have GERD.. But, I have yet to visit my Internist again. Thank you and I bookmarked this!
ReplyDeleteThis is good to know as hubby oftentimes complains of it.
ReplyDelete