Stay on Top of Reflux with Gaviscon Dual Action

GORD

Symptomatic gastro-oesophageal reflux disease (GORD), is a complex disorder that affects over 11% of the Australian population1. Typical symptoms associated with GORD usually include heartburn and regurgitation, both of which generally occur after eating2. Most people suffering from GORD experience troublesome symptoms that may be triggered by a host of precipitating factors1.

The Acid Pocket

Recently, a major source of postprandial acid reflux has been identified: the acid pocket. This is a layer of highly-acidic gastric secretion that accumulates close to the gastro-oesophageal junction after meals3. It also acts as a source of acid reflux after meals4.

In patients with GORD, the acid pocket extends over the gastro oesophageal junction, and towards the oesophagus3. This may also contribute to underlying symptoms.

Up to 45% of GORD patients experience breakthrough symptoms in spite of being on heartburn medication5.

Implications for Treatment

Traditionally, Proton Pump Inhibitors (PPI’s) have been the favoured course of treatment for those experiencing reflux. However, owing to their mode of action, PPI’s do not provide immediate symptom relief and are normally reserved for patients with symptoms that occur more frequently6,7.

Although acid suppression treatment provides effective relief for some of the symptoms of reflux, many symptoms associated with GORD are not acid related.8 Addressing some of the mechanical causes of symptomatic reflux may be an alternative approach to treatment. It is important then, to focus on a treatment option that addresses all symptoms of GORD. Alginate antacid formulations may be the solution.

An alginate antacid formulation such as Gaviscon Dual Action has been shown to form a buoyant, calming raft that provides a physical barrier to reflux and also directly targets and displaces the acid pocket3,9.

Treatments Have Different Mechanisms of Action

Treatments involving antacids sink rapidly in the stomach and may do very little to directly target the acid pocket. However, alginate antacid combination formulations such as Gaviscon Dual Action form a buoyant raft in the region of the stomach closest to the oesophagus3. These alginate antacid combinations neutralise the acid in the stomach10.

Along with targeting the acid pocket directly, treatments such as Gaviscon Dual Action also reduce exposure of the oesophagus to acid3,10,11. They may be particularly useful for customers with post-prandial symptoms.

It is always important that you ask customers to not only describe their symptoms, but also any patterns that they may have observed in terms of the timing and onset of symptoms. This may assist with counselling the patient on an appropriate form of treatment.

Symptoms That Require Referral

As the pharmacist is often the first healthcare professional consulted by those with reflux symptoms, it is important to have an open conversation about the customer’s history and symptoms. This may help you determine if the customer can be managed in pharmacy or if they should be referred to their GP for further consultation. Some of the ‘alarm symptoms’ that require immediate referral may include:

• Difficulty swallowing
• Unexpected weight loss
• Vomiting
• Abdominal mass/swelling11
• Anaemia

Always read the label. If symptoms persist consult your healthcare professional.

To help pharmacists ‘visualise’ the acid pocket concept and Gaviscon mode of action, RB teamed up with an expert bartender and community pharmacist Stuart Nankivel to create a short educational video for pharmacists. To check out the ‘Gaviscon-inspired’ cocktail and learn more about the acid pocket, watch the Gaviscon video by visiting www.rbhealthhub.com.au.

For more information on Gaviscon Dual Action, to view our new video content with Stuart Nankivell and our Gaviscon mixologist, and to update your knowledge on GORD, visit www.rbhealthhub.com.au.

References
1. El Serag HB et al. 2014
2. Kahrilas PJ. Cleve Clin J Med. 2003;70(Suppl5): S4-19
3. Kahrilas PJ, et al. AM J Gastroenterol 2013; 108 (7): 1058-1064
4. Clarke AT, Wirz AA, et al. Gut. 2009;58(7):904-909
5. El-Serag H et al. Aliment Pharmacol Ther 2010; 32: 720–37. P2
6. Pharmaceutical Society of Australia. Guidance for provision of a Pharmacist Only medicine, Proton Pump Inhibitors (PPI’s), July 2011
7. Tytgat GN, et al. Aliment Pharmacol Ther 2008;27(3):249-256
8. Boeckxstaens G et al. Gut 2014;63(7):1185-93
9. Kwiatek MA, et al. Aliment Pharmacol Ther 2011;34:59-66
10. Rohof WO, et al. Clin Gastroenterol Hepatol 2013;11(12):1585-91
11. Veldhuyzen van Zanten SJ, et al. Can J Gastroenterol 2005; 19(5)285-303