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Management of GERD: Diagnosis

Many diagnostic tests and procedures can be performed to confirm gastroesophageal reflux disease (GERD) and establish disease severity, such as endoscopy, barium swallow tests, and ambulatory pH monitoring. However, pharmacists are often the first health professionals that patients approach to seek advice about heartburn relief. It is important for pharmacists to be able to assess the frequency and severity of heartburn and suggest appropriate referral for patients with GERD who are at risk of complications. The pharmacist should ask questions about duration, intensity, and frequency of heartburn episodes and their temporal relationship to food intake. The pharmacist should also determine whether the patient consumes foods or beverages known to aggravate reflux (TABLE 1). Quality-of-life changes should also be assessed. Medication history should be carefully evaluated to identify any medications that may contribute to heartburn, as well as any therapies the patient had previously used to treat the heartburn. Patients should be questioned about any atypical symptoms such as cough, wheezing, hoarseness, sore throat, laryngitis, or asthma. Finally, the pharmacist should establish whether the patient has any warning signs that would require immediate medical referral.

Table 1. Factors That Decrease Lower Esophageal Sphincter Pressure
Foods and beverages Medications
Chocolate Anticholinergics
Citrus juices Barbiturates
Coffee, cola, tea Benzodiazepines
Fatty meals Beta-adrenergic agonists
Garlic Caffeine
Onions Dopamine
Peppermint, spearmint Dihydropyridine calcium channel blockers
Spices Estrogen
Tomato juice Ethanol
Narcotics
Nicotine
Nitrates
Progesterone
Theophylline

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