Writtne by: Rebecca Webb, PharmD Pharmacy Clinical Services Manager

Stay on the right “tract” this month.  Gastrointestinal (i.e., GI) tract health, also known as gut health, continues to remain the theme in April.  Last month, we focused on how to keep the lower parts of your digestive system healthy.  This time around, we will be concentrating on upper GI tract health, specifically pertaining to your esophagus and stomach.  

When talking about upper GI health, it is first important to have a basic understanding of the structure and functions of the esophagus and stomach.  

•   The esophagus is the hollow, muscular passageway where food and liquids flow down from your throat to your stomach.  There are several important muscular sphincters located within your esophagus that open and close, allowing for food and liquids to travel.  The upper esophageal sphincter relaxes so contents can enter your esophagus.  The lower esophageal sphincter relaxes so contents can exit your esophagus and move on to your stomach.  These sphincters are usually closed when food or liquid is not present.

•   The stomach is the J-shaped organ located in your upper abdomen on the left side of your body.  This is where food is temporarily stored, mixed by muscular contractions, and broken down by special enzymes.  Here, stomach acid plays an important role in the digestion process.  The stomach then leads on to the lower parts of the GI tract (e.g., small intestines, large intestines, and rectum).   

 

Part of staying on the right “tract” with upper GI health is being aware of some of the common terminology associated with the esophagus and stomach.  

•   Esophagitis – This is inflammation of the esophagus.  Esophagitis has various causes including acid reflux, medications, allergies, and infections.  Medications associated with esophagitis include nonsteroidal anti-inflammatory drugs (i.e., NSAIDs) [e.g., ibuprofen (Advil®, Motrin®) and naproxen (Aleve®)], certain antibiotics (e.g., doxycycline, tetracycline), potassium supplements, and bisphosphonates [e.g., alendronate (Fosamax®)] for osteoporosis.  Treatment for esophagitis depends upon the underlying cause.  To reduce drug-induced esophagitis, it is important to speak with your Food City Pharmacist on how to best take these medications. 

•   Gastritis – This is inflammation of the stomach.  Gastritis can be acute or chronic and erosive (e.g., causing ulcers) or nonerosive.  Various situations can lead to inflammation of the stomach lining, including infections, certain medications, stress, and autoimmune conditions.  One of the most frequent causes of gastritis is the overuse of NSAIDs.  Gastritis can manifest as a loss of appetite, feeling full after eating, stomach pain, bloating, or nausea and vomiting.  If ulcers are present, there may be gastrointestinal bleeding which can lead to dark blood in your stool and possibly anemia.  Treatment for gastritis will depend upon the cause.  Acute inflammation of the stomach generally resolves once the cause has revolved (e.g., infection clears, offending medication is stopped or reduced, or stress is managed).  Chronic inflammation of the stomach does not typically resolve on its own and may require specific treatments for resolution.  

•   Acid reflux.  This occurs when the lower esophageal sphincter does not work properly and opens when it should not.  This allows stomach contents, including stomach acid, to flow back up into the esophagus.  This is a common cause of esophagitis and can result in the classic symptoms of heartburn (e.g., an uncomfortable, burning sensation behind your sternum and a bitter/acidic taste in your mouth).   

•   Gastroesophageal reflux disease (i.e., GERD).  This is a more severe, persistent form of acid reflux.  Individuals with GERD may develop additional symptoms including a cough, chest pain, hoarseness, halitosis (i.e., bad breath), and difficulty swallowing.  GERD can have damaging effects on your esophagus.  

 

Knowing how to treat or manage these conditions affecting your upper GI tract is also part of staying on the right “tract.”  Over-the-counter (i.e., OTC) and prescription medications, as well as important lifestyle modifications can help.  It is important to always follow the directions on the package labeling of any of the following OTC medications.     

•   Antacids [e.g., Tums®, Mylanta®, Rolaids®] are OTC.  These work quickly by neutralizing stomach acid and are used to relief occasional mild acid reflux symptoms. 

•   Histamine (H2) receptor blockers [e.g., famotidine (Pepcid AC®), cimetidine (Tagamet HB®) are available both OTC and by prescription.  These work by blocking histamine which in turn, reduces stomach acid production.  H2 blockers are used for mild acid reflux symptoms.  

•   Proton pump inhibitors (i.e., PPIs) [e.g., omeprazole (Prilosec®), esomeprazole (Nexium®), lansoprazole (Prevacid®)] are available both OTC and by prescription.  They work by inhibiting an enzyme that produces stomach acid.  PPIs may take a few days for the full effect and are thus not generally used for quick relief.  They do however relieve chronic symptoms of GERD and help to heal or prevent stomach ulcers.  It is important to note that these medications have specific directions for use in order to work most effectively.  The long-term use of these medications has also been associated with potential serious side effects (e.g., vitamin absorption issues, electrolyte imbalances, bones fractures, and increased risk of infections).

•   Cytoprotective medications [e.g., bismuth subsalicylate (Pepto-Bismol®, Kaopectate®), which are available OTC; sucralfate (Carafate®), which is available by prescription) coat the lining of the stomach, preventing damage from stomach acid.  

•   Certain lifestyle modifications can help manage these conditions and support gut health.  This includes changes in eating habits such as avoiding foods and substances that trigger acid reflux (e.g., chocolate, caffeine, peppermint, alcohol, fatty foods, fried meals, spices, citric products, and carbonated beverages), obtaining adequate fiber, limiting the intake of processed products, consuming probiotic-rich foods, not eating before bedtime, and eating smaller-sized meals.  Other lifestyle adjustments that can assist in gut health include staying hydrated by drinking plenty of water, exercising routinely, losing weight (if overweight or obese), getting more quality sleep, managing stress, and of course, not smoking.   

 

If you have any questions pertaining to gut health, please stop by and speak with our knowledgeable and friendly pharmacists at Food City Pharmacy.

 

_References:

_{1. Esophagus. Cleveland Clinic website. https://my.clevelandclinic.org/health/body/21728-esophagus. Accessed March 14, 2024.} 

_{2. Stomach. Cleveland Clinic website.  https://my.clevelandclinic.org/health/body/21758-stomach. Accessed March 14, 2024.}