Whelehans Health Blog

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

Gastro-oesophageal reflux disease (GORD) is a condition which develops from reflux of stomach contents upwards.GORD is a condition that tends to be more common at Christmas due to over-eating or rich and heavy food.

Causes

The oesophagus is a tube of muscle connecting the mouth to the stomach. In normal circumstances, the lower oesophageal sphincter (LOS) (the muscular ring at the lower end of the oesophagus) opens like a valve, enabling food to pass into the stomach and then closes to prevent stomach acids seeping back into the oesophagus. However, in GORD the sphincter pressure reduces, relaxing the muscle and allows the stomach's acidic contents to reflux into the oesophagus.

How common is GORD?

The most common cause of indigestion in Ireland, GORD affects up to 1 in 4 people. 10% to 20% of people in the western world have at least one bout of GORD per week. It is twice as common in males as females.

Predisposing factors

Here are lifestyle and medication risk factors that increase the possibility of developing GORD:

-Being overweight or obese, particularly if this is physically around the waist. This increases pressure on the stomach from beneath forcing contents upwards.

-Fatty foods slows stomach digestion so it takes longer to expel stomach acids

-Consuming excess alcohol, coffee, spicy foods or chocolate increases the acidity of the stomach contents and relaxes the oesophageal sphincter thus increasing reflux potential

-Smoking relaxes the oesophageal sphincter increasing reflux risk

-Pregnancy increases risk of GORD because.

Changes in hormone levels can weaken the LOS

The baby pushes into the stomach which pushes stomach contents upwards (especially in later stages of pregnancy)

-Hiatus hernia is when part of a stomach pushes up through the diaphragm (the muscle used for breathing). This creates pressure on the stomach, leading to reflux

-Stress

-If you have a predisposition to GORD, sleeping flat can increase risk.

 

Medication

Some drugs prescribed for non-GORD related conditions can cause the oesophageal sphincter to relax increasing the potential for reflux including:

-Non steroidal anti-inflammatory drugsare anti-inflammatory pain killers and include aspirin, ibuprofen, diclofenic and naproxen.

-Antibiotics such as tetracyclines and ciprofloxacin

-Calcium-channel blockers – treats high blood pressure (eg) amlodipine (Istin^®) and lercandipine (Zanidip^®)

-Theophylline – treats respiratory conditions including asthma and chronic pulmonary obstructive disorders (COPD) such as bronchitis and emphysema

-Benzodiazepines are tranquilisers used on a short term basis only to treat anxiety, panic attacks and sleeping disorders (eg) diazepam (Valium^®), alprazolam (Xanax^®) and temazepam (Insomniger^®)

-Nitrateswhich treat angina by relaxing blood vessels thus reducing chest pains and discomfort. Examples include Isosorbide Mononitrate (Imdur^®) and glyceryl trinitrate spray which is an under-tongue spray (eg) Glytrin Spray^®, Nitrolingual Spray^®.

-Biphosphonates to treat osteoporosis including Alendronic Acid (Fosamax^®), Risedronate (Actonel^®) and ibandronic acid (Bonviva^®)

-Anticholinergics used to treat respiratory, digestive, neurological problems (eg) Atrovent^® and Spiriva^® inhaler used for COPD, Detrusitol^® used for urinary incontinence

 

Symptoms

-Heartburn

This is the main symptom. It presents as a burning feeling of discomfort, rising from the upper abdomen or lower chest up towards the neck. It has actually nothing to do with the heart.

-Regurgitation

Regurgitation of acid up the oesophagus often as far as the throat. This usually causes an unpleasant, sour taste.

-Dysphagia

Dysphagia means difficulty swallowing. Around 30% people with GORD have problems swallowing. It occurs when scarring through repeated exposure to stomach acid causes the oesophagus to narrow making food difficult to swallow. Many describe it as feeling like a piece of food becoming stuck somewhere near the breastbone.

-Severe chest pain

This is a non-cardiac chest pain caused by GORD; this has been found in up to 50% of patients with chest pain and normal coronary angiography. Usually there is no relationship to exercise and this helps to differentiate most cases of reflux induced chest pain from true angina.

Other common symptoms include nausea, bloating and belching. These symptoms are periodic in nature and may flare up after eating, bending over or after a period of lying down.

The HSE revealed earlier this year that Westmeath is among the worst three counties in Ireland for overuse of antibiotics. Pharmacist Eamonn Brady from Whelehans Pharmacy Mullingar explains that “antibiotics do not work for colds and flus and should be reserved for more serious infections”. Eamonn explains that “Antibiotic resistance still remains a major European and global public health problem and is, for a large part, caused by misuse of antibiotics. Antibiotic resistance is considered to be one of the biggest future threats to world health; already diseases which were considered curable such as tuberculosis and malaria are getting resistant to antibiotics and could become incurable in the future if we don’t tackle antibiotic overuse”.

 

One in four people still think an antibiotic cures a cold

 

Eamonn explains that a “2013 HSE survey revealed some worrying findings. It was revealed that one in four people in Ireland still wrongly believe that antibiotics prevent colds developing into more serious illness or that they speed up the recovery from colds. The HSE explain “Antibiotics have truly transformed modern medicine and are appropriately used to treat or prevent bacterial infections. However, we are all in danger of taking antibiotics for granted and we all have a role to play so that we don't return to the pre-antibiotic era. Before antibiotics were available, common injuries such as cuts and scratches that became infected sometimes resulted in death or serious illness because there was no treatment available. Thankfully, this does not happen anymore as we have antibiotics available to treat these infections. However a casual attitude to antibiotics is damaging their effectiveness”.

 

Under the weather?

 

European Antibiotic Awareness Day is an annual event to raise awareness on how to use antibiotics in a responsible way that will keep them effective now and in the future. To mark the occasion, Pharmacists are collaborating with GP’s and the HSE on a public campaign; this campaign is being launched today, Wednesday 18 November. The campaign is being supported by the HSE website www.undertheweather.ie and is being promoted as the place to go for sensible, practical advice on common complaints. Most young mothers, when discovering their child is ill, search online for advice. This website will give practical advice on what to do and when to seek help from the pharmacist or GP.

 

What to do if you have cold or flu

 

Pharmacist Eamonn Brady explains that “antibiotics are now becoming ineffective to many infections leading to the development of superbugs such as MRSA. Infections such as tuberculosis are now re-emerging because the bacteria are developing resistance because of our overuse of antibiotics. The best way to prevent this problem is for all of us to only use antibiotics when we really need them. Many infections are viral so an antibiotic should not be prescribed. Your GP or pharmacist can explain which infections need and which don’t need antibiotics” Pharmacists give the following advice if you have a cold or flu, “Stay at home and rest if necessary. Drink plenty of water or soft drinks. Take paracetamol to reduce your temperature if feverish or if you are in any discomfort. You may wish to take other remedies, but be aware that they may contain paracetamol - do not exceed the maximum daily dose of paracetamol by combining different products - ask your pharmacist. Ask your pharmacist about other remedies you can safely take to relieve your symptoms. If you are concerned that your symptoms are getting worse or you are not better in a few days, phone your GP surgery for further advice. Finally, personal hygiene precautions such as hand washing regularly prevent the risk of infections spreading and will protect you and others.”

 

What is midazolam?

 

Midazolam belongs to a group of medicines called benzodiazepines. It is a relation of diazepam. It has traditionally used for sedation. Midazolam can be used to treat a number of different conditions, including seizures. It is prescribed for some but not all epileptics (eg) if a person has a history of longer seizures (also known as fits). If a seizure lasts for more than five...

Dementia is an umbrella term used to describe various conditions which damage brain cells and lead to a loss of brain function over time. Dementia causes a progressive decline in a person’s mental functioning. It is a broad term, which describes a loss of memory, intellect, rationality, social skills and normal emotional reactions. The symptoms of dementia develop gradually over a period of years. The progression of these diseases is largely unpredictable for each individual.

 

Facts in brief

Risk Factors

The risk factors for Alzheimer's disease include increasing age being female, family history, head injury, Parkinsons, hypothyroidism, exposure to dietary aluminium, cardiovascular disease, smoking and high alcohol intake

This article is shortened for this Health Blog.. More detailed information and leaflets is available in Whelehans or check www.whelehans.ie

 

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacy, Pearse St, Mullingar. If you have any health questions e-mail them to info@whelehans.ie

A cough is a reflex action to clear the throat of any foreign bodies or particles, such as dust.  But when you get a cold, the infected mucus from your nose drips down the back of your throat in a process called post-nasal drip.  This post-nasal drip causes a type of cough that is not helpful at all. Essentially there are two types of cough, a DRY or a CHESTY cough.  Chesty coughs occur when mucus (also called phlegm or catarrh) builds up in the airways and the cough occurs so your body can clear the mucus. 

Chesty cough mixtures such as Viscolex^® contain an expectorant which liquefy the catarrh so it can be coughed up easier.  There are other chesty cough mixtures that cause drowsiness which can be used at night to help you sleep.  Sugar free versions of cough mixtures such as Exputex^® are available for diabetics. 

Dry cough mixtures contain ingredients such as pholcodeine, codeine and dextromethorphan.  Dry cough mixtures come in drowsy or non-drowsy versions. The likes of pholcodeine and codeine should only be used in moderation as they cause side effects like constipation and can cause withdrawal symptoms like headaches and can be addictive even if only using for a few days. There are also combination cough mixtures available which contain decongestants which are effective for cough with congestion.  

You should see your doctor if you experience any of the following symptoms with your cough: