6) TREATMENT OF GERD (GASTROESOPHAGEAL REFLUX DISEASE)

GERD is a common condition caused by gastric acid reflux into the esophagus. This irritates the esophagus and frequently causes heartburn and other symptoms including belching, coughing, wheezing, heartburn, nausea, vomiting, regurgitation of food, rarely hoarseness, and even occasionally major gastrointestinal bleeding. The chest pain can sometimes simulate symptoms of a heart attack, and on occasion a sufferer ends up spending several days in a coronary care unit before a heart attack is ruled out. On the other hand, I have run into cases of individuals self-medicating with over the counter drugs for GERD, but later it turned out it was angina and a precursor for a heart attack. Hiatal hernia, (a condition in which part of the stomach moves above the abdomen) can also pecipitate symptoms.

Basic common sense treatments for GERD that have been used for decades include avoiding food that commonly causes symptoms. (common precipitators of pain include chocolate, spicy foods such as pizza, caffeine, alcohol, and even peppermint), avoiding aspirin and Motrin type drugs (as they can increase gastric acid), avoiding lying down after meals, sleeping with the head of the bed elevated, taking all medicines with a 8 ounces of water, and even weight reduction (which reduces intra-abdominal pressure that pushes up on the stomach).

Many drugs can worsen symptoms including anticholinergics for seasickness, beta blockers and calcium channel blockers for hypertension and heart disease, bronchodilators for asthma, some Parkinson drugs, sedatives, and tricyclic antidepressants. However if you suspect you’re being affected, don’t stop the medicine on your own; talk it over with your doctor.

Tests to confirm diagnosis range from barium swallow x-ray to upper GI endoscopy by a gastroenterologist. A stool guaiac test (for blood) is a good idea, but is underused.

Occasionally GERD can have serious complications. Chronic exposure of the lower esophagus to acid sometimes transforms the normal esophageal cells to abnormal cells called “Barrett’s esophagus”. These cells have a small but definite risk of turning into cancer.

Treatments of GERD: Antacids such as Maalox, Mylanta, and Tums neutralize stomach acid and usually provide quick relief. Side effects include diarrhea or constipation. Milk used to be recommended to neutralize acid. It does relieve pain temporarily, but results in an acid rebound, and is not recommended.

H-2 receptor blockers such as Tagamet, Pepcid, Axid, and Zantac reduce acid production. They don’t work as quickly as antacids but provide longer relief. Side effects are rare but Tagamet can sometimes act as an anti-androgen, so men should choose an alternative drug.

Proton pump inhibitors block acid production and allow the damaged esophageal tissue to heal. PPI’s include Prevacid, Prilosec, Nexium (the famous little purple pill), Protonix, and Aciphex. In the test tube, all PPI’s are equal, but many people feel that one of them consistently work better than the others. I wish I could tell you side effects are rare, but there is one underpublicized serious effect. Several years ago it was discovered that chronic maintenance use of PPI’s decreases calcium absorption and is associated with an increase in hip fractures in young people. Many Fantastic Fifties members are aware of the pandemic of vitamin D deficiency present in North America. Use of PPI’s is another reason to get a 25-hydroxyvitamin D level, and aggressively correct low levels with supplements. The vitamin D would increase calcium absorption and help counteract this side effect of the PPI’s.

Medications to strengthen the muscular barrier between the esophagus and stomach are occasionally used in severe cases. Surgery is used only in the most intractable cases, but is frequently unsuccessful.

The generics of these drugs for GERD are very inexpensive. For example, some of the OTC PPI’s can be obtained for $6 a month. Treatment should result in a relief of symptoms in almost all cases.