MORE than 7 million persons in the United States have gastro-esophageal reflux disease (GERD) and some of them are taking antacids; more are on Proton Pump Inhibitor (PPI) pills to reduce acid secretion in the stomach.
For normal digestion, the stomach needs an acidic milieu to enable Pepsin, an enzyme essential for preliminary digestion of protein, to work properly. Thus, the stomach normally secretes hydrochloric acid for this purpose which also acts as a barrier to microorganisms and infection.
Old standby antacids like Maalox, Mylanta, Tums, Rolaid, Gaviscon, Alka Seltzer, and others contain alkali and are taken to neutralize the stomach acid, but the newer variety of drugs prevent the actual production of acid by inhibiting the “acid pump,” hence called Proton Pump Inhibitor or PPI.
The late ‘70s ushered in histamine 2-receptor (H2) blockers, like Zantac (ranitidine), Tagamet (cimetidine), and Pepcip (famotidine). Then came the PPI came along: Prilosec (Omeprazole), Nexium (Esomeprazole), Prevcid (Lansoprazole), AcipHex (Rabeprazole), Protonic (Pantoprozole) and Kapidexn (Dexlansoprozole).
The PPIs are becoming the pills of choice because they have been found to be more effective than antacids or H2 blockers in the treatment of GERD, although PPIs are much more expensive.
What is GERD?
Gastro-esophageal reflux disease is a condition where the gastro-esophageal sphincter (valve) has become incompetent (loose) and allows the acidic gastric content to regurgitate (“back-up”) to the esophagus, causing irritation in the lower end of the esophagus where it attaches to the stomach, resulting in esophagitis (inflammation of the lower end of the esophagus and later stricture from scarring caused by repeated inflammation).
What is Reflux Heartburn?
Reflux Heartburn is a milder stage of Reflux Esophagitis, caused by the hydrochloric acid from the stomach.
Why is acid reflux bad?
The stomach mucosa (lining) normally produces the digestive acid and tolerates it much better than the esophagus, which has a different cell lining that is less resistant to the acid. Reflux of stomach acid into the lower end of the esophagus causes esophagitis (irritation, inflammation and swelling), which, if allowed to continue untreated, could cause esophageal stricture (scarring) and narrowing, making the channel connecting the food pipe to the stomach too small for food to pass through.
Is this condition common?
Yes, very common. Sixty percent of the adult population has some type of GI reflux. As stated above, about seven million Americans have GERD. Most patients complain of burning discomfort in the pit of the stomach after meals or at night, while lying down, allowing stomach acid to flow back to the esophagus. Many times the burning disappears when the person gets up. The symptom could also be that of indigestion or “sour stomach.” People who take antacids, like Alka Seltzer, Maalox, Tums, etc. could have GERD, undiagnosed.
Is Hiatal Hernia present in Reflux Esophagitis?
The food pipe, which is in the chest, goes down through a hole in the diaphragm (the tent-like flat muscle that separates the abdomen from the chest) to connect with the stomach in the abdomen. This hole is called a hiatus. If this hole becomes too large, the stomach, which is normally in the abdomen, could move up to the chest through the hole. If this happens, it is called Hiatus Hernia. While Hiatus Hernia usually leads to GE reflux, it is found in only 20-30 percent of those with reflux esophagitis. The majority do not have accompanying Hiatus Hernia.
What is the treatment for GERD?
The initial management of patients with persisting symptoms of GERD consists of: (1) Changing diet (avoiding spices, caffeine, chocolate, alcohol, cola drinks); (2) quitting cigarette smoking; (3) avoiding tight, binding clothing, especially after a meal; (4) refraining from lying down immediately after a meal, and elevating the head of the bed when lying down to keep gastric acid and contents in the stomach by gravity; and (5) taking PPI pills under the close supervision of your physician which is usually 80 percent successful in healing severe erosive esophagitis. This also includes blood monitoring of the levels of electrolytes (calcium, magnesium, etc.) and B12, and follow-up endoscopies.
What are the side effects of long-term PPI?
Some side-effects of antacids, H2 blockers and PPI, which are rare, could include headache, stomach pain, nausea, constipation or diarrhea and itching. Long-term use of PPI increases the risk for bacterial infection of the intestinal system, low magnesium and vitamin D level that predispose to bone fractures, vitamin B12 deficiency and anemia. PPI also interferes with certain medications, like blood thinner Plavix (clopidogrel) and theophylline, and increases the risk for pneumonia from “aspiration” of stomach content with severely reduced acids and less sterile. The less acidic environment in the stomach also allows Clostridium difficile bacterium to thrive and cause life-threatening diarrhea and colitis. PPI also reduces calcium absorption which leads to osteoporosis and fractures, especially hip fractures, and predisposes to Helicobacter pylori infection, gastric atrophic changes, and the formation of stomach polyps. The long-term use of PPI may also lead to confusion, delirium and dementia, and a slight increase in the risk for heart attack.
Is suppression of gastric acid unhealthy?
Since acid secretion in the stomach is normal for the process of digestion, does the use of antacids, H2 blockers and Proton Pump Inhibitors to neutralize or suppress normal acid secretions have unintended consequences for disruption of normal body physiology? This is a question researchers are still investigating. So far, there is no evidence that these medications are more harmful than beneficial. PPI drugs are wonders in modern therapy and benefit hundreds of millions of people around the globe. Clinical studies worldwide continue to monitor behavior of all drugs, including PPI. Medical consultation is recommended prior to taking any of these drugs, especially for those with kidney disease, pregnant or breast-feeding.
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