Heartburn Help


[Also, see Gerd Lifestyling and My Gerd Opinion]

Gastroesophageal Reflux Disease, or GERD. Sounds like one of those Northern European names, like Gerda or Gerta or Gerhardt or Gudrun. A lot of folks just call it heartburn. Of all those who come into hospital emergency rooms thinking they’re having heart attacks, nearly half are actually suffering from heartburn.

Depending on the source, 15 million to 25 million Americans suffer from GERD, 20% of the population has heartburn weekly and/or 60 million suffer from it at least once a month. Whatever the stats, it’s hydrochloric acid surging up from the stomach to scorch the esophagus.

GERD itself is a broad term describing heartburn and other problems associated with this so-called “acid reflux.” The muscular ring just above the stomach, the lower esophageal sphincter, is supposed to be a one-way valve that lets food go down but keeps stomach contents from coming up. When that valve doesn’t do its job, results range from simple pain to asthma, cancer or even death.

I’m a lower-esophageal sphincter-boy myself, and that’s what got me interested in what this is all about. The biggest problem we have with heartburn in the U.S., according to one doctor, is that almost everybody has an occasional episode, and TV ads minimize the problem. “Oh, I thought I had a heart problem, but my doc said it was only heartburn.” Even some docs tend to minimize the problem. “Take this medicine, and if it doesn’t get any worse, don’t worry. It won’t kill you.”

Problem is, it might. “Barrett’s esophagus” results when the lower esophagus goes through “metaplasia,” transforming its tissues to resemble the lining of the stomach in an apparent effort to protect the esophagus from the upwelling stomach acid. Barrett’s esophagus is a precancerous condition” 5% of the cases develop into esophageal cancer. AND, among pathologies, cancer of the lower esophagus related to Barrett’s metaplasia has among the fastest growing cancer incidence rates in the U.S.

Millions of people have GERD without heartburn, and heartburn is not GERD’s only symptom. Chronic coughing and throat-clearing, especially after sleep or meals, can be caused by acid reflux. Acid upwelling over the larynx causes chronic sore throat or hoarseness, all too familiar in one of the most famous of GERD sufferers, former President Bill Clinton. Studies suggest that up to half of all asthmatics could e either significantly improved or actually cured with anti-reflux therapy.

Antacids have been around since the ancient Romans ground coral to powder as a heartburn remedy, and a good one it was thanks to its high concentration of calcium carbonate. Antacids are great for – as many of these ads promise – “fast, temporary relief of occasional heartburn,” but not for chronic heartburn. Then they become a bandage that simply masks the symptoms of a serious disease. And they only work for a short time, which means you have to keep gobbling them.

Tagamet was the wonder drug of some 30 years ago, the first of the products to take a front-end approach by preventing stomach acid from being produced rather than neutralizing it after the fact. It’s one of the group of drugs known as histamine blockers, which interfere with the chemical process that produces stomach acid when the brain gets messages from the eyes, nose and mouth saying, “I see…smell…taste food.”

Taken at prescription strength, histamine blockers cut acid production by about 50%. Unfortunately, over-the-counter versions available under names such as Tagamet, Zantac, Pepcid and Axid, tend to have only about half the strength of their prescription counterparts. For most people, however, when taken two or three times a day, these OTC medications are enough to keep the heartburn beast at bay around the clock.

Then came Prilosec, which some doctors called “the magic purple pill” because of the way that one pill a day could work cures in extreme cases of heartburn, asthma and other GERD-related problems. Appearing in the late 1980s, Prilosec was the first of the “proton pumps,” so called because they cut down the stomach’s acid production almost completely. A second proton pump, Prevacid, was approved in the U.S. in 1995.

Eliminating stomach acid might sound insane, when common wisdom says we need stomach acid to digest food. But we don’t. Some people have their entire stomach removed and continue to digest food anyway. Food is digested mainly in the small intestine by bile and enzymes, and by enzymes in the stomach and mouth as well. Stomach acid’s primary role is to kill bacteria.

A lot of carnivores each dead animals, spoiled food, road kill, full of bacteria. And people vary in their hydrochloric acid production. Mine is high. I have what one doc called a “road-kill stomach.” So does my daughter; must have inherited it from me. My wife and son, on the other hand, don’t have the road-kill stomachs. I surmise this by the pattern of many years. Whenever we eat bad food, my wife and son get puke-sick from what my wife calls “stomach flu.” My daughter and I never do. Not that we are about to eat dead animals off the high way, but hey, maybe we could get away with that too.

Most of the time, of course, we Americans don’t need all that stomach acid. We eat processed foods, cooked foods, and have clean water to drink. Although acid is helpful to us, in many ways it does more harm than good

Eliminating stomach acid also reduces coughing and throat-clearing, problems that result from upwelling stomach contents interfering with the respiratory system, because acid makes up most of the volume of what’s in the stomach.

Miraculous and wonderful! So why fool around with antacids or histamine blockers? Why not go directly to the big guns, Prilosec or Prevacid? Why not go directly to sphincter-tightening surgery, in fact, since that’s done laparoscopically nowadays through a few small punctures that the docs cover with bandages, rather than cutting you open like a fish as they did a few decades ago? And it’s always advancing. Why, just in April of this year, Methodist Hospital in Houston reported on success of a new surgery using a ring of magnetic beads to make the esophageal sphincter work like it should. In February, the University of Pennsylvania announced study results showing that endoscopic surgery allowed removal of all of the damaged and precancerous cells in “Barrett’s esophagus” in 95% of cases; until recently, the whole esophagus was removed.

And what about those other drugs, those “prokinetic agents” like Propulsid that help move foods downward? Why does one person take Zantac for heartburn, while somebody else takes Prilosec and Propulsid?

It all depends on what your problem is and how strong a medicine you need, and sometimes on how your other physical attributes or pathologies may respond to the side effects characteristic to each drug. This is where you should visit a gastroenterologist who can assess you intelligently and advise you through a course of treatment.

Chronic severe-heartburn suffers will likely be advised to have an endoscopy, where a gastroenterologist directly inspects your esophagus and stomach by inserting a television camera down your throat, a long, flexible tube using video chips and fiber optics. I got an endoscopy, and they even gave me color photos of my innards once the Demerol and Valium had worn off enough that the nurse could press the prints into my hands without danger of my drooling on them.

Before this episode, I’d seen nauseating color photos of lower esophageal sphincters ravaged by “erythema,” “isolated erosion,” “confluent erosions,” and “Barrett’s esophagus,” so I was puzzled. Mine appeared completely normal.

A large proportion of reflux patients have no visible damage. But just because you don’t have scars doesn’t mean your sphincter is operating correctly. Another test is the “pH probe,” a monitor you wear for 24 hours to see how much acid is above the sphincter, but I started with an exploratory treatment phase of taking prescription Axid twice a day. The idea was to see whether Axid cleared up the problem when combined with lifestyle modifications I’d already put in effect. After a couple of months, I moved on to Prilosec.

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