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GERD: More Than a Balky Stomach

But over-the-counter drugs can help most sufferers, experts say

SUNDAY, Feb. 20, 2005 (HealthDay News) -- It was once known as acid indigestion, or heartburn or upset stomach. It was remedied by a couple of Tums -- or maybe just a small glass of ginger ale.

Apparently, what was once pitched as an annoyance to be cured by a couple of over-the-counter antacids may have become a serious health problem. GERD -- gastroesophageal reflux disease -- has become almost as popular a health conversation topic as the Atkins diet or erectile dysfunction. But is this condition as dangerous as the dire warnings would have us believe?

GERD affects an estimated 5 percent to 7 percent of the world's population, according to the International Foundation for Functional Gastrointestinal Disorders, a nonprofit education and research group. GERD is the backward flow of acid from the stomach into the esophagus caused by a faulty valve.

Left untreated, particularly by expensive prescription drugs, will GERD turn into erosive esophagitis, an inflammation of the esophagus, or a rare condition called Barrett's esophagus, and will Barrett's predictably turn into an adenocarconoma at the junction of the stomach and esophagus? In other words, is untreated heartburn a one-way street to this usually fatal cancer?

Or can its painful symptoms be relieved for the overwhelming majority of patients by the old standby antacid OTC agents, such as Tums or Pepto-Bismol, Alka-Seltzer, Maalox, Mylanta, Riopan, or Rolaids.

Yes, said Dr. David L. Jaffe, an assistant professor of gastroenterology at the Mount Sinai School of Medicine in New York City. "The majority of patients do very well on these old remedies," he said. They also do well on former prescription drugs, now over-the-counter, such as Tagamet, Zantac, or Pepsid.

"The risk of Barrett's turning to cancer," he said, "is grossly overstated." According to the National Institutes of Health, some 700,000 Americans have Barrett's, and they have a 30-to-125 times higher risk of developing an adenocarcinoma than people who don't have Barrett's. Nevertheless, the risk of cancer for people with Barrett's is very low. About half of 1 percent of Barrett's patients develop an adenocarcinoma.

The incidence of esophageal adenocarcinoma is increasing rapidly in white men, but most authorities attribute it to the rise in obesity, which contributes to GERD.

"Some of this emphasis on erosive esophagitis, I think, is a bit overblown," said Dr. William Chey, a spokesman for the American Gastroenterological Association (AGA) and an associate professor of internal medicine at the University of Michigan Medical Center. Be the drugs cheap or expensive, "80 to 85 percent of patients will get very good relief of their symptoms," said Chey. Others suggest that estimate is low.

A goodly percentage of gastroenterologists' practices stem from the heartburn symptoms of GERD. The AGA policy line is that gastroenterologists only see GERD patients who don't respond to standard approaches prescribed by generalist internists or family physicians, and that may mean medication that can be only obtained through a prescription.

These proton-pump inhibitors include Prilosec. Formally a prescription drug but now also available over-the-counter, Prisolec "is a very powerful medicine and really works very, very well for heartburn," said Dr. J. Patrick Waring, a professor of medicine at Emory University School of Medicine in Atlanta.

However, a Dutch study in the Oct. 27, 2004, Journal of the American Medical Association suggested that taking proton pump inhibitors for prolonged periods may nearly double the risk of developing pneumonia.

Smoking contributes to GERD. But a recent Norwegian study exonerated coffee, tea, and alcohol.

More information

The International Foundation for Functional Gastrointestinal Disorders has more facts about GERD.

SOURCES: William Chey, M.D., spokesman, American Gastroenterological Association, and associate professor, internal medicine, University of Michigan Medical Center, Ann Arbor; J. Patrick Waring, M.D., advisory board member, International Foundation for Functional Gastrointestinal Disorders, and professor of medicine, Emory University School of Medicine, Atlanta; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.
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