Wednesday, October 8, 2008

From Indi-GES-tion to GERD!

Okay, we grew up calling it "indigestion" or "heartburn" (remember the peptobismal commercial?), but thanks to drug companies and the media, we now have patients coming in with the chief complaint of "GERD"- Gastro Esophogeal Reflux Disease. Not only do they say they have "GERD", but that they'd like a prescription for a purple pill, because it's cheaper than paying for the over-the-counter version. 
So, what causes GERD? Pain comes from the stomach acid sloshing back up into the food tube (the esophogus), because the muscle (sphincter) that usually squeezes down to keep the acid in the stomach is relaxed too much. What relaxes that sphincter? Well, think about when you've eaten way too much food at a nice restaurant, and you're "stuffed". What are we trained to do? People smoke ciggarettes, have an after-dinner drink of alcohol or coffee, and grab a peppermint on the way out the door. Nicotine, alcohol, caffeine and mints all relax that sphincter, allowing food and acid to go backwards up into the esophagus and making us feel less like our stomach is about to explode. 
The problem is that the stomach lining is prepared for acid, because it has a mucus coating over it, while the esophagus has more skin-like covering, and acid is damaging to it. When the acid "burns" the lining in the esophagus, you feel "heartburn", aka. GERD. 
So, yes, there are pills on the market that reduce or neutralize the amount of acid- from the inexpensive antacids (TUMS), to the mid-range (Tagamet) H2 blockers to the expensive proton-pump inhibitors (Prilosec). All of these medicines work, and for the occasional episode, pick your favorite pill.
However, for chronic symptoms, instead of taking a pill to reduce acid every day, (risking side effects such as decreased calcium absorption and subsequent osteoporosis) why not address the cause of the problem?
BOTTOM LINE: If heartburn has become a part of your everyday life, make changes that will stop causing acid to go the wrong direction: limit or eliminate nicotine, alcohol, caffeine and excessive mints (for those chronic breath mint poppers out there) instead of chasing them with pills.

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