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Gastroenterology (Expert Forum)
GIRD
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
GIRD
by L-M-L, Mar 17, 1998 12:00AM
Posted By HFHSM.D.-ym on March 19, 1998 at 13:54:36:
In Reply to: GIRD posted by L M L on March 17, 1998 at 17:01:04:
I am already familiar with GIRD. I am having that problem now. Heartburn
is everyday and reflux too. At the moment, I am not taking anything because
them medicine is so expensive. When I do take meds, it is Prilosec. It is
the only thing that has helped me in a long time. I have tried others but
they dont seem to touch the problem at all. I go to the doctor about it
but he just keeps me going on this med or tries me on that med. Im (pardon
the pun) sick of meds and I want a change.
Heres my questions: Are there any other dangers with this? And is it a
curable thing? The reason I ask this is because I have had this problem
for some years now and the prilosec only keeps it from being a problem
as long as I take it. It does not cure the problem and nothing else
touches it. I cant really afford to keep taking the prilosec so I end
up having the heartburn and the reflux quite a bit. Any ideas? Ive taken
Axid (alergic (allergic) to it), Tagamet (no reaction), Pepcid (works for about
2 hours using 6 OTC tabs), and I do use Gaviscon, which helps a little
bit with the reflux but doesnt seem to help the heartburn much.
_Dear L M L,
Heartburn and gastroesophageal reflux (GERD) can be very troublesome. Unfortunately, they tend to be chronic problems that get better with time and then flare up. It is unclear at this time what triggers these flare-ups but in my experience dietary indiscretion and stress seem to play a role. Most patients with GERD have a benign clinical course, but GERD can lead to a variety of complications especially if left untreated. Bleeding or discomfort from esophagitis (inflammation of the foodpipe), narrowing of the lower esophagus (foodpipe) and a change in the lining of the lower esophagus (called Barrett’s esophagus) can occur. Barrett’s esophagus can sometimes lead to the development of esophageal cancer.
You mentioned a variety of medications that are usually helpful in the management of GERD. Different classes of medications work differently to help decrease acid production or to neutralize acid in the stomach. Nizatidine (Axid), Cimetidine (Tagamet) and Famotidine (Pepcid) work similarly. Sometimes using a higher dose of these medications may work better. It’s best to consult your doctor to define the right dosage for you. You may benefit from prescription Pepcid if you obtained some relief with over the counter Pepcid. Furthermore, as you stated Omeperazole (Prilosec) or Lansoprazole (Prevacid) are very effective and very expensive. These medications belong to a new class of acid inhibitors called proton pump inhibitors (PPI). They have revolutionized the treatment of GERD to the point where many patients have little or no symptoms. When the PPIs were first introduced in Europe there was concern about their safety. Laboratory animals given high doses of Omeperazole developed a rare type of stomach tumor called carcinoid tumors. Initially the FDA only approved these drugs for short periods of time. These restrictions have been recently rescinded since these medications have been prescribed for GERD patients in Europe for at least five years with no development of stomach tumors in humans. In my clinical practice I try to prescribe the lowest dose of PPIs that will control the patient’s symptoms. I also try to wean patients off of the drug whenever possible.
There are three other options that you might consider in your treatment. Firstly, it would be important to carefully review your dietary and lifestyle habits. Anti-reflux measures are the cornerstone of GERD management. Sometimes just adhering to anti-reflux measures makes a big difference in controlling symptoms. Briefly, anti-reflux measures are: avoiding coffee and cola beverages (with and without caffeine), avoiding citrus fruits and tomatoes and avoiding fatty and spicy foods, onions, peppermint and chocolate. Other habits to avoid are smoking, drinking alcohol, eating large meals or eating right before lying down. Losing excess weight is also occasionally helpful. A variety of medications can decrease lower esophageal sphincter pressure (LES) and predispose you to more episodes of gastroesophageal reflux. Review the medications that you are taking with your doctor to see if they are aggravating your problem. Elevating the head of your bed at night (by sliding blocks under the bedpost or purchasing a wedge which fits under the mattress) will allow gravity to work in your favor and help to empty the contents of your stomach while you are asleep. Secondly, another medication that is sometimes helpful in the treatment of GERD is called Cisapride (Propulsid). This medication belongs to a class of medications called the prokinetic agents. These help to more rapidly empty the stomach. Cisapride (Propulsid) also tightens the lower esophageal sphincter to prevent reflux of stomach contents into the lower esophagus. Sometimes Omeperazole (Prilosec) and Cisapride (Propulsid) are used in combination. Thirdly, if you are frustrated with taking medications long term you might want to consider anti-reflux surgery. These days surgeons can perform this surgery with a laparoscope and without an open procedure. Prior to surgery you will need further testing to document gastroesophageal reflux and to rule out an esophageal motility disorder. Although, the results of surgery are comparable to medical therapy the research that has been done did not include patients on PPIs and long term data is not yet available. Therefore, before you consider this option I would caution you to consider all the benefits, risks and alternatives of the operation before going through with it. I hope you find this information helpful.
Good luck to you. If you are seen at our institution I look forward to meeting you in person.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux, complications, treatment
In Reply to: GIRD posted by L M L on March 17, 1998 at 17:01:04:
I am already familiar with GIRD. I am having that problem now. Heartburn
is everyday and reflux too. At the moment, I am not taking anything because
them medicine is so expensive. When I do take meds, it is Prilosec. It is
the only thing that has helped me in a long time. I have tried others but
they dont seem to touch the problem at all. I go to the doctor about it
but he just keeps me going on this med or tries me on that med. Im (pardon
the pun) sick of meds and I want a change.
Heres my questions: Are there any other dangers with this? And is it a
curable thing? The reason I ask this is because I have had this problem
for some years now and the prilosec only keeps it from being a problem
as long as I take it. It does not cure the problem and nothing else
touches it. I cant really afford to keep taking the prilosec so I end
up having the heartburn and the reflux quite a bit. Any ideas? Ive taken
Axid (alergic (allergic) to it), Tagamet (no reaction), Pepcid (works for about
2 hours using 6 OTC tabs), and I do use Gaviscon, which helps a little
bit with the reflux but doesnt seem to help the heartburn much.
_Dear L M L,
Heartburn and gastroesophageal reflux (GERD) can be very troublesome. Unfortunately, they tend to be chronic problems that get better with time and then flare up. It is unclear at this time what triggers these flare-ups but in my experience dietary indiscretion and stress seem to play a role. Most patients with GERD have a benign clinical course, but GERD can lead to a variety of complications especially if left untreated. Bleeding or discomfort from esophagitis (inflammation of the foodpipe), narrowing of the lower esophagus (foodpipe) and a change in the lining of the lower esophagus (called Barrett’s esophagus) can occur. Barrett’s esophagus can sometimes lead to the development of esophageal cancer.
You mentioned a variety of medications that are usually helpful in the management of GERD. Different classes of medications work differently to help decrease acid production or to neutralize acid in the stomach. Nizatidine (Axid), Cimetidine (Tagamet) and Famotidine (Pepcid) work similarly. Sometimes using a higher dose of these medications may work better. It’s best to consult your doctor to define the right dosage for you. You may benefit from prescription Pepcid if you obtained some relief with over the counter Pepcid. Furthermore, as you stated Omeperazole (Prilosec) or Lansoprazole (Prevacid) are very effective and very expensive. These medications belong to a new class of acid inhibitors called proton pump inhibitors (PPI). They have revolutionized the treatment of GERD to the point where many patients have little or no symptoms. When the PPIs were first introduced in Europe there was concern about their safety. Laboratory animals given high doses of Omeperazole developed a rare type of stomach tumor called carcinoid tumors. Initially the FDA only approved these drugs for short periods of time. These restrictions have been recently rescinded since these medications have been prescribed for GERD patients in Europe for at least five years with no development of stomach tumors in humans. In my clinical practice I try to prescribe the lowest dose of PPIs that will control the patient’s symptoms. I also try to wean patients off of the drug whenever possible.
There are three other options that you might consider in your treatment. Firstly, it would be important to carefully review your dietary and lifestyle habits. Anti-reflux measures are the cornerstone of GERD management. Sometimes just adhering to anti-reflux measures makes a big difference in controlling symptoms. Briefly, anti-reflux measures are: avoiding coffee and cola beverages (with and without caffeine), avoiding citrus fruits and tomatoes and avoiding fatty and spicy foods, onions, peppermint and chocolate. Other habits to avoid are smoking, drinking alcohol, eating large meals or eating right before lying down. Losing excess weight is also occasionally helpful. A variety of medications can decrease lower esophageal sphincter pressure (LES) and predispose you to more episodes of gastroesophageal reflux. Review the medications that you are taking with your doctor to see if they are aggravating your problem. Elevating the head of your bed at night (by sliding blocks under the bedpost or purchasing a wedge which fits under the mattress) will allow gravity to work in your favor and help to empty the contents of your stomach while you are asleep. Secondly, another medication that is sometimes helpful in the treatment of GERD is called Cisapride (Propulsid). This medication belongs to a class of medications called the prokinetic agents. These help to more rapidly empty the stomach. Cisapride (Propulsid) also tightens the lower esophageal sphincter to prevent reflux of stomach contents into the lower esophagus. Sometimes Omeperazole (Prilosec) and Cisapride (Propulsid) are used in combination. Thirdly, if you are frustrated with taking medications long term you might want to consider anti-reflux surgery. These days surgeons can perform this surgery with a laparoscope and without an open procedure. Prior to surgery you will need further testing to document gastroesophageal reflux and to rule out an esophageal motility disorder. Although, the results of surgery are comparable to medical therapy the research that has been done did not include patients on PPIs and long term data is not yet available. Therefore, before you consider this option I would caution you to consider all the benefits, risks and alternatives of the operation before going through with it. I hope you find this information helpful.
Good luck to you. If you are seen at our institution I look forward to meeting you in person.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians’ Office and make an appointment to see Dr. Muszkat one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux, complications, treatment
Doctor's Answer
