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GERD--Gastroesophageal Reflux Disease

The TVClubHouse: General Discussions ARCHIVES: Jan. 2007 ~ Mar. 2007: Health Center: GERD--Gastroesophageal Reflux Disease users admin

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Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 9:42 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported February 23, 2005


Stopping Heartburn


By Amy Bomar, Ivanhoe Health Correspondent

(Ivanhoe Newswire) -- It starts as a burning sensation in the chest, before slowly making its way up toward the neck and throat. At one time or another, nearly everyone experiences heartburn.

Occasional heartburn is normal. However, when heartburn occurs more than twice a week it can signal gastroesophageal reflux disease, or GERD.

An estimated 5 percent to 7 percent of the United States population is affected by GERD. Anyone, including men, women and children, can have GERD. The disease occurs when acid in the stomach flows backwards, into the esophagus. Under normal conditions, a muscle called the lower esophageal sphincter acts as a valve between the esophagus and stomach, helping to prevent acid reflux. When it fails to close properly, acid can leak back into the esophagus.


What are the Treatment Options for GERD?

There is no cure for GERD. It is a chronic disease, requiring long-term treatment. Most people with mild symptoms can ease their symptoms by making lifestyle changes. These may include losing weight; avoiding alcohol; eliminating foods and beverages such as chocolate, coffee, or greasy foods; and not eating late at night.


Prescription Medications

For many people, prescription medications may help. Over-the-counter antacids, such as Alka-Seltzer, Mylanta or Rolaids are often recommended to relieve mild symptoms. Antacids help neutralize stomach acid.

GERD sufferers also might benefit from proton pump inhibitors (PPI). These drugs, including Prilosec, Prevacid, Protonix, Aciphen and Nexium, provide long-term symptom relief and heal erosive esophagitis. “Proton pump inhibitors provide the safest and most predictable treatment for GERD,” says Joel Richter, M.D., chairman of Temple’s Department of Medicine in Pittsburgh. “Now that Prilosec is available over-the-counter, cost isn’t an issue.”

Proton pump inhibitors work by reducing the production of acid in the stomach, leaving little acid to back up into the esophagus. Studies have shown that proton pump inhibitors are more effective than other heartburn medications. However, new research suggests that taking proton pump inhibitors for prolonged periods may increase the risk of developing pneumonia. A recent Dutch study found the risk of pneumonia nearly doubled for people taking the drugs for prolonged periods.

“Despite the slight evidence of chronic pneumonia, proton pump inhibitors are safe,” says Dr. Richter. “Some drug companies have the attitude that once on a PPI, always on a PPI. There is a subset of people who may continually need PPI, but most don’t.” Dr. Richter also suggests that PPI dose reduction may be appropriate for some patients.


Surgical and Endoscopic Options

Some patients may want to seek an alternative to taking medication for their symptoms. Surgical techniques to improve the barrier between the stomach and the esophagus can help. “When performed by a skilled, high volume surgeon, laparoscopic antireflux surgery is very effective,” says Dr. Richter.

In recent years, endoscopic techniques have been introduced as promising treatments for GERD. These procedures are performed through a flexible tube inserted through the mouth and down the throat.

One of the more popular endoscopic procedures is Enteryx. Doctors inject a sponge-like material that thickens the valve at the base of the esophagus, stopping stomach acid from coming back up. Other endoscopic approaches include the EndoCinch system and Streta system.

Dr. Philip B. Miner, Jr., M.D., from the Oklahoma Foundation for Digestive Research in Oklahoma City and professor at the University of Oklahoma, advises caution for patients considering endoscopic techniques. “These therapies need to be carefully investigated. Complications have ranged from failure to correct the problem to death.”

Dr. Richter agrees. “There have been documented deaths from endoscopic procedures. People shouldn’t die from reflux disease. Federal agencies need to take a stronger look at these procedures, the studies are not going through close enough scrutiny.”


The Consequences of Untreated GERD

Without proper treatment, GERD can cause serious complications. Years of exposure to stomach acid may cause cancer of the esophagus, or Barrett’s esophagus, a precancerous condition. Inflammation of the esophagus can cause bleeding or ulcers. Persistent symptoms of heartburn and reflux should not be ignored. The best way to prevent these conditions is by seeing a doctor early.


Further Hope Through Research

Despite treatment, there are still some individuals who continue to suffer persistent symptoms of GERD. Research is underway to investigate why.

Some researchers are focusing on nonerosive reflux disease. Individuals with nonerosive reflux disease present the same symptoms as others with GERD, although nonerosive reflux disease does not cause esophagitis. This does not mean that nonerosive reflux disease is less serious that erosive reflux. “New therapies are needed for people with nonerosive GERD,” says Dr. Miner. “They often do not respond to acid suppressants.”

“Nonerosive disease is actually the most common presentation of GERD,” says Ronnie Fass, M.D., University of Arizona in Tucson. “The whole issue of nonerosive disease has really started to explode. These patients fall under the definition of GERD, but they really don’t have GERD, making them difficult to treat.”

If you would like more information, please contact:

American College of Gastroenterology
800-HRT-BURN
http://www.acg.gi.org

American Gastroenterological Association
301-654-2055
http://www.gastro.org

The Society of American Gastrointestinal and Endoscopic Surgeons
310-437-0544
http://www.sages.org

International Foundation for Functional Gastrointestinal Disorders, Inc.
888-964-2001
http://www.aboutgerd.org

National Digestive Diseases Information Clearinghouse (NDDIC)
(A service of the National Institute of Diabetes and Digestive and Kidney Diseases)
800-891-5389
http://www.digestive.niddk.nih.gov/ddiseases/pubs/gerd

National Heartburn Alliance
877-471-2081
http://www.heartburnalliance.org

Further reading on heartburn and GERD:

Cheskin, Lawrence J. & Lacy, Brian E. Healing Heartburn. John Hopkins University Press, 2002.

Leheij, Robert, et. al. “Risk of Community-Acquired Pneumonia and Use of Gastric Acid-Suppressive Drugs” JAMA, 2004;292:955-1960

Miskovitz, Paul. The Doctor’s Guide to Gastrointestinal Health, Wiley, 2005.

Minocha, Anil & Adamec, Christine. How to Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux. Wiley, 2001.

Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 9:48 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported June 21, 2005


GERD Linked to More Esophageal Cancers


(Ivanhoe Newswire) -- New research suggests more cases of esophageal cancer may be attributed to gastroesophageal reflux disease than doctors previously thought.

Investigators who studied the link between GERD and different types of esophageal cancers found a more advanced form of the disease that occurs at the point where the esophagus meets the stomach may be caused by reflux.

The authors note doctors have long known GERD is responsible for cancers occurring along the tubular part of the esophagus. They also know some cancers occurring near the opening to the stomach are caused by reflux because they can see signs of a condition called Barrett mucosa, which indicates damage caused by GERD. However, they’ve typically attributed another form of cancer occurring in the same region to other causes because Barrett mucosa hasn’t been present.

This study compared 215 people whose cancerous tumors were located near the opening to the stomach. Results showed tumors linked to Barrett mucosa were generally smaller, identified earlier, and less likely to have spread than those not linked to Barrett mucosa. This led the researchers to conclude the latter were simply more advanced cancers that had already destroyed the underlying Barrett mucosa, rather than a separate form of the condition.

If these two types of cancer really are one disease, report the authors, it would nearly double the number of esophageal cancers caused by GERD every year.


SOURCE: Archives of Surgery, 2005;140:570-575

Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 9:51 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported December 27, 2005


GERD
More Effectively Managed
With Drugs


(Ivanhoe Newswire) -- A new report reveals drugs can be as effective as surgery for managing gastroesophageal reflux disease (GERD).

Researchers compared various treatments for chronic uncomplicated GERD --a less serious disease of the esophagus that usually requires life-long management. They reviewed over-the-counter medications, proton pump inhibitors (PPIs), surgery and endoscopic procedures.

Investigators found for most patients, PPIs can be as effective as surgery in relieving GERD symptoms and improving quality of life. The study also shows even if patients have surgery, they still may need to take medications.

The report is the first Comparative Effectiveness Review from a new program from the Agency for Healthcare Research and Quality (AHRQ). It is designed to help patients and health care providers choose the best evidence-based treatment for their situation. The program reviews existing studies and compares the outcomes of different treatments.

"These reports take a new step by asking not merely which treatments can be effective, but how treatments compare with one another," says AHRQ Director Carolyn M. Clancy, M.D. "They will provide a useful, balanced source for obtaining the best scientific information to help select the right treatment for the patient."

Dr. Clancy, however, stresses the report does not recommend treatments nor include cost considerations. She says it's essential for patients and physicians to discuss how the findings would apply to each individual's case.

SOURCE: Agency for Healthcare Research and Quality, published online Dec. 13, 2005

Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 10:04 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported October 10, 2005

Help for Heartburn


RECALL NOTICE: On Sept. 23, 2005, Boston Scientific Corporation (the company that makes the device) initiated a voluntary recall of the product. In a company statement, Boston Scientific said the recall is not related to the safety of the Enteryx product but rather based on the procedural injection technique.

DALLAS (Ivanhoe Broadcast News) -- Nearly 60-million Americans suffer from heartburn at least twice a week. Heartburn happens when muscles relax and allow acidic stomach juices back into the esophagus, causing a burning sensation, and can also be a precursor to esophageal cancer. Now, doctors are building barriers to heartburn without medication.

1

Learning about a procedure to get rid of heartburn was music to Jan Harper's ears. Medication took care of her pain caused by heartburn, but as a side effect, she lost her voice. She says, "It had gotten so bad that maybe two weeks out of a month, I would not have a voice to speak with." Harper, a fifth-grade teacher, couldn't even speak to pass out awards to her students. "I just felt awful, and I said, 'I've got to try to get to the bottom of this.'"

Doctors discovered almost 30 years of gastro esophageal reflux disease, or GERD, had damaged her vocal chords, a common symptom of GERD -- which medications don't always help.

2

Daniel Demarco, M.D., a gastroenterologist at Baylor University Medical Center in Dallas, performed an endoscopic procedure called Enteryx on Harper. During the procedure he injects a polymer substance into the lower esophagus, so it won't relax as much. He says: "And when that relaxes, acid comes up into the esophagus. Acid belongs in the stomach, does not belong in the esophagus or the back of the throat. That's what causes their burning sensation."

Doctors think the procedure is a permanent solution. "Patients who got the procedure had significant reduction in medication use and much higher symptom relief," Dr. DeMarco says.

It's kept stomach acid out of Harper's esophagus and kept her off her daily meds. Plus, she hasn't lost her voice since the procedure. "It was wonderful to say 'bye' to the Nexium and to be able to know I can talk every day," she says. Now, she's looking forward to handing out awards for all to hear.

The most common side effect of the Enteryx procedure is bad breath following the procedure. Doctors believe good candidates for this kind of procedure are people whose symptoms can be managed with medication but don't want to worry about taking a pill every day. The Enteryx procedure costs about $3,000 and insurance will sometimes cover it.

3
If you would like more information, please contact:

Maria Carpenter
Public Relations
Baylor University Medical Center
3500 Gaston Ave.
Dallas, TX 75246
(214) 820-4827
mariaca@baylorhealth.edu

Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 11:02 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported May 1, 2000

Esophageal Cancer:
Is Heartburn to Blame?

Full-Length Doctor's Interview


James Luketich, M.D., discusses heartburn and its role as an early warning sign of esophageal cancer.

Ivanhoe Broadcast News Interview Transcript with
James Luketich, M.D., Thoracic Surgeon
University of Pittsburgh Medical Center, Pennsylvania


Is the incidence of esophageal cancer on the rise?

Dr. Luketich: Yes. If you look at the big picture in the United States, there are nearly 180,000 new cases of lung cancer per year, compare that to esophageal cancer, where the most recent statistics say 12,000-13,000 new cases per year. The National Institutes of Health has seen a change in the incidence of esophageal cancer in North America that could appear to be increasing at such a level that, if it continues, we could be facing basically an epidemic of esophageal cancer.


So even though it's now a small percentage, it's getting worse?

Dr. Luketich: The rate of rise is worrisome, and the association is worrisome. We're trying to see if we can do anything to interrupt that rise. One thing we're doing to evaluate this further is conducting an ongoing effort with the School of Public Health here in the epidemiology department of the University of Pittsburgh Medical Center. In fact, one of our big research projects is studying the incidence and the changing patterns of esophageal cancer that are taking place in Western Pennsylvania. Esophageal cancer has changed. It used to be related to heavy smoking, alcohol abuse, and even patients who were mildly to moderately malnourished. Now what we're seeing is a very different location at the junction between the esophagus and the stomach -- a very different type of cancer called an adenocarcinoma.

At first look, you can see the difference between a squamous and an adenocarcinoma under the microscope. Adenocarcinoma are what we're now seeing associated with the lower esophagus cancer and in association with the phenomenon that we call Barrett's esophagus -- where the lining of the esophagus undergoes a change that we can see under the microscope. It's probably an adaptive response of the human body to acid, bile and undigested proteins that are hitting that esophageal surface. That's irritating. So the body is trying to do something about it. One of the things we see in some patients is just inflammation. In others, it develops an actual change in the epithelium -- what we call Barrett's esophagus. Barrett's takes place in up to 10 percent of patients who have chronic gastroesophageal reflux disease (GERD), or heartburn. So if you look at the millions of people who have heartburn and those that have severe heartburn that are treated for a number of years, we estimate that up to 10 percent of those patients could develop Barrett's esophagus. Once Barrett's esophagus develops, how many of those patients that develop cancer is unknown. It's estimated between one and 10 percent of all patients with Barrett's will ultimately develop a cancer of the esophagus. Looking at those figures, you can see that the actual esophagus cancer risk to the average American is relatively low.

Our youngest patient with esophageal cancer is 19 years old. We've also seen it in patients in their mid-20s. Certainly the ages that we're seeing patients now (in their 30s and 40s) with esophagus cancer tell us chronic heartburn doesn't have to be around for a lifetime to show someone's at risk for Barrett's esophagus and esophageal cancer.


What do you consider chronic heartburn?

Dr. Luketich: Good question. There's a lot of variability in that definition. When a patient says that for all of his life he's had a little heartburn after a spicy spaghetti dinner and it happens maybe once or twice a month, it's probably not chronic heartburn. For some patients, heartburn gets better if they make minor lifestyle modifications like avoiding heavy, spicy meals or quitting smoking. In many cases a stressful period in someone's life can exacerbate heartburn, but when you take that stress away sometimes it gets better. Therefore we don't consider that chronic heartburn, either. We consider chronic to be probably anything that requires more than fairly potent doses of medications to control the symptoms for more than a year or two. What we're really looking at is groups of patients who have had very definite progression of their heartburn. For example, it started with an occasional Tums, and so they cut out cigarettes and caffeine. When that didn't work, they moved on to drugs like Tagamet and Zantac. That worked for a while, but then they required increased doses and decided to move on to proton pump inhibitors like Prilosec or Prevacid, taking them once a day, but began adding Tums or Maalox to it. Once you see that type of progression then you can clearly say, "Now I've got a patient with chronic gastroesophageal reflux disease."


What would you say is the best treatment for people suffering from GERD?

Dr. Luketich: There are very different subgroups of patients with chronic GERD. Some can be managed with lifestyle modification and that would be the first approach. Those modifications include elevating your head in bed, dietary modifications, quitting smoking and losing weight -- all very straightforward modifications that most Americans don't make very well. The next step would then be over-the-counter medications. If a patient knows he's going to take in a spicy meal or has a particularly stressful day coming up, he may take his over-the-counter medication and do quite well with that. Those patients really have a very mild degree of GERD.

Then you get into the patients who require chronic medical therapy, and when they miss their medications for a week or two, their symptoms come back with a vengeance. They simply are committed to the medication. Most of these patients have declared themselves as having a chronic heartburn problem that's not going to go away.


What are their options?

Dr. Luketich: They can continue with medical therapy and the lifestyle modifications that they may have already made. In other words, they will have a choice of continuing on with medical therapy forever if their medicines still work well every day. They clearly have the choice of staying on the medications and should be followed by a gastroenterologist. If they have Barrett's esophagus, they need to be sure it hasn't undergone any worrisome changes. However, let's say they haven't had any progression or maybe they don't have Barrett's and they're simply well-controlled on medical therapy. They have options -- staying on medication or undergoing surgery. Today it's a minimally invasive procedure that works in about 95 percent of patients. If a patient doesn't want to continue taking pills or perhaps they started with one pill and progressed to needing two or three, they may realize medicine is not going to work forever and want to undergo a change. Those patients may not really have a great choice in that they're pushed to get away from the medical therapy for a variety of reasons. They come to us seeking a surgical alternative and most of those patients are candidates for minimally-invasive anti-reflux surgery.


Can you say whether medications cause, change or mask esophageal cancer?

Dr. Luketich: We know this increase in the incidence of esophageal cancer began sometime in the mid-70s and has continued right up to today. What also happened in the mid-70s was the introduction of more potent medications and their widespread availability for acid reduction and treating peptic ulcer disease. So they introduced these at about the same time that we began to see this increase in the incidence, and they have paralleled that with the widespread introduction of even more potent medications like the proton pump inhibitors. Now, does that necessarily mean that they're related? Maybe. Maybe not. One of the studies discussed in the New England Journal of Medicine evaluated patients who had chronic heartburn and assessed what their medical therapy had been and for how long. They came up with some very statistically significant numbers that showed the patients that were at the highest risk of developing esophageal cancer were those patients that were on the highest doses of medications for the longest periods of time. I think it is a landmark article in that it really made us question the safety of treating patients indiscriminately with long-term powerful medications for GERD. Does it mean that we should stop using medical therapy for GERD? No. I think it means we need a heightened awareness by patients and physicians to refer those patients earlier than they have been to specialists so they can get a baseline screening endoscopy to evaluate their esophagus. I think that has to be an individual decision. Early referral to a specialist in GERD makes a lot of sense to me, and that's what I recommend to my patients.


Do you strongly believe the connection between medication and cancer?

Dr. Luketich: I strongly believe the association. I'm not saying medications are definitely causative, but I'm saying we're chronically changing the local environment -- the physiology of the stomach -- in patients on chronic medical therapy for GERD. We don't know the long-term effects, but there's a known association between the chronic medical therapy and patients who have developed cancer. We just need to be a little more cautious in recommending chronic medical therapy for our patients that might be ongoing for 10, 20 or 30 years if they're a younger patient. I think we need to be aware of it.


Since you are a surgeon, do you favor surgery over medication?

Dr. Luketich: I think that we want to be cautious in sending a message to all patients that have GERD that they need an operation because they don't. The majority of patients with GERD, some estimate 85 percent, can be successfully managed with medication. I don't think we have a good handle on that exact number, but I would agree that the majority don't need surgery. The first person to see is not a surgeon but rather a primary care physician. The next person would be a specialist in GERD. They will then help determine if an opinion is needed from a surgeon. Not all doctors are aware of surgical options. So some patients will seek out a surgeon on their own. They've educated themselves on the Internet or through TV programs, and they've decided they want an opinion from a surgeon, even if they've been told that medication two or three times a day is adequate. Not all patients need surgery for GERD, and not all patients with even severe chronic GERD need or want surgery. However, it does open up another option.

When we start to look at what the best option for someone with GERD is, we talk about the potential side effects and cost of chronic medical therapy and possibly patient compliance. Americans like to have an alternative choice, but there are a number of perturbations of the normal physiology that take place when you're on chronic medical therapy. Then you compare it to surgical therapy. Surgical therapy is aimed at replacing or rebuilding the valve between the esophagus and the stomach -- much less of a perturbation of the system. So if you look at the basic simple approaches of surgery vs. medical therapy, I think that surgery is quite simple in its approach of trying to rebuild the valve. Of course that requires general anesthesia, surgery, a hospital stay. That's why we don't recommend it for all patients.


Obesity has increased along the same lines of esophageal cancer. So couldn't it also be the reason behind esophageal cancer's increase?

Dr. Luketich: It could be. Some of the studies have shown associations with obesity and esophageal cancer. However, it's less of an association than has been made with heartburn. We are currently looking at the issues of obesity and esophageal cancer, but I think it's just a little more of an unknown right now, and when you look at our population with esophageal cancer, they're not obese. In fact, a large percentage of my patients who presently have esophageal cancer were never obese. So I can't clearly state that obesity is not a risk factor, but we're not seeing it as a consistent risk factor. However, looking at patients who have Barrett's esophagus and esophageal cancer is a much stronger association than we're seeing with obesity.


Where are you headed with your research?

Dr. Luketich: We're looking at a number of issues that relate to esophageal cancer. Some are as basic as the changes that take place in the esophagus from patients who have heartburn are. We know they develop esophagitis and can then go on to Barrett's esophagus. Some go on to cancer. We're looking very closely at the change that occurs in the epithelium in our basic science laboratory and attempting to identify molecular markers. We may possibly even someday develop a blood test that may tell us who is on the verge of developing or has developed an early esophageal cancer. Those research efforts are still in their infancy. We don't have a blood test to identify patients who have those problems ongoing.

We're also looking at more directly applicable research projects like which chemotherapy works best for esophageal cancer and how to stage the patient with esophageal cancer in terms of determining if the cancer has left the esophagus and gone to lymph nodes, or to distant sites, which would mean a worse prognosis for the patient.

A very recent project we recently presented at the Society of Thoracic Surgery was regarding our ongoing efforts to perform minimally invasive surgery, not only for heartburn surgery, but also now to completely remove the esophagus. We've performed that in over 125 patients now, and we're very encouraged that the operation may be a surgical breakthrough in terms of an improvement in morbidity of surgery. That operation remains somewhat controversial, because it's a new operation and will require further studies outside of our own institution to confirm that it has a potential to be better.

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

Heather Szafranski
UPMC Health System
3708 Fifth Ave., Suite 201
Pittsburgh, PA 1521

Herckleperckle
Member

11-20-2003

Friday, June 02, 2006 - 11:10 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported October 28, 2005

Healing Heartburn


NASHVILLE (Ivanhoe Broadcast News) -- If you suffer from heartburn regularly, you may be one of more than 15 million Americans who has the condition gastroesophageal reflux disease can sometimes be a precursor to esophageal cancer. Now, there's a non-surgical alternative.

Darlene Van Hoos has always enjoyed spicy foods. What she didn't like were the after effects. "I would have coughing spasms because of the acid coming up into my throat," she says. "Just a general miserable feeling."

Darlene has gastroesophageal reflux disease, or GERD. She didn't want to take medication indefinitely, so she jumped at the chance to be in a study on this -- the Plicator.

A guide wire helps doctors move this snake-like device through the esophagus into the stomach. The Plicator pulls back tissue where the stomach and esophagus meet. Jaws clamp down and deploy an implant that sutures the tissue.

Doctors tighten the valve between the stomach and esophagus, restoring the normal anti-reflux barrier. The procedure replicates what's done in surgery.

Alfonso Torquati, M.D., an abdominal surgeon at Vanderbilt University Medical Center in Nashville, says, "Definitely, something different from surgery where people stay in the hospital at least one night and have a longer recovery time compared to endoscopic procedure where people can go back to work the day after."

Because it's done in a 30-minute outpatient procedure, he thinks patients will welcome the idea. "Some of these patients, they don't want to consider surgery because they think it's too extreme. Now, finally, there is a treatment for them that is available."

Darlene has noticed a big difference. Now she can experience the pleasure of eating without the pain of heartburn.

The FDA has approved the Plicator, and it's now available for heartburn sufferers. One hundred eighty patients in the United States and Europe are in this international study, which aims to prove the Plicator's effectiveness so that more insurance carriers will cover the procedure.

If you would like more information, please contact:

John Howser
News and Public Affairs
Vanderbilt University Medical Center
CCC - 3321, MCN Vander
Nashville, TN 87232
(615) 322-4747
john.howser@vanderbilt.edu

Grannyg
Member

05-28-2002

Saturday, June 03, 2006 - 6:15 am   Edit Post Move Post Delete Post View Post Send Grannyg a private message Print Post    
Thanks, HP. A lot of this son has already been through. But the last article was very enlightening.

Twinkie
Member

09-24-2002

Saturday, June 03, 2006 - 1:55 pm   Edit Post Move Post Delete Post View Post Send Twinkie a private message Print Post    
I take my Protonix every single day with all my other pills. I've taken it for years now and it works great.

Herckleperckle
Member

11-20-2003

Sunday, June 04, 2006 - 8:35 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
And Twinks, I take Prilosec daily, too. But if you read those articles above, a couple clearly say that docs believe that taking these PPI drugs over a long period of time can--in some of us--lead to cancer of the esophagus. Better to rearrange your dietary habits, if you can beat the GERD that way.

I'm gonna check with my doc about that very thing and report what she says here.

Beachcomber
Member

08-26-2003

Monday, June 05, 2006 - 9:19 am   Edit Post Move Post Delete Post View Post Send Beachcomber a private message Print Post    
I am worried about that too Herck. I take Nexium and I still have some bloating/indigestion when I am under a lot of stress. I chug Maalox and that always does the trick. I am considering going off the Nexium and just trying the Maalox as needed. Hopefully Maalox isn't bad too.

Herck, thanks for posting all of this wonderful information!

Meme9
Member

07-30-2001

Monday, June 05, 2006 - 3:26 pm   Edit Post Move Post Delete Post View Post Send Meme9 a private message Print Post    
Try fat-free yogurt. This works for me, the prescription meds didn't work well for me. I take large amounts of ibuprofen for imflamation, pinched nerves...ect. Adding yogurt regularly to my diet was the only thing that has help with the stomach issues. Good luck to those in need.

Herckleperckle
Member

11-20-2003

Monday, June 05, 2006 - 8:13 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Beachy, hi! The one thing I know is that every medication has side effects in your system. So that chugging Maalox may not be benign. Check the ingredients and then think about it. (Not saying I know, cuz I don't! But I know masking symptoms is not a great thing in the long-run, and I am guessing that's what Maalox does. Again, I could be completely wrong about that.

We need a doctor on this board!!!

Meme, watch it with the large amounts of ibuprofen. You think you're safe cuz it's not aspirin, right? My niece did the same thing (with Tylenol) while she was in college when she was trying to keep up with studies and her volleyball team while fighting off what she thought was just a minor illness--and became very, very sick--was hospitalized due to the amount of Tylenol she was ingesting--affected her liver, thankfully, temporarily. Just don't go overboard!

Meme9
Member

07-30-2001

Monday, June 05, 2006 - 8:53 pm   Edit Post Move Post Delete Post View Post Send Meme9 a private message Print Post    
Herckle, thanks for the concern, the doctors know. I really have no choice, the steroids are worst for my body. I worked to hard for to long...now I pay the price. I have been told I could end up in a wheel chair if I can't keep the inflamation down because it pinches nerves. I don't want that. I can't sit to long at a time. I bought a Segway, that helps me get around much faster. Right now, I'm doing better. I have to space out my work, which is hard for me. It's a fine line with the ibuprofen and the stomach, the yogurt seems to be the trick for me. I take only what I have to.

Twinkie
Member

09-24-2002

Tuesday, June 06, 2006 - 8:47 am   Edit Post Move Post Delete Post View Post Send Twinkie a private message Print Post    
I'm thinking about going off of the Protonix. I started taking it when I was drinking alcohol and soft drinks and now I don't drink either. I'm going to talk to my doc about it. BTW, if she was the least bit concerned about it she would have taken me off of it. She's young and keeps up on everything. She won't even prescribe those fat binders that flush fat through your system quickly because she's read medical reports that they can cause problems with the heart valve in some cases. She also didn't want me to take hormones for the hot flashes and night sweats but I got those from my gyno anyway. LOL

Beachcomber
Member

08-26-2003

Tuesday, June 06, 2006 - 5:06 pm   Edit Post Move Post Delete Post View Post Send Beachcomber a private message Print Post    
I think I may just adopt my husband's tactic which has been around forever and he swears by it. A dash of Baking soda in a small glass of water. I remember my grandparents doing that but don't know if I can handle the taste

Twinkie
Member

09-24-2002

Wednesday, June 07, 2006 - 1:50 pm   Edit Post Move Post Delete Post View Post Send Twinkie a private message Print Post    
Beach, that's what I was using for many years before going on the protonix. Just do a little walking around to get the burps up after you drink it. I got used to the taste very quickly. It really does work, but you get the heartburn to begin with before you get rid of it. With the pills you don't even get the heartburn at all.

Dahli
Member

11-27-2000

Wednesday, June 07, 2006 - 3:06 pm   Edit Post Move Post Delete Post View Post Send Dahli a private message Print Post    
Non-Drug Options for GERD (from Men's Health Journal)

1. Do you have anything to say about the concern that long-term use of acid suppressants, might be linked to gastric cancer, since continued acid suppression can lead to the stomach's protective linings atrophying?

Propulsid, perscribed for GERD (gastroesophageal reflux), was taken off the market over two years ago in the US. This and other drugs used to treat GI are major moneymakers for drug companies. Last year Prilosec was the top selling prescription drug in the world, earning Astra Zeneca, the drug's maker, 6 billion dollars.

While Prilosec and other proton pump inhibitors and H2 blockers do not kill people immediately like Propulsid did, they surely contribute to the worsening of overall health. Drugs are rarely, if ever, necessary for the common ulcer and associated stomach problems. The proton pump inhibitors like Prevacid, Prilosec and the H2 blocker agents like Tagament, Pepcid, and Zantac are some of the worst drugs you can take. They significantly reduce the amount of acid you have, thus affecting your ability to properly digest food. Reduction of acid in the stomach also diminishes your primary defense mechanism for food-borne infections and increases your risk of food poisoning.

I am not yet aware of any direct evidence supporting their association with stomach atrophy or cancer; however, there is plenty of indirect evidence. One does not need a medical degree from a prestigious medical school to understand that the acid in the stomach is there for a good reason -- to help you digest your food.

Equally basic is the idea that if you don't digest and absorb your food properly, you will not only increase your risk of stomach atrophy but also nearly every other chronic degenerative disease.

So what are the options?

Routinely maintaining a healthy eating program such as a no-grain diet, and drinking about one gallon of pure water per day combined with high doses of a good quality probiotic (beneficial bacteria), is enough to restore normal stomach function in the vast majority of patients.

Occasionally, those with a hiatal hernia will require additional structural adjustments; the one I find that works best is a gentle massage structural rebalancing technique from Australia called neurostructural technique, or NST. We teach this gentle technique to patients, who then use it to help support their diaphragm support and speed the healing of their problem.

2. Do you have an opinion of either of the surgical options for GERD?

Absolutely. I believe they have absolutely no role in the management of this purely physiologic problem and future generations will realize how foolish our current medical model has been by trying to treat a primarily biochemical problem with surgery.

3. An important question for those suffering from chronic GERD to ask themselves is: should they be opting for surgery, or trying an alternative remedy and changing their lifestyle first?

Treatment of GERD is one of the easiest issues I resolve in my clinical practice. Our success rate is well over 95%, and it is quite rare for any of our patients to fail to respond to our conservative, non-drug, non-surgical treatments. The first step is to increase the quantity of pure water, typically around one gallon per day for the typical 150 pound adult. Most people are dehydrated and this causes a major challenge.

Elimination of sugar is also a major effective strategy that aids healing. If one is overweight it is also likely that the short-term elimination of most grains will also be helpful by lowering insulin levels.

Adequate vitamin D intake is also an important variable for stomach health, as suggested in Lancet earlier this year. Normally, sunshine is the ideal source for vitamin D, but over half the US does not have adequate sources of sunshine for a large percentage of the year, so in this case supplements are important. Vitamin D3 (not vitamin D2, which is synthetic) is the preferred form. One can also monitor blood levels to make certain that adequate doses are taken.

Garlic is one food that you should be eating every day. It is important to note that the garlic MUST be fresh. The active ingredient is destroyed within several hours of smashing the garlic. Garlic pills are virtually worthless and should not be used. When you use the garlic, it is important to compress the garlic with a spoon prior to swallowing it if you are not going to juice it. If you swallow the clove intact you will not convert the allicin to its active ingredient. One problem, of course, is the smell, but most people can tolerate a few cloves a day. If one develops a "socially offensive" odor, then all you do is slightly decrease the volume of garlic until there is no odor present.

I realize that with homeopathic treatment, no generalizations can be made and that a full investigation of the patient is necessary.

Dahli
Member

11-27-2000

Wednesday, June 07, 2006 - 3:16 pm   Edit Post Move Post Delete Post View Post Send Dahli a private message Print Post    
How to Treat GERD


By Tom Cowan, MD

Medicines for stomach and upper digestive system problems are currently the largest selling medicines in the country, an amount totaling billions of dollars per year. Luckily for you and many others, this is a problem that is often rapidly amenable to dietary intervention.

Treating GERD brings up a quandary that one often encounters in the world of medicine. That is, in many cases two diametrically opposed theories may be proposed, both of them often sounding perfectly valid and, of course, both of them having their vehement proponents. Think of the low-fat versus low-carb arguments that are raging through the dietary circles of this country as an example of how two competing theories for weight loss may, at first, sound equally valid. In many cases only the actual testing of each theory will show which is the right approach.

Regarding GERD, there are also two theories that at first both sound good. Since everyone accepts the fact that it is stomach acid that causes the problem of burning, the question is why is there too much acid in the stomach? One answer could be that the person is eating too much food that "tells" the body to secrete acid. Since protein foods are what cause the stomach cells to produce acid, the therapy is simple: stop eating so much protein. Then the stimulus to produce acid will be lessened, less acid will be produced and eventually the symptoms will abate.

The competing theory states that producing acid is a natural function of the stomach in response to the eating of food--any food. In fact, the acid helps the stomach and pancreatic enzymes assume their proper form, so without stomach acid the whole digestive system is thrown off. Stomach acid is beneficial in other ways in that stomach acid kills the invading microorganisms that we inevitably ingest with our food. Stomach acid thus protects us from infections, both acute and chronic, in our GI tract.

Furthermore, the very group of people who lacks stomach acid, that is the elderly, is the group that most often suffers from GERD. So in this case, the solution is not to inhibit production by eating less protein, but rather to increase protein (and fat) consumption so as to give the acid something to do, which is to digest the protein.

Which Reasoning is Correct?

A recent study examined this very question. Much to their amazement, researchers reported that in spite of continuing to smoke, drink coffee, and other GERD-unfriendly habits, in each case the symptoms of GERD were completely eliminated within one week of adopting a very low-carbohydrate diet (about 20 grams per day). The patients were able to stop all antacids and prescription stomach medicines and this improvement continued even after they liberalized their carbohydrate intake to a more tolerable 70 grams per day.

The researchers were unable to definitively say why this had occurred but they postulated that the lower-carb intake influenced the activity of various hormones that open and close the value between the esophagus and the stomach.

By the way, this therapy is particularly appropriate for a diabetic, for it stabilizes the blood sugar.

To address the question of the long term effects of taking antacid drugs, the main problem is simply that our stomach acid is not only necessary for protein digestion, but it protects us against a variety of gastrointestinal infections. Long term blocking of this acid is a very poor strategy indeed.

I have used this low-carbohydrate approach for the treatment of GERD for many years and with many patients. I can report that it is one of the most effective interventions that I use. It is not unusual for people to report relief even within a few days. There is no longer any doubt in my mind as to which of the above theories is correct.

Serate
Member

08-21-2001

Monday, June 19, 2006 - 6:53 pm   Edit Post Move Post Delete Post View Post Send Serate a private message Print Post    
By the way, this therapy is particularly appropriate for a diabetic, for it stabilizes the blood sugar.

Actually it depends on which doctor you talk to. My husband's doctor and registered diatician strongly disagree with a diabetic or any person going on a low carb diet. They say a controlled carb diet is much better. It keeps the blood sugar evenly leveled. It seems to work with my husband when he follows it. 50 - 80 carbs per meal, 15 - 20 carbs between breakfast and lunch, again between lunch and supper. He lost 20lbs in 3 months by doing this, and this was without counting calories or fat intake. I wanted to start him slowly so maybe it wouldn't be such a drastic change. Lower the carbs, then work on fat and calories. His doctor was talking about taking him off his Metformin and Glyburide.

Beachcomber
Member

08-26-2003

Tuesday, June 20, 2006 - 8:35 am   Edit Post Move Post Delete Post View Post Send Beachcomber a private message Print Post    
I have been off my Nexium for 3 weeks after taking it for 3-4 years. I had some bad acid reflux prior to going off the meds and have not had any problems since. I have tested the limits and drank beer and eaten spicy food in moderation which used to kill me even when I was on the med. I have been eating Breyer's Light Yogurt (advertises Probiotic) on its label every day to help restore my stomach's natural state. I am hoping that I can go off the medicine permanently and just control any flare-ups with a swig of Maalox.

They had a story on the news about a new procedure to "cure" GERD. It grabs, folds, and sutures the upper stomach area near the esophagus to tighten the muscle. The woman who had the procedure done swears it works. Anybody heard about this?

Herckleperckle
Member

11-20-2003

Wednesday, June 21, 2006 - 8:39 am   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Beachy, I think that is the 'Plicator' approach described above in the Ivanhoe.com article I posted there. Sounds like it, anyway.

Dahli, that makes complete sense to me because when Loupup had me on a strict organic diet, she kept the carbs very low. I had zero problems during that time. I drank a lot of tea during that time (Loupup pushed caffeine-free tea, but I kept sneaking caff Earl Grey)--and still had no problems--something which previously WAS a problem for me. (I know Serate has had a different experience in that chocolate and caffeine seem to relieve her symptoms. But she's and oddball, anyway. Jk, jk, Serate!)

Wonder how Granny's ds is doing?

Serate
Member

08-21-2001

Wednesday, June 21, 2006 - 10:27 am   Edit Post Move Post Delete Post View Post Send Serate a private message Print Post    
HP I'm the FIRST to say I'm an oddball!!!! Matter of fact, I think I'll change from serate to oddball. hehehehe

Dahli
Member

11-27-2000

Thursday, June 22, 2006 - 9:22 am   Edit Post Move Post Delete Post View Post Send Dahli a private message Print Post    
Yep HP - I'd believe it for sure, that's how Randy got off meds back in 97 when he was suffering with H-Pylori and GERD. Amazing really how simple things can be sometimes.

Herckleperckle
Member

11-20-2003

Sunday, November 19, 2006 - 11:57 pm   Edit Post Move Post Delete Post View Post Send Herckleperckle a private message Print Post    
Source: Ivanhoe.com
Reported October 25, 2006


Heartburn Drug Linked to Bad Breath


(Ivanhoe Newswire) -- If you take drugs like Prilosec or Prevacid to treat your chronic heartburn or acid reflux disease, you may end up with another unwanted problem -- bad breath.

New research reveals the class of medication that includes those drugs -- known as proton pump inhibitors (PPIs) -- is linked to halitosis or bad breath.

PPIs reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid.

Doctors in Brazil studied 23 adult patients with acid reflux disease (GERD) and 17 patients with indigestion. They found 39 percent of the GERD patients had bad breath, and in at least 75 percent of the cases, taking a PPI was one of the reasons. Also, 18 percent of indigestion patients had bad breath.

"Once we excluded oral causes of halitosis, we discovered that bacteria overgrowth associated with PPI usage might play a role in causing bad breath," reports Luciana Camacho-Lobato, M.D., Ph.D., UNIFESP, from Brazil. "It certainly is worth further investigating this matter."


SOURCE: Presented at the 71st Annual Scientific meeting of the American College of Gastroenterology in Las Vegas, Oct. 20-25, 2006

Kearie
Member

07-21-2005

Sunday, February 11, 2007 - 2:13 pm   Edit Post Move Post Delete Post View Post Send Kearie a private message Print Post    
So glad all this was here to read.

Thanks for all the time and effort you put into this Herkie.

Perhaps my cocoa puff night left me feeling this horrible today. How do I make it go away. 5 Tums didn't help.

Cndeariso
Member

06-28-2004

Sunday, February 11, 2007 - 2:35 pm   Edit Post Move Post Delete Post View Post Send Cndeariso a private message Print Post    
i have GERD but have never had heartburn that goes along with it. go figure. i take prevacid every night before i go to bed. i take it some mornings if i have a particularly stressful event coming up like laying on my back for an hour in a MRI machine. LOL

i used to take Nexium. took it for over 3 years but i guess i got 'used' to it.

i have taken pepcid ac over the counter when i ran out by accident. maybe that would help you, kearie.

Mameblanche
Member

08-24-2002

Sunday, February 11, 2007 - 2:55 pm   Edit Post Move Post Delete Post View Post Send Mameblanche a private message Print Post    
dratted file-lock. LOL.

Mameblanche
Member

08-24-2002

Sunday, February 11, 2007 - 2:55 pm   Edit Post Move Post Delete Post View Post Send Mameblanche a private message Print Post    
Kearie, Vinblanche has a prescription for Nexium and says to tell you that it really helps him a lot. You might want to discuss it with your doctor. :-)

Mocha
Member

08-12-2001

Sunday, February 11, 2007 - 5:23 pm   Edit Post Move Post Delete Post View Post Send Mocha a private message Print Post    
I have gerd and get the hearburn. I used to be on prescription meds like Zantac before it went otc but for the last 3-4yrs I only take otc meds when needed.

Cndeariso
Member

06-28-2004

Sunday, February 11, 2007 - 5:29 pm   Edit Post Move Post Delete Post View Post Send Cndeariso a private message Print Post    
kearie, the symptoms i have with GERD are that i want to puke all the time - even with an empty stomach. my stomach also fails to empty and digestion stops after i eat. that was what was so great about the Nexium. it not only helped with the refluxing, it also made the stomach empty.

prevacid does pretty well but not as well as nexium did - for me. that is why i have to eat dinner by 6 or 6:30 on work nights. i need a few hours to get the food out of my stomach before i lie down for the evening.

not sure why i have been so lucky and not felt the heartburn that everyone talks about. i have no idea what it is. unfortunately, i do have the reflux so without the medication the damage was being done.

i do not have a hiatal hernia though.