GERD Heartburn
Home Up DHEA Dental Diabetes Endometriosis Estrogen & HRT Eye Diseases Fertility Fibromyalgia Genetics GERD Heartburn Headaches Herniated Discs Hepatitis Herpes High Blood Pressure

 

Heartburn at night is caused by acid reflux from the stomach past a weakened esophageal sphincter muscle which normally keeps the acid in the stomach.  About 25% of adults are aroused from sleep at least twice a month from this reflux.  In a study of 15,000 adults, excessive weight, high blood pressure, asthma, insomnia, and obstructive sleep apnea were linked to a higher risk of reflux (Fass et al. Chest 5/05).  Carbonated beverages were highly associated with nighttime reflux.  Benzodiazepine and similar sleeping pills also increased the risk. 

Treatment of heartburn and gastroesophageal reflux is primarily with proton pump inhibitors (PPIs).  Only one is available over-the-counter, omeprazole.  Although the patent expired in 2002, there is still no generic on the market.  Consumers are stuck purchasing the Prilosec brand for between $.60 and $1.00 a tablet.   I was able to purchase generic Prilosec from India for just $.25 a tablet, (overseasrxdrugs.com).  Four other PPIs (Prevacid, Nexium) are available only as a prescription at much higher costs, at least $3 to $6 a pill, but have no significant medical advantage.  Acid blockers do have the disadvantage of increasing the risk of bacterial infections, e.g. pneumonia.  Acid blockers plus antibiotics increase the risk of treatment-resistant infections.

Patients with milder symptoms may use antacids and some patients respond to the less expensive histamine-2 blockers like cimetadine (Tagamet), which are also available over-the-counter.  I used to take huge quantities of antacids in medical school and gave up coffee and tea to get rid of the problem.  I have since returned to drinking these beverages and have wondered if taking antacids creates a vicious circle on lowering stomach acid with the stomach responding by increasing acid output.  In any case, by avoiding taking antacids, the problem seems to have gone away.  

H. Pylori Treatment Doesn't Affect GERD or Heartburn:

Proton Pump Inhibitors Are All Equal: Proton pump inhibitors are used at different dosages for the treatment of acid-related gastrointestinal disorders, such as gastro-oesophageal reflux and peptic ulcer disease. Comparisons of four different proton pump inhibitors: omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), and pantoprazole (Protonix). show that they all have similar potency and efficacy. Rabeprazole, however, displays a slightly more rapid onset of acid inhibition than the others; the clinical advantage of this seems limited. The S-isomer of omeprazole, esomeprazole (Nexium), exhibits a somewhat higher potency than the other proton pump inhibitors. Reports supporting a clinical advantage of this property are not convincing. The Choice of Proton Pump Inhibitor: Does it matter? Hellstrom PM, Vitols S. Karolinska Hospital,Stockholm, Sweden. Pharmacol Toxicol. 2004 Mar;94(3):106-11

Lansoprazole 15 mg as Good as 30 mg: In a DB PC Chinese study, both doses worked equally well. Aliment Pharmacol Ther. 2004 Feb 15;19(4):455-62

Acid Reflux and Difficulty Swallowing Symptoms NOT Related to Severe Esophagitis in Japanese Study: This study aimed to evaluate the correlation between symptoms and endoscopic findings in reflux esophagitis. Subjects, 8031 persons without medication for gastrointestinal disease, were briefly asked about the presence of heartburn, dysphagia, odynophagia, and acid regurgitation by associated medical staff before endoscopy for assessment of esophagitis utilizing the Los Angeles Classification. Endoscopically, 1199 (14.9%) were classified as positive reflux esophagitis, and 2223 (27.7%) had heartburn, 1522 (19.0%) had dysphagia, 493 (6.1%) had odynophagia (pain on swallowing), and 1466 (18.3%) had acid regurgitation. Multivariate analysis indicated that the symptom most related to esophagitis was heartburn (odds ratio: 2.46), although approximately 40% of subjects with grade C or D did not complain of heartburn. Regarding the other symptoms, less than 30% subjects with severe esophagitis complained of the symptoms and the odds ratio was approximately 1. These results indicate that endoscopic esophagitis was not equivalent to any reflux symptoms from which subjects suffered in their daily lives. Clinical symptoms in endoscopic reflux esophagitis: evaluation in 8031 adult subjects. Okamoto K, Iwakiri R, Mori M, Hara M, Oda K, Danjo A, Ootani A, Sakata H, Fujimoto K. Saga Medical School, Japan. Dig Dis Sci. 2003 Dec;48(12):2237-41

DGL Licorice Promoted for GERD: A synthetic drug, carbenoxolone, reportedly similar to an ingredient of licorice was popular in Europe for ulcer therapy until the early 1980’s. Double-blind trials have shown it to be of some benefit and perhaps as good as cimetidine (Tagamet), but inferior to proton pump inhibitors, e.g. Prilosec, etc. (Reed PI, Davies WA. Controlled trial of a carbenoxolone/alginate antacid combination in reflux oesophagitis. Curr Med Res Opin 1978;5:637–44; Young GP, Nagy GS, Myren J, et al. Treatment of reflux oesophagitis with a carbenoxolone/antacid/alginate preparation. A double-blind controlled trial. Scand J Gastroenterol 1986;21:1098–104.). Ed: Licorice itself remains unexamined as a treatment for GERD and is unlikely to be of much benefit. iHerb.com sells 200 tabs of DGL licorice for $13.50. DGL licorice seems safe to try and is inexpensive, but don't expect a great chance for success.

Stomach Acid Suppression Increases Pneumonia Risk: Of 364,683 individuals from the Netherlands who developed 5,551 cases of pneumonia for the first time, researchers found that current use of all acid-suppressive drugs was associated with a 27% increase in the risk of pneumonia, with higher risks for specific classes of acid-suppressive drugs (such as proton pump inhibitors or H2-receptor antagonist drugs). Robert J.F. Laheij, Nijmegen, Netherlands, JAMA. 2004; 292:1955-1960.