Re: DrugDigest Bulletin on GERD

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DrugDigest Bulletin on GERD

> HELPING CONSUMERS UNDERSTAND THEIR TREATMENT

>OPTIONS

>DRUG DIGEST

>

>UNDERSTANDING AND PREVENTING GASTROESOPHAGEALREFLUX DISEASE (GERD)According

>to research published in the journal Archives of Internal Medicine, more

>than $1 billion was spent on over-the-counter heartburn remedies in 1996.

>Clearly, this indicates a large number of people are trying to get relief

>from GERD and related digestive disorders. But what many of those sufferers

>don't realize is that heartburn (or reflux), the most prominent symptom of

>GERD, is not just the result of lifestyle and overindulging. GERD also

>signals a specific physical dysfunction: an improper functioning of a small

>band of muscle fibers (thegastroesophageal sphincter) at the base of the

>esophagus which, when functioning normally, prevent gastric (stomach) acid

>from backing up into the esophagus. In extreme cases, endoscopic surgery is

>performed to help block the entrance to the esophagus.For most people,

>however, lifestyle changes in combination with drug therapy can alleviate

>the symptoms of GERD. Among several factors that have been shown to

>influence the severity of GERD-associated symptoms, sleeping position and

>diet stand out. One study, published in the American Journal of

>Gastroenterology, suggested that people who suffer from GERD could benefit

>from sleeping on their left sides. Researchers believe that during sleep

the

>slight left curve of the esophagus, where it connects with the stomach,

>straightens out, allowing acid to seep up into the esophageal tube. They

>speculate that left-sided sleeping may help to solve this problem by

>supporting the natural curve of the esophagus and utilizing gravity to help

>prevent acid from entering the esophageal tube. Right-sided sleeping was

>considered the worst position for reflux sufferers because it has the

>opposite effect. It is well established that eliminating certain foods and

>other substances that stimulate acid secretion-coffee, chocolate, fatty and

>spicy foods, smoking, and alcohol-can ease the symptoms of GERD by

lessening

>or neutralizing gastric acid production. Some prescription drugs may also

be

>culprits: chlorpromazine, an antipsychotic; trihexyphenidyl, an

>antiparkinsonian; and amitriptyline, an antidepressant. (Consult your

>physician before discontinuing or altering any drug regimen.) Lifestyle

>modifications coupled with a drug regimen that may include over-the-counter

>antacids or, in more severe circumstances, a class of prescription drugs

>known as proton-pump inhibitors, usually does the trick. Proton-pump

>inhibitors work by stopping the secretion of acid into the stomach. For

more

>information about the use of the proton-pump inhibitor, Prevacid, click

>here.Regardless of what method of prevention/treatment is used, it is

>important not to ignore GERD. Complications may include inflammation of the

>esophagus, esophageal ulcers, and, if left untreated, esophageal cancer.

>

>

>THE HEARTBURN-CANCER LINKPeople who suffer from heartburn at least once a

>week are at a substantially increased risk for developing cancer of the

>esophagus, according to the results of a study published in The New England

>Journal of Medicine. The risk was highest among individuals who reported

>symptoms of gastroesophageal reflux disease (GERD) when lying down to

sleep.

>Another strong predictor of esophageal cancer was the presence of an

>ulcerative sore on the lining of the lower esophagus, a condition known as

>Barrett's syndrome. Of the 189 patients diagnosed with esophageal cancer,

>62% had this reflux-relatedsyndrome.This study reinforces the notion for

>both doctors and patients that GERD should not be taken lightly and should

>be evaluated as quickly as possible and treated aggressively. Treatment

>options range from lifestyle changes (see " Understanding and Preventing

>GERD " ) to taking antacids after meals in order to neutralize stomach acids

>to the use of proton pump inhibitors such as lansoprazole oromeprazole.

>Proton pump inhibitors are used to help heal esophageal, stomach, and

>duodenal ulcers resulting from chronic GERD. Proton pump inhibitors act to

>halt the secretion of acid, allowing the ulcer lesions time to heal.

>Initially it was thought that long-term proton pump inhibitor therapy

>increased the risk of stomach cancer, however, this is no longer a concern.

>Because of the range of effective drug therapies, surgery is the last

resort

>in treatment options, and one filled with possibilities for postoperative

>symptoms. While surgical procedures are performed only in extreme cases of

>GERD, it is estimated that as many as 30% of patients who have GERD-related

>surgery suffer from postoperative symptoms, such as weight loss, difficulty

>with digestion, anemia, vomiting bile, and recurrence of ulcers.

Researchers

>stress that while drug therapies provide effective relief of GERD symptoms,

>finding new methods for healing the lining of the esophagus will be the

most

>valuable tool in eradicating this disorder and its complications.

>Gastroesophageal Reflux Disease (GERD) What is GERD? GERD is a common

>medical disorder that is generally chronic in nature and typically requires

>long-term therapy. More frequently called heartburn or indigestion, GERD is

>a sense of burning and discomfort between the ribs just below the sternum

>(breastbone). Sometimes people with GERD experience a sour or bitter taste

>in the back of their mouth or throat, excessive burning or belching, an

>upset stomach, and/or vomiting. How common is the condition? GERD can

occur

>in adults and children, men and women. A national survey estimated that

>approximately 44% of adult Americans experience heartburn at least once

>every month and that 13% of the adult population take medication for

>indigestion at least a couple of times per week. What causes GERD? The

>esophagus is the passageway ( " food pipe " ) that carries swallowed food to

the

>stomach. GERD occurs when the muscular valve between the esophagus and the

>stomach does not function properly, causing stomach acid to back up into

the

>esophagus. The acid can then cause inflammation of the esophagus

>(esophagitis). GERD can cause: --internal bleeding --esophageal ulcers

>Chronic GERD can result in: --narrowing of the esophagus from chronic

>scarring, making it difficult to completely swallow --a condition known

as

>Barrett's esophagus, which is sometimes a precursor to esophageal cancer

>What are the risk factors? The following may increase your chances for

>developing GERD: --drinking alcoholic beverages and coffee --smoking

>--eating foods with a high acid content such as tomatoes or orange juice

>--being overweight --being pregnant Things you can do to help --Eat

smaller

>meals. --Do not eat within two hours of going to bed. --Avoid foods that

>bring on your heartburn. Common culprits include chocolate, citrus fruits

>and juices, tomatoes and tomato juice, peppermint or spearmint flavored

>foods or drinks, fried or fatty foods and carbonated beverages. --Avoid

>alcohol. --Stop smoking. --Lose weight. Losing weight can take pressure off

>the valve between the esophagus and stomach. --Raise the head of your bed

>(e.g., by placing the legs on thick telephone books). This may help to

>decrease the backward flow of acid from the stomach to the esophagus

>while you are sleeping. --Do not take aspirin, ibuprofen, naproxen or other

>NSAIDs. Try acetaminophen instead, if needed for pain or fever. --Try an

>over-the-counter antacid such as Maalox or Mylanta to neutralize the

>painful stomach acid. If it is not effective, consider trying over the

>counter acid- blockers such as Pepcid AC or Tagamet HB. Be sure to

follow

>the package instructions carefully and inform your doctor. Treatment

>Options Non-prescription antacids (e.g. Maalox, Basajel, Mylanta) are

>typically used first to help neutralize stomach acid. If relief is not

>obtained from this type of agent, then non-prescription H2-blockers (e.g.

>Pepcid AC, Zantac 75, Tagamet HC, Axid AR) can be tried. These work to

>reduce the amount of acid released in the stomach. If these treatments do

>not provide adequate relief of GERD symptoms, three different treatment

>options are available: prescription strength H2 blockers in standard doses,

>sucralfate (brand name: Carafate, works to provide a protective barrier to

>acid in the stomach), or prokinetic agents (e.g. cisapride, metoclopramide,

>or bethanechol), which work to move food through the stomach more quickly.

>The next step, if relief is still not provided, is to increase the H2

>blocker's dose or to start a proton pump inhibitor (e.g. Prevacid,

Prilosec,

>Aciphex).

>

>Proton pump inhibitors work to inhibit stomach acid secretion. To learn

more

>about how this type of medication works, click here. Finally, if

medication

>therapy fails, surgery may be required. Summary If you suffer from GERD,

>you should discuss your treatment options further with your health care

>provider. Never start a non-prescription treatment without first discussing

>it with a doctor or pharmacist. Remember, changing your lifestyle habits

>(e.g. stop smoking, avoid alcohol, and others as listed above) may be the

>best treatment. This eletter was sponsored in part by an unrestricted

grant

>from TAP Pharmaceuticals Inc. For more information about Prevacid or GERD,

>click here.

>

> References Dipiro JT, Talbert RL, Yee GC, editors. Pharmacotherapy: the

>pathophysiologic approach. Gastroesophageal reflux disease. Appleton &

>Lange. Stamford, CT. 1997. Heartburn across America: A Gallup Organization

>National Survey, Princeton, NJ, The Gallup Organization, Inc. 1998

>www.Drugdigest.org. Gastroesophageal Reflux Disease Monograph found in the

>Health Conditions Section.

>

> LANSOPRAZOLE (PREVACID) WORKS AS WELL AS HIGHERPRICED COMPETITION

>FOR GASTROESOPHAGEAL REFLUX DISEASE (GERD)Researchers have found that

>lansoprazole (Prevacid) is as effective as omeprazole (Prilosec) in

>alleviating GERD-related symptoms, such as heartburn, chest pain, stomach

>pain, vomiting or belching acid, and a chronic sour or bitter taste in the

>mouth. Lansoprazole and omeprazole belong to the class of drugs known as

>proton pump inhibitors, which work to stop the secretion of acid into the

>stomach. Proton pump inhibitor therapy is usually continued for

>approximately four to eight weeks, along with an antibiotic regimen, to

>ensure that the esophagus is completely healed.The small clinical study,

>published in the most recent issue of the American Journal of Managed Care,

>involved 27 patients who received both proton pump inhibitors at different

>times over the course of the study. The subjects were also given varying

>doses of each drug. Based on responses given by patients, researchers

>concluded that there was no difference in the effectiveness of the

>treatments. While the drug treatments had identical results, omeprazole had

>a higher price tag, prompting researchers to recommend the less expensive

>therapy for GERD-related symptoms.

>

[Guest guest]

I received this follow-up message. I'll let you know what they send out

next.

DrugDigest Bulletin on GERD

>This is the DrugDigest ebulletin service. Please disregard the previous

>message on GERD. It was sent out by mistake. The correct message will be

>forthcoming in a few days. Again, please accept our apologies for any

>inconvenience we may have caused.

>Thank you and Happy Holidays

>DrugDigest

>

[Guest guest]

You will find below a good site for information on GERD. Last week, I

posted an article that was sent to me; they sent me an e-mail immediately

after, " recalling " the article (I forwarded this to you as well). Now here

is the site which I presume is meant to replace the article.

>Welcome to DrugDigest's eNewsletter Service on Gastroesophageal Reflux

>Disease (GERD). We are contacting you because you requested information

>about this disease and its treatment options. For clear and concise

>state-of-the-science news on what causes GERD, how it can best be prevented

>and treated, as well as specific information on medications that can help

>sufferers of GERD (including lansoprazole/Prevacid), go to:

>http://www.drugdigest.org/misc/supplements/newsletter.html.

>

>

>DrugDigest is the most comprehensive source of non-commercial,

>fact-based health and medical information on the Internet. We offer

>eBulletin Service on more than 25 health topics. To learn more, go to:

>http://www.drugdigest.org/bulletins//bulletins/index.html

>

>

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