Heartburn (GERD) Dialogue (cont.)

paige18_webmd: How do you determine if your reflux is at the point where you need a prescription medication to treat it?

Prakash: Usually we tend to treat patients who have symptoms at least three times per week or more often than that.

shala4_webmd: Does heartburn sometimes manifest itself as drainage in the throat or is it always like classic heartburn?

Prakash: These days it is becoming increasingly recognized that there are some patients who do not manifest the classic or typical symptoms of heartburn or acid regurgitation in the back of the throat. Some of the other conditions that can be caused by acid reflux include asthma, laryngitis, sometimes sinusitis, sore throat, chest pain, sometimes aspiration phenomena or rarely erosion on teeth. So if you have sinus drainage and your ENT physician cannot find another reason for this, it could possibly be related to reflux. We usually approach this in two ways. First, your gastroenterologist could put a little probe into your swallowing tube and measure acid for a 24 hour period. On the other hand, your doctor could treat you with acid medication and see if your symptom goes away.

Wyman: I think that covers it.

Moderator: Member question: I just had a wire inserted thru my nose and into my stomach to measure for acid. What do the pH levels mean? I see levels on the meter like 7.7 and 3.8 I don't understand what the levels mean. Could you explain it to me?

Wyman: The pH is the measurement of acid, and we believe that anything below pH 4 causes the damage to tissue that we have talked about before. So we hope by using prescription medications or even by surgery to prevent acid being refluxed into the esophagus that we can protect the lining of the esophagus and these other structures that have been described and prevent that damage from occurring. So a pH of 7 is very safe. A pH of 3.8 probably can result in chronic inflammation.

Prakash: Everyone has a degree of acid splashing to the esophagus during a 24-hour period. So if the acid drops below 4 as Dr. Wyman talked about for short periods of time, it may not mean a whole lot. On the other hand, if the pH remains below 4 for more than about five or six percent of the day, which is about an hour during a 24-hour period, that is significant and abnormal.

mommyme1_webmd: My husband takes many asthma medications. Could his inhalers be contributing to his heartburn?

Prakash: The answer is yes. Some of the medicines used for asthma tend to relax the sphincter between the esophagus and the stomach. On the other hand, the asthma could also potentially be related to reflux. It is important that your husband's pulmunologist and gastroenterologist talk to each other and decide if either of the scenarios are occurring in his situation.

paige18_webmd: I was taking Prilosec but read some bad things about it's long-term effects. Do you have any thoughts on this?

Prakash: For the average patient, long-term use is probably safe. In fact, there have been studies where patients have been given Prilosec for over 10 years without any serious long-term side effects. Your doctor is the best person to decide if you can benefit from long-term treatment with medications of this kind.

Wyman: Prilosec has been taken by humans since 1979 and is the safest in this family of drugs that I prescribe.

johnsmom2_webmd: Can long-term intake of acid inhibitors stop the natural acid makers from making the acids we need to digest food?

Prakash: Even the strongest acid suppression medications used these days prescribed at high doses do not cut acid out completely from the stomach. Even if it did, the likelihood of having problems with digestion per se is probably negligible. We usually do not worry about eliminating acid causing problems for patients, it is usually the other way around.

Wyman: I can only add that acid probably is not necessary for digestion it is a fine tuner to how our gastrointestinal system works. Probably the greatest concern is that we swallow micro-organisms all of the time and these can grow within the small intestine. We believe that acid is the barrier to most of these. But in answer to the question, when one stops these medications, the acid reducing cells surge forth and secret acid, so they do not stop it permanently.

coric_msn: Is it normal to experience heartburn before you eat or drink anything in the morning?

Prakash: Usually our patients complain of heartburn after meals. Sometimes there can be a sensation of heartburn even without acid in the swallowing tube. At other times small amounts of acid can generate a lot of symptoms. The best way to find out if your heartburn in the morning is related to acid reflux is to be treated with a potent acid inhibition medication for a week or two and see if your symptom goes away.

Wyman: There is a condition we call functional heartburn which has nothing to do with acid and is somehow related to the nerve supply to the muscle of the esophagus or the muscle itself. So a trial with a potent medication to reduce that secretion would be in order.

Moderator: Member question: Does chewing gum affect heartburn?

Prakash: Chewing gum does a couple of things that I can immediately think about. On the one hand it increases salivation and saliva. In other words, the opposite of acid. On the other hand, when you chew gum you tend to swallow a lot of air and burp.While it may not affect heartburn very much directly, it may increase belching and burping, which sometimes go together with GERD and reflux disease.

cherylk25_webmd: I have just switched from omeprazole to ranitidine and am finding my nighttime heartburn getting much worse. Should I talk to my doctor about switching back? My concern is I am only 33 years old and I don't want to be taking omeprazole for the rest of my life.


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