Heartburn (GERD) Dialogue (cont.)

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.

Prakash: If your nighttime heartburn has increased since you were switched off the omeprazole [Prilosec], it is imperative that you be put back on the medication. However, it is sometimes not that easy, depending on what kind of insurance you carry. At your age, if you have significant reflux that is confirmed on testing, and if you do not want to take medications for the rest of your life, getting more invasive therapy like surgery is an option, but this decision should be made between you and your doctor.

Wyman: I would like to add that I personally think that rantidine has little place in the treatment in GERD disease. This can raise the pH usually to only 3, whereas omeprazole will raise it to about 4 for hours at a time. Omeprazole is a very safe agent and people have been taking it daily for over 20 years with no severe side affects. You should ask your doctor to give you omeprazole again to protect your esophagus.

jessica105_webmd: what's the difference between meds like Tums/Rolaids and Tagamet/Zantac. Which should I take for heartburn?

Prakash: Tums and Rolaids are antacids and they neutralize acid. They do nothing to the stomach's ability to make acid. Therefore, their affect only lasts for a short time, and large amounts may have to be taken for complete relief. Medicines like Tagamet decrease acid formation by the stomach to a certain degree, especially in the doses available over the counter. What you need for your reflux symptoms really depends on how often you have symptoms. If you only have symptoms very occasionally then medications like Tums, Rolaids and Tagament may be enough, especially if they take your symptom away. However, if you have symptoms more often than three to four times per week and if these over-the-counter medications do not control your symptoms completely, you may need to see your physician for a prescription acid-suppressing medication.

Wyman: For occasional heartburn, a change of habits might be of benefit. Don't eat or drink anything within three hours of going to bed. Cut down or stop caffeine or tobacco. Changing these things can stop heartburn.

Moderator: Members, we are approaching the end of our discussion. Please send in any final questions you have for our guests.

cstrotmeyer_webmd: Are heartburn and stress related?

Prakash: There may not be a very simple answer to this. There are situations where symptoms coming from gastro organs are exaggerated during periods of stress. This is especially true if there is an element of visceral hypersensitivity, where the organs are highly reactive to stress hormones and nerve impulses. This is a situation where the patient's symptoms are out of proportion to whatever is causing those symptoms. Now this situation can coexist with GERD. There is also some indication that acid generation may go up during periods of stress, although it is unclear if this increased acid translates into more heartburn symptoms from GERD.

Wyman: Heartburn may have nothing to do with acid as we have said before. The symptom caused by stress may be interpreted as heartburn and yet obviously it has something to do with the stressful episodes. If this happens, one might try over-the-counter medications, and if no benefit is given from this then probably the symptom has nothing to do with acid. It is a stress-related symptom that would be relieved when the stress is relieved.

Moderator: Member question: We are now seeing a lot on television about digestive enzymes as a supplemental "vitamin". Are using these a good idea?

Wyman: The use of supplemental enzymes and vitamins is probably a waste of money if the person is eating a balanced diet. The available enzymes are usually pancreatic enzymes. Our pancreas has a great capacity of producing enzymes that digest dietary protein and fat, and unless one has diagnosed pancreatic disease the enzymes that one takes by mouth are digested by our own pancreatic enzymes and so it serves no purpose. Most of the vitamins that are taken supplementally are also in excess of what our bodies need, so that most of these end up in the toilet. Certainly supplemental vitamins are appropriate for some people who are unable to eat a balanced diet. The very young and the very old often are candidates for supplemental vitamins.

Prakash: We are not saying that patients who have vitamins and other enzymes prescribed by a physician should not take them. We are just suggesting that patients who decide to pick up these supplements from the grocery store may not necessarily benefit from them.

Moderator: We are just about out of time. Dr. Wyman, before we say goodbye, do you have any closing comments?

Wyman: I am very pleased that people are sending these questions to us and I would hope that this kind of dialogue can continue with all physicians. It is very important to understand how they function and how they don't function, and perhaps we as physicians can help them.

Moderator: Dr. Prakash, would you like to make any final comments before we leave?

Prakash: It was a pleasure answering these questions. I am impressed by how much insight our members have into their disease. I would urge all patients with GERD to follow their physicians' instructions.

pokus1_msn: Thank you.

johnsmom2_webmd: Thank you very much for taking this time to chat with us.

Moderator: Unfortunately, we are out of time. Thank you very much for joining us today, Dr. Wyman and Dr. Prakash. It was a pleasure having you both on WebMD Live. Thank you for sharing your knowledge and expertise with us.

Wyman: Thank you.

Prakash: Thank you.

Moderator: Members, thank you for all of your great questions. For more information , please visit the AGA web site at www.gastro.org. You can also visit the WebMD Heartburn Center and our message boards on digestive disease. Thanks, everyone, and have a great afternoon.

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