Our visitors send us interesting questions that can help others suffering from acid reflux disease. We thought this was quite interesting because it highlights one of our major concerns about medical treatment today – the use of medications. Medications, including PPIs to treat acid reflux disease, have many advantages and benefits; many have saved and extended lives. However, are medications always the answer?
I have acid reflux 24×7 and I was on Nexium twice a day for 2 years and it didn’t help. What can I take?
Thank you for sending us your question. I think it is interesting that you asked “What can I take?” rather than “What can I do?” to address your reflux symptoms. Somehow we have become a society where we seek a pill for every ailment, rather than a society that seeks to address underlying problems. I think both of those questions are important, and with a little understanding of what causes GERD symptoms, you will see there are many more alternatives to the second question.
What Causes GERD Symptoms?
As we have documented on our website, there are many symptoms from GERD. However, there is only one cause of acid reflux disease: a weak or damaged lower esophageal sphincter, or LES. The LES is located at the junction of the esophagus and the stomach. It is a muscle that acts as a valve that allows consumed food and liquid to pass into the stomach, but provides a barrier to keep the contents of the stomach from passing up into the esophagus. When the LES is damaged, its barrier capability is reduced and those acidic stomach contents can enter the esophagus resulting in GERD symptoms.
Medication As A Treatment Plan
The acidic nature of the stomach contents contributes to many of the symptoms resulting from GERD. Consequently raising the pH of those contents (increase of pH is more alkaline/less acidic) can often reduce or eliminate those symptoms. There are three primary types of medications used to reduce stomach acid levels: antacids, H2 blockers, and proton pump inhibitors, also known as PPIs. Dr. Chandrasoma wrote an article titled “How GERD Medications Work: Gastric Acid Reduction”, where he noted that the first two types are very effective when taken after a meal; however, their symptom relief is short lived. PPIs, on the other hand, shut down the body’s production of gastric acid, thus reducing the amount of acid available for digestion. An excellent list of all available medications can be found at www.drugs.com.
The Risks Of Long-Term Medication Use
Dr. Chandrasoma stated our beliefs in his article, Medications to control GERD symptoms: Pros and Cons, “Over the past four decades, while PPIs have dramatically reduced injury-associated changes such as ulcers and strictures, the incidence of Barrett’s esophagus and esophageal cancer have dramatically increased. This begs the question as to whether acid suppression, while beneficial to the squamous lining of the esophagus, has a negative effect on the GERD-induced columnar epithelium, driving it to Barrett’s esophagus and cancer. In my opinion, the medical community has not performed the studies necessary to address this critical question seriously.”
In a study by one of RefluxMD’s GERD experts, Blair Jobe MD, it was determined that GERD patients treated with medications are at a higher risk of esophageal cancer than patients with severe GERD symptoms. “We are learning that the chronic and long-term use of PPIs may not be entirely without consequences and may lead to more insidious problems such as calcium malabsorption, or cause one to be asymptomatic in the face of continued esophageal injury from GERD,” said Dr. Jobe. You can read more about Dr. Jobe’s study here.
If Not Medications For Treatment, Then What?
All of these antireflux medications play an important role in treating GERD if used properly. However, they do not address the underlying problem: a damaged LES. There are several actions that can reduce GERD symptoms resulting from a weak LES, including weight loss to reduce pressure on the abdomen, diet changes, lifestyle changes, reduced alcohol use, and smoking cessation to name a few. For those who are unable to manage their GERD symptoms, serious considerations should be given to surgical alternatives that address the structural issue of a weak LES. There are more alternatives today than ever before, and in the hands of an experienced GERD expert, there is a very high probability of eliminating symptoms with no risk of disease progression. It is our hope here at RefluxMD that our members and visitors will take the time to explore all of their treatment options and ask us “what can I do” rather than just “what can I take.”
Learn more: Weight loss program to reduce GERD symptoms