Heartburn Dilemma

To provide relief, doctors may be prescribing too much of a good thing

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Dr. Marcus Thygeson once wrote his patients countless prescriptions for heartburn drugs such as Prevacid, Prilosec and Nexium - the "little purple pills" of TV ads.But several months ago,when his own doctor advised him to start taking the pills,he refused. "It was all I could do to get out of the office without a prescription," he said.

The Twin Citie gastroenterologist has come to see the popular pills as a symbol of the'excesses of modern medicine a powerful medication "handed out like water" in his words, in his words, amid mounting evidence that it may do many people more harm than good.

"It's a drug we've become very cavalier about;" says Thygeson, president of the Center for Healthcare Innovation,at Allina Hospitals & Clinics. "Now it's like front-line therapy if you so much as belch."The heartburn drugs,known as proton-pump inhibitors (°PPIs),'are designed to reduce the body's ability to pump acid into the stomach.
Today, they are among the nation's best-selling medications, with more than 119 million prescriptions written last year, in addition to over the-counter sales. Experts have called them a godsend for ailments like acid reflux,a major cause of heartburn.Yet there's a growing consensus that millions of people are taking the pills needlessly, or far longer than necessary, wasting billions of dollars and in some cases triggering significant side effects.


Lifestyle changes that can help:

  1. Stop smoking.
  2. Avoid foods and beverages that worsen symptoms.
  3. Lose weight if needed.
  4. Eat small, frequent meals.
  5. Wear loose-fit€ing. clothes.
  6. Avoid lying down for three hours after a meal.
  7. Raise the head of your bed 6 to 8 inches. Just using extra pillows will not help.

GERD medications:

  1. If you have gastro esophageal reflux disease, your health care provider may recommend over-the-counter antacids or medications. You can buy many of these medications without a prescription. However,see your health care provider before starting or adding a medication.
  2. Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids and Riopan are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms.
  3. Calcium carbonate antacids such as Tums, Titralac and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
  4. Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole.(Prevacid), pantoprazole (Protonix), rabeprazole (Aciphe'x) and esomeprazole (Nexium), which are available by prescription.
    Prilosec is also available in over-the-counter counter strength.
    Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.

San Diego Union Tribune
By Maura Lerner
November 9, 2010