By : Farshid Dabirzadeh, MD. (farshiddb@gmail.com)
Attention: this article has been provided to be used by all to help the patients wherever they are to tolerate less pain and costs . This is not a substitute for the physician counseling.
The gasteroesophageal reflux is a common digestive disease affecting 14- 24 percent of American adults, during which return of stomach contents to the esophagus causes some symptoms in the patients. The most common symptom is the “heartburn” which should occur at least 2 times a week (or there are complications of the disease) to be called “reflux disease”. There are some symptoms outside of the digestive tract including lanryngeal inflammation and chronic cough which are among the most common complications of this disease. If the reflux remains untreated and is severe and lasts for a long time, it can cause esophageal inflammation, stricture and narrowing of the esophagus, cancerous changes in the innermost lining of the lower end of the esophagus and some peculiar cancers of this area. Something to remember is that every retching is not reflux. If you have any doubts about it, you should ask your physician.
Overeating, obesity, alcohol consumption, smoking, delayed gastric emptying, excessive secretion of acid in the stomach (for example due to emotional stresses), weak lower esophageal sphincter ( in the junction of the esophagus and the stomach), decreased peristaltic movements of the esophagus are among the causes which increase the prevalence and severity of the reflux. Genetic factors role in this regard are undeniable.
Reflux is the most common cause of the heartburn but there are other rare causes too. When the disease’s signs and symptoms are evident and there is a good response to treatment modalities, there would be no need to any other examinations including endoscopy to confirm the diagnosis. In addition to heartburn, other signs and symptoms are retching, compromised digestion, and chest pain. The patients and their physicians should be careful not to attribute some symptoms such as chest pain due to a heart attack, to reflux or other diseases of the esophagus, stomach, duodenum or gall bladder!
What changes in the life style can help to decrease the prevalence and recurrence of reflux?
Avoiding acidic or irritant foods such as citrus fruits( oranges, sour lemons, …), onions, hot and spicy foods.
Avoiding foods which cause reflux such as fried or fat foods, coffee, tea, chocolate, peppermint, caffeinated or gaseous beverages.
Reducing alcohol consumption.
In those who feel the symptoms of reflux during the night(or lying down), avoiding foods during the 3 hours before sleep or avoiding lying down within 3 hours after meals and elevating the head of the bed is beneficial.
Those who have abdominal obesity shouldn’t wear tight belts.
Avoiding smoking .
Avoiding emotional stresses.
Medical Treatment
The mainstay of medical treatments are drugs that are capable to lower stomach acidity as much as possible. There are many drugs to do so including “ Omeprazole” , “ Ranitidine” , and “Cimetidine”. Drugs such as Omeprazole have more potency in lowering the stomach acidity so are preffered to drugs such as Ranitidine and Cimetidine. Antiacid drugs are used for rapid relief of symptoms(heartburn) . These drugs (including Aluminium Mg) directly neutralize the acid so their effects are immediate but drugs such as Omeprazole need 0.5 to 1 hour to take effects and actually prevent the secretion of more acid but can’t neutralize the acid which has been secreted before.
Fortunately taking drugs such as Omeprazole for a long time doesn’t have much side effects. The antiacid drugs aren’t absorbed and most of what taken is excreted. There are side effects for Omepralzole ( and other drugs of this group called “ proton pump inhibitors”) if used for a long time. These rare side effects include reducing calcium absorption (and hence increasing pelvic fractures in patients over 50), and probability of reducing host resistance against certain digestive tract bacteria. Routine therapeutic courses are short and take a few weeks or months . Side effects are rare during such short courses.
In pregnant women, Ranitidine is preferred to Omeprazole.
Also there are surgical methods to treat gastroesophageal reflux which can be used if the disease doesn’t respond to medical treatments.
Example: The suggested treatment in a patient who has typical symptoms without any complications, is as follows:
1 – Modifying life style including reducing weight, avoiding spicy foods, avoiding cigarettes, avoiding emotional stresses, …. . Remember that modifying life style cannot alleviate all the symptoms completely.
2 – Taking one 20mg Omeprozole capsule half an hour before breakfast for 2 to 8 weeks. Thereafter some physicians recommend reducing it to minimum effective dose and continue for a long time.
3 – Chew and swallow 2 antiacid tablets whenever the symptoms recur and repeat it after a few minutes if necessary. Some physicians prescribe 2 antiacid tablets half an hour after meals and also before sleep.
Thus the best advice for the patients is to have their medicine with them to be able to take them as soon as necessary.
Omeprazole is available in 14 capsules packages in Iran. Each package is sold 1100 to 1200 Tomans(1.1 to 1.2 US$). These are made in Iran and their sale without physician prescription is prohibited but most of the pharmacies sell them without prescriptions!
One of the famous trade names for Omeprazole is Prilozec in the US. There it can be sold as an OTC drug , in other words you don’t need any prescription to buy it. For example there are 14, 28, and 42 tablets packages as OTC drugs at Walgreens. These are made in Sweden and each 14 tablets package is sold at 14 US$, 28 tablets package at 19US$, 42 tablet package at 27US$. There are Omeprazole tablets in generic name sold at lower costs at the Walgreens. The drugs in their generic names are cheaper.
Antiacid tablets (Aluminium Mg) are OTC drugs and every 10 tablets are sold at 60 Tomans( 6 cents) in Iran. There are also Aluminium Mg Suspensions in Iran. Each 240 ml suspension bottle is sold at 600 Tomans(60 cents).
Antiacid tablets in the US are in different brands and packages. For example there are 150 tablets packages produced by the creditable “GSK” company , with the name “ TUMS” at 4 US$. There are calcium enriched versions of these tablets in 60 tablets packages at 4 US$. Also there are other antiacids including “ Maalox” , “Alka Seltzer” and other drug forms such as suspensions.
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Note: The writer has used articles of New England Journal of Medicine and information obtained from some Iranian pharmacies and the “Walgreens” in the US.
There is no financial relationship between the writer and the pharmacies or companies named above.
Mentioning the reference, reproduction or distribution of part or all of this publication is permitted.
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