Is the treatment the problem?

In March I wrote about gastroesophageal reflux disease because someone I care about has it. Since then I am more likely to take note of articles, ads, and research studies regarding this condition and the prevention or treatment of it. Today I am following up with a summary of a newly published study and a editorial response to it. For history of the disease, please see the original blog entry which also has a link to a very good patient information website.


http://yourhealtheducator.blogspot.com/2009/03/wellness-weekly.html


Very simply speaking, one medicine that is used to treat the symptoms of GERD appears to cause some of the very same symptoms it alleviates once the medicine is discontinued. The technical term for this is RAHS or Rebound Acid Hypersecretion. The biggest problem being, this type of medicine is not meant for long term use. Another problem, besides the need to extend use because of use, is that it is prescribed for mild symptoms or symptoms that have not been evaluated for actual GERD.


The medicine is in a class of drugs called Proton Pump Inhibitors, or PPI. These drugs reduce acid production and are also used in peptic ulcer disease and to neutralize a bacteria known as Heliobacter pylori.





A study that was published in a recent issue of the peer reviewed journal Gastroenterology notes that people without these diseases who were given the drug for two months, developed the acid reflux symptoms at discontinuation of the medicine. They were compared to a group that received a placebo. The participants were randomly assigned to either group. The medicine is called esomeprazole, or the little purple pill, Nexium. This is not the first study to raise these concerns.


Briefly, the gastric juices that we secrete are meant to aid in digestion. GERD is not a condition of too much acid, but that of the gastric fluids gaining access to the esophagus because the lower sphincter is not working correctly.

In an editorial response to the research study, Kenneth McColl and Derek Gillen both physicians with the University of Glasgow call for a limit to the use of these meds and a renewed effort to modify lifestyle factors that may lead to GERD as well as more research into how to correct the LES [lower esophageal sphincter]. There are options for surgery at this time but they do not reverse the situation completely. GERD is the leading cause of esophageal cancer.


The study and response can be found in Gastroenterology 2009; 137:20-39.


I consider this to be another example of over medicating a public that is demanding to be over medicated because the drug industry has led them to believe drugs are the answer to every possible discomfort they may experience, regardless of the often more serious outcomes related to the taking of said medicines!



My friend, by the way, no longer uses PPIs. Yea her!