ASK THE DOCTOR: What comes up...may be acid reflux
By DR. JIM MITTERANDO
The Patriot Ledger

Q I have heartburn frequently. What do you recommend for treatment?

A "Heartburn," also known as Gastroesophageal Reflux Disease (GERD) or simply acid reflux, affects most people at sometime. Reflux is caused by a loosening of the stomach's sphincter muscle, allowing stomach acid and contents to back up the esophagus, resulting in a burning sensation in the stomach and chest and occasionally a bitter taste in the mouth.

Before discussing how to treat acid reflux, make sure you are not experiencing heart-related chest pain or peptic ulcer disease. Chest pain or pressure associated with shortness of breath, nausea, sweating or discomfort in the arm or neck may signal an underlying heart problem, such as angina, and needs to be evaluated by your doctor.

Other suggestions of angina include chest pain that worsens with activity but improves with rest. Symptoms of peptic ulcer include black stools, stomach pain that is worse on an empty stomach but relieved with meals. Acid reflux, on the other hand, often worsens after meals or when lying down. Simple measures to prevent reflux include eating smaller meals, not eating three hours before bedtime or not lying down after a meal.

Extra weight around the abdomen can exacerbate acid reflux by increasing the pressure on the stomach and causing the acid to leak through the sphincter and into the esophagus. People often tell me that their reflux improves after losing 10 to 20 pounds. Caffeine, chocolate and mints, all of which lower sphincter tone and allow stomach contents to leak back up the esophagus, also contribute to reflux. To avoid heartburn, switch to decaffeinated beverages and stop eating chocolate and mints.

If heartburn persists after that, try several over-the-counter medications. A liquid antacid, such as Mylanta, Maalox or Gaviscon, would be a good choice after a meal, though people with kidney disease should avoid antacids containing magnesium.

If your symptoms occur daily, consider trying over-the-counter Zantac or Pepcid. These drugs, called H2 blockers, help cut down secretion of acid in the stomach. I do not recommend another H2 blocker, Tagamet, because it interacts with many drugs. H2 blockers, preventive medicine, must be taken before a meal. If you forget, and heartburn occurs, you would be better off taking a liquid antacid.

If the above measures do not help, I recommend you follow up with your doctor to check other possibilities, such as an ulcer. If your doctor attributes your symptoms to reflux, she may prescribe higher doses of the H2 blockers on a regular basis or try Prilosec or Prevacid, Proton Pump Inhibitors that halt acid production. Originally, there were concerns about long-term use of Prilosec or Prevacid because each caused tumors in lab animals. But experience over the past decade has shown their prolonged use to be safe in humans. Be aware, though, that halting acid production can increase the chance of diarrhea and food poisoning, because stomach acid defends against bacteria- laden food.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.Readers should send questions to Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269- 9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2001 The Patriot Ledger
Transmitted February 20, 2001