According to the National Institutes of Diabetes and Digestive and Kidney Diseases, gastroesophageal reflux disease (GERD) affects approximately 20 percent of the U.S. population. Such a prominent portion dealing with the condition signifies the importance of effective treatment options, though a very important fragment of GERD management is becoming scrutinized. Certain acid blockers, a mainstay in symptom reduction, are raising concerns not only surrounding chronic health risks, but even premature death.
Understanding Acid Reflux
Medically known as gastroesophageal reflux disease (GERD), acid reflux is a condition in which stomach acid refluxes back into the lining of the esophagus. Common signs and symptoms of GERD include a burning sensation in the chest (also casually recognized as heartburn), chest pain, swallowing difficulty, regurgitation and feeling as if a lump is in your throat. If GERD carries into the night, individuals may experience chronic cough, new or aggravated asthma, and disrupted sleep. Not managing and treating the symptoms can compromise quality of life, along with increasing the risk of more severe complications later down the road. Prolonged and chronic inflammation of the esophagus may narrow the esophageal pathway, cause an ulcer, or trigger precancerous changes known as Barrett’s esophagus, which proliferates the risk of esophageal cancer.
Managing GERD with Acid-Reducing Drugs
As the name suggests, acid blockers reduce stomach acid to decrease its entry into the esophagus, aiming to diminish and eradicate associated symptoms. Acid reducers are broken down into three common medications, including antacids, histamine H2-receptor antagonists (H2 blockers), and proton pump inhibitors (PPIs):
Antacids work by neutralizing the pH of stomach acid. Popular antacids include Alka-Seltzer, Maalox, Rolaids, and Tums, which more than likely reside in your medicine cabinet to manage sporadic heartburn.
• Histamine H2-Receptor Antagonists
Also known as H2 blockers, these acid reducers work by decreasing the amount of acid produced by the stomach. Commonly used H2 blockers are Pepcid, Tagamet, and Zantac and come in variable dosage forms.
• Proton Pump Inhibitors (PPIs)
Similar to H2 blockers, PPIs also reduce stomach acid production. They are the most frequently used in the treatment of acid reflux disease, potentially even assisting in a diagnosis; if symptoms do not resolve in the presence of a PPI, you more than likely have an alternative health condition or issue. Well-known PPIs include Nexium, Prevacid, Prilosec, and Protonix.
The Rising Concerns of Acid Blockers and Reducers
It goes without saying not treating GERD can be extremely dangerous and even start compromising quality of life. To subdue these risks, acid blockers have shown to be highly effective. But if only the story stopped there…
Rising concerns surrounding PPIs have intrigued researchers and sparked worry in past, current, and prospective users. Surfacing evidence suggests prolonged PPI use can lead to a number of threatening health conditions, including nutritional deficiencies, bone fractures and osteoporosis, infection, dementia, organ damage, and premature death. But even discontinuing PPIs after long-term use can be dangerous. Since acid reflux medications cause the stomach to lessen acid production, abruptly discontinuing their use can cause overcompensation of stomach acid. The phenomenon, known as rebound hyperacidity, has not only reintroduced GERD symptoms, but has even made them worse in some individuals.
First and foremost, lifestyle factors have a prominent role in acid reflux symptom, including trialing certain food irritants, eating smaller and more frequent meals, wearing loose-fitting clothing, increasing physical activity, managing stress, and quitting smoking and tobacco use. Weight loss can also be an extremely effective approach, if not the most viable tactic, in mitigating GERD symptoms. A study published in The New England Journal of Medicine implies that moderate amounts of weight gain may result in the development or exacerbation of symptoms of GERD. Furthermore, the data suggests that even normal-weight persons moving from a BMI of 22 to 24 doubles the risk of reflux. Based on the same BMI fluctuation, this calculates to a 5’4″ woman going from 128 pounds to 140 pounds. Though a 12-pound gain may seem trivial and slightly insignificant, there is a sense of urgency to maintain a healthy, yet stable weight.
Severe cases certainly may warrant the need for an acid blocker, so now what? What it mostly comes down to is the patient’s need and the justification for medicinal use. For instance, PPIs can be highly beneficial and effective in reducing chronic GERD symptoms and even healing peptic ulcers. Ultimately, healthcare providers are in a unique position to answer the questions of worried consumers and develop an individualized care plan surrounding patient needs. Doctors are obliged to keep up with and discuss all treatment options, including switching to H2 blockers (shown to be mostly safe at this point) and potential surgical routes. Individuals warranted to discontinue acid reflux medications should also do so in a slow and gradual fashion to lessen the risk of rebound hyperacidity. Ultimately, acid reflux sufferers should confide in a healthcare professional to ensure the upmost safety surrounding the entire management process.