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Tuesday, April 30, 2013
Q: At age 79, I’ve been dealing with the effects of GERD for the past two or more years. For a year, I took omeprazole, which I believe was responsible for an immediate weight gain and a worsening of my osteopenia. It was a nasty drug from which to wean myself, but I did it. Currently, I’m not taking any medication for this condition.
I’ve made changes in diet and lifestyle, and have been sleeping on an incline; I’m trying to keep portion size of meals to a minimum; and I have been chewing a lot of sugar-free gum. So far, it’s been working quite well, except for evenings, after I’ve quit eating for the day. Can GERD problems be triggered by an empty stomach?
My internist wants me to see a gastroenterologist and have an endoscopy done, but I’m leery of the risks of introducing a foreign object down my throat. I understand that GERD is a chronic condition, but what causes it?
A: GERD (gastroesophageal reflux disease) is an extraordinarily common condition that comes about when stomach acid splashes backward, up the esophagus — the muscular tube that conducts food from the throat to the stomach. Acid isn’t meant to enter the esophagus; there is a muscular valve called the lower esophageal sphincter that should prevent food and acid from going the wrong way.
Symptoms may include heartburn, a sour taste in the back of the throat, a cough or no symptoms at all.
What causes GERD? Although several conditions are known to predispose a person to GERD, many people with no risk factors at all have symptoms. At least 15 percent of people have GERD symptoms in any given week. Risks include being overweight or pregnant (increased abdominal pressure tends to push food backward), having a hiatal hernia or diabetes, and medications, especially high blood pressure medicines like calcium channel blockers and asthma medicines like albuterol.
You have mentioned some important treatments. Sleeping on an incline (the whole bed needs to be inclined —using lots of pillows usually doesn’t work) helps by keeping acid down in the stomach when you sleep.
Reducing portion size is also important, as is reducing fat intake, which tends to worsen GERD. As such, empty stomachs seem to be best for most people with GERD. I wonder if the chewing gum is helping you by having you swallow more, which also helps clear acid from the esophagus.
Omeprazole certainly can cause weight gain and predispose one to bone loss, so I agree with relying on lifestyle changes and not medication, if possible. However, some people need medication. The old-fashioned H2 blockers, like ranitidine (Zantac) or famotidine (Pepcid) still are good medicines, and they have the advantage of being used on an as-needed basis. Omeprazole and its ilk are very useful, but I think they are overused.
I have only one disagreement with you: There is a time to get the endoscopy done. I have seen too many serious problems misdiagnosed as GERD. The risk of an endoscopy is less than the benefit gained by making sure it’s not a serious problem in the stomach or esophagus.
Make an appointment with a gastroenterologist.
Dr. Keith Roach’s column runs in Tuesday’s Extra.
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