Heartburn and Acid Reflux Becoming More Common



The results of a study published in the medical journal GUT on 21 December 2011 are showing a worrying increase in the frequency with which symptoms of heartburn or acid reflux are suffered.

The research which was carried out in Norway collected health information by questionnaires over two periods from almost 30,000 people.  The first period covered 1995 to 1997 and the second period covered 2006 to 2009.  The questionnaire asked the participants whether they experienced the symptoms of heartburn or acid reflux and if so how severe these symptoms were.  Some of the participants were also questioned about the frequency with which these symptoms were suffered.

The main points coming out of this study which was conducted by researchers from Norway, Sweden and King’s College London are that:-

  • the incidence of all heartburn/acid reflux symptoms rose 30% over the two review periods
  •  the incidence of  severe symptoms rose by 24%
  • the numbers experiencing  heartburn/acid reflux symptoms at least least once a week increased by 47%
  • Women under 40 were least likely to experience the symptoms and were more likely to have the symptoms disappear without treatment
  •  Those aged 60 to 69 were the most likely to have severe symptoms, with women experiencing this symptoms more frequently than men
  • Age did not increase the likelihood of a man suffering  heartburn/acid reflux symptoms.

Possible explanations for the increases proposed include:-

  • Excessive weight – over the period of the study there has been a large increase in the numbers of the population who are overweight or obese.
  • The use of HRT (Hormone Replacement Therapy).
A more detailed article on this topic can be found here.

 

Stretta® Therapy in the News

On 22 November 2011  the American Journal of Gastroenterology gave advance online publication to the findings of a study to evaluate the application of radiofrequency energy (Stretta® therapy) in the treatment of GERD.  The data which came from the double blind, sham controlled study confirmed that Stretta® therapy improves the physiology of the LES (lower esophageal sphincter) and that this was the likely cause of the improvement in GERD symptoms.

There have been several studies which have reported relief from the symptoms of GERD following Stretta treatment at the gastro-esophageal junction (GEJ), but these studies did not identify how this improvement was achieved.  This study was set up to test the hypothesis that the Stretta therapy alters GEJ resistance.

The study was carried out in a tertiary care center using consecutive GERD patients.  All participants in the study underwent two upper gastrointestinal endoscopies at 3 monthly intervals, during which either active or sham radiofrequency treatment was performed in a randomized double-blind manner.   Each patient undertook a symptom assessment, endoscopy, manometry, 24 hour esophageal pH monitoring, and a distensibility test of the GEJ both before the start of the study and after 3 months.

The results were measured using a Barostat distensibility test of the GEJ before and after administration of the relaxant sildenafil.  Twenty two patients took part in the study with eleven in each group.  After three months the sham treatment produce no impact on any of the measures used but the Stretta therapy produced improved symptom score and decreased GEJ compliance.  After the administration of sildenafil, GEJ compliance returned again to pre-Stretta level, thereby establishing that GEJ fibrosisis was not causing the improvement.

Mederi Therapeutics who manufacture Stretta are of course delighted by the results of this study and Will Rutan their CEO said,

“These results add to the significant body of research on Stretta. The treatment works exceptionally well to reduce or eliminate symptoms in sufferers of GERD, but exactly how it works is now more clearly understood , with 67 publications supporting Stretta as a safe, effective, and durable treatment, Stretta offers an excellent alternative to invasive surgery.”

Heartburn Home Remedy: Baking Soda for Heartburn or Reflux




Baking soda is an effective home remedy for heartburn and acid reflux which has helped soothe the symptoms of many sufferers but it is very high in sodium so it is not suitable for everyone to use nor it is suitable for long term use.

Baking soda works to ease the symptoms of heartburn and reflux because it neutralizes the stomach acids in exactly the same way as an OTC antacid but it should not be used by anyone taking prescription medication or with high blood pressure without first checking with your doctor or pharmacist.

Baking soda produces a chemical reaction when it combines with the Hydrochloric acid in your stomach and it breaks down to produce common salt, carbon dioxide and water. Just like an OTC antacid taking too much will reduce the acidity of the stomach to the situation where it is unable to digest food properly and this can then cause the body to compensate and produce more acid.

The use of baking soda as a heartburn and acid reflux remedy is so established that Arm and Hammer one of the major producers of baking soda provides directions for its use for this purpose.  Their recommendations, unless directed otherwise by your medical practitioner, are as follows:

  • If you are following a sodium restricted diet consult your doctor before use
  • If you are taking a prescription drug consult your doctor or a pharmacist before use, as antacids may interact with certain prescription drugs
  • Do not give to a child under the age of 5
  • Add exactly 1/2 teaspoon of baking soda  to 1/2 glass (4 fl. oz.) of water and take every 2 hours
  • The baking soda must be completely dissolved in the water before drinking or this could cause serious injury
  • It is also important not to take this remedy when your stomach is overly full
  • If you experience severe stomach pain after taking this product you should consult your doctor
  • Do not exceed 7 x 1/2 teaspoons in any 24 hours unless over 60 when this should be restricted to 3 x 1/2 teaspoons
  • Do not use the maximum dose for more than two weeks
  • If the symptoms last more than two weeks stop using the baking soda to treat the heartburn and consult your doctor

 

Important information

Baking powder and baking soda are not the same.  Baking soda is pure sodium bicarbonate but baking powder is not. Baking powder does contain sodium bicarbonate, but it also includes cream of tartar which is an acidifying agent, together with a drying agent which is normally starch.

Taking baking powder for your heartburn symptoms would have no effect as the baking powder would neutralize itself.

 

If you are looking for natural methods to relieve heartburn you might also like to read these articles: 

Home Remedy for Reflux and Heartburn at Night: Bed Wedges




Most heartburn sufferers are likely to experience heartburn symptoms at night, but this is not really surprizing as lying down on your bed can often put considerable pressure on your lower esophageal sphincter(LES), as the contents of your stomach press against this valve. If you have a weakened or damaged LES this pressure then causes the LES to fail, allowing the acidic stomach contents to flow back into the esophagus and cause the burning sensation that is stopping you sleeping at night.

One of the simplest home remedies to help prevent reflux or heartburn at night is gravity. By ensuring that your head is higher than your stomach you can prevent the pressure on your LES and keep your evening meal firmly where it belongs, which is of course in your stomach.

You can keep your head elevated either by sleeping in a chair, which many chronic sufferers of heartburn have done in the past not really knowing why this helped prevent their pain and discomfort, or your can make some alterations to your bed that will allow you to sleep in your bed with your head raised above your stomach.   There are a couple of ways to adapt your bed, you can just place bricks or sturdy blocks of wood under the legs at the head of the bed or in my view a much more practical option is to use a bed wedge instead.

A bed wedge can be used in two ways. It can either be used on top of your mattress or if it is firm enough can be placed under the mattress instead. 

Foam bed wedges come in many sizes and prices and at the lower end of the market the foam bed wedges made by Mabis Healthcare and Duro-Med Industries (DMI) are very popular with a high number of positive reviews on Amazon.com.  Their wedges are available in two different heights, 7 inches  and 12 inches and at the date of writing this post you can buy the wedges in two colors; the 7″ x 24″ x 24″ comes in white at $25.66 and in blue at $24.99; the 12″ x  24″ x 24″ comes in white at $29.98 and in blue at $28.54.  These prices are all considerably less than some of the specialist heartburn pillows that are on the market.  If you are travelling a lot you might find an inflatable bed wedge very helpful.

You can also buy plastic wedges which are designed to be placed under your mattress.  The Wellness Wedge  costs $44.99 and contains two stackable 3″ wedges.

Although I’ve written about bed wedges because they can elevate your head and assist in relieving heartburn you can also use these wedges to

  • elevate your feet and legs
  • help prevent snoring
  • help ease breathing difficulties
  • read or watch TV in bed

The Side Effects of Proton Pump Inhibitors (PPIs)




Proton Pump Inhibitors (PPIs) are an important type of medication that can help to treat heartburn and ulcers but like all medications they do carry certain risks and side effects.  If you have been prescribed any of these medications and have concerns you should discuss these concerns with your medical practitioner but don’t stop taking any prescribed PPI medication without discussing the matter first with your doctor.  Most people tolerate the use of PPIs very well so short term, low dose use of these drugs only usually causes minor side effects if any, such as diarrhea, headaches, rashes, constipation, dry mouth, nausea or abdominal pain.  These drugs can however interact with other medication either directly or indirectly. PPIs are designed to reduce stomach acid and altering the acid levels can reduce or increase the absorption of certain drugs

  • Ketoconazole (Nizoral or Sebizole)

PPIs can reduce the absorption of Ketoconazole, an antifungal drug which is often prescribed for those with compromised immune systems to prevent or treat fungal skin infections. It also has the effect of reducing testosterone levels and surpressing glucocorticoid synthesis and can therefore be used to treat other health conditions.

  • Digoxin (Lanoxin, Digitek, and Lanoxicaps)

PPIs can increase the absorption of Digoxin a drug which is extracted from the foxglove plant. Digoxin is used to treat heart conditions that cannot be controlled using other treatments. The combination digoxin with a PPI can also cause low magnesium.

  • Diazepam (Valium), Warfarin, (Coumadin) and Phenytoin (Dilantin)

PPIs can reduce the breakdown of these drugs in the liver increasing the concentration of the drug in the bloodstream.
Long term use or higher doses may bring more serious side effects so this is why any treatment should be at the lowest dose possible for the shortest time.

  • Increased risk of osteoporosis and bone fracture

Studies have shown an increased risk of fracture amongst those using PPIs when compared to those not taking them. It is thought that the reduced stomach acid interferes with the absorption of calcium which then leads to an increased risk of fracture or osteoporosis.

  • Higher risk of pneumonia

Researchers believe that the decrease in stomach acid allows the bacteria which cause pneumonia to multiply and spread.

  • Infection with clostridium difficile (c difficile)

There was a study in 2010 which showed that hospitalized patients taking PPIs were at increased risk of infection with c.difficile. Infection with c. difficile infection can lead to dysentery, long standing colon problems or possibly death.

  • Other Stomach problems

As bacteria which would normally have been destroyed by the stomach acid pass into the intestines they multiply. This bacterial growth can cause contagious diarrhea or colitis.

  • Vitamin B12 deficiencies

Vitamin B12 deficiencies, especially in the elderly, can be very serious as they already have a decreased ability to absorb this vitamin. PPIs appear to affect the absorption of Vitamin B12 in the same way as calcium. B12 is vital to the correct functioning of the nervous system, metabolism and brain function. A deficiency can cause irreversible nerve damage, dementia, depression anemia or fatigue.

  • Low Magnesium levels (Hypomagnesemia)

Using PPIs for as little as three months can cause the depletion of magnesium levels. Magnesium is a very important mineral to help in the prevention and treatment of heart disease. Low levels of magnesium may cause kidney disease, high blood pressure, severe muscle spasms, seizures, tremors or irregular heartbeat.

  • Severe Rebound Acid Secretion 
This is a side effect with a difference as you only notice it when you stop using the PPIs.  Although the PPIs are very good at neutralizing the stomach acid they also appear to stimulate acid production.  This means that for an initial period while this increased acid production is returning to normal, heartburn or acid reflux symptoms can recur and could be worse than before.