Use Antacids First for Indigestion

Treating indigestion with antacids first, then moving up to more sophisticated drugs if needed, is less expensive than starting with more powerful drugs, according to study findings reported in the January 17, 2009, issue of The Lancet.

Proton pump inhibitors (PPIs), histamine type 2 (H2)-receptor antagonists, and antacids are all used to treat indigestion in its various forms. The guidelines on how to use these drugs, however, are inconsistent, said the authors. For the study, 664 patients with newly occurring indigestion were randomly assigned to 1 of 2 treatment groups. The ?step-up? therapy group was initially treated with antacids, then H2-receptor antagonists, and finally PPIs.

The ?step-down? group started with PPIs and worked down to antacids. Each treatment lasted 4 weeks, and patients only moved to the next tier of treatment if they continued to have symptoms. The study?s findings showed treatment success was similar in both groups: 72% of patients doing the step-up approach and 70% of patients doing the step-down. The average medical costs were $299 for those in the step-up group and $322 in the step-down group.

COPD May Cause Acid Reflux

A new study found that heartburn or gastroesophageal reflux disease (GERD) may be a problem for individuals with chronic obstructive pulmonary disease (COPD). The opposite, however, does not seem to be the case.

One analysis involved patients initially free of chronic heartburn or GERD; 1628 patients had COPD, and 14,243 did not have the condition. In the 5 years of follow-up, the occurrence of GERD was 46% greater among patients with COPD, compared with patients without breathing problems. The incidence of COPD was not any more frequent among 4391 patients with GERD and 5118 patients without GERD.

The findings showed that ?COPD appears to predispose patients to GERD rather than vice versa,? concluded the researchers in the December 2008 issue of Chest.

Nonsurgical Options Relieve Acid Reflux

Individuals experiencing acid reflux disease who do not respond to medications may find relief from nonsurgical procedures.

The study, published in the January 2009 issue of the Archives of Surgery, indicated that endoluminal therapies reduced heartburn, swallowing difficulties, and voice hoarseness in many patients. The 2 procedures are done with an endoscope. The full-thickness plication uses the endoscope to tighten the junction between the esophagus and the stomach with sutures. Radiofrequency therapy uses heat to improve the function of the valve between the esophagus and stomach.

?I think medication is still the first thing that people should try for reflux,? said researcher Louis Jeansonne IV, MD. ?Surgery is still the most effective treatment.... But this study shows that this therapy without surgery is a viable option.?

GERD Severity Raises Cancer Risk

Researchers found that individuals with specific mutations in the epidermal growth factor (EGF) gene and gastroesophageal reflux disease (GERD) face greater risk of cancer of the esophagus, according to study findings presented recently at the Gastrointestinal Cancers Symposium.

The study showed that a variant of the EGF gene known as G/G was linked to nearly 2 times the risk of developing esophageal cancer, compared with the A/A ?wild type??or normal form?of the gene, but only in individuals with GERD. The risk was magnified when GERD was more severe. Overall, the patients without GERD had a lower risk, and those with more GERD had almost 10 times the risk. The researchers also found that the patients who had GERD more than once a week or who had GERD for >15 years had almost 22 times the risk.

Obesity Ups Risk of Digestive Health Issues

Studies reported recently in The American Journal of Gastroenterology looked at the association between obesity and the risk of colorectal cancer and gastroesophageal reflux disease (GERD). The studies highlighted the correlation between increasing body mass index and the frequency and severity of acid reflux symptoms.

One study indicated that the accumulation of abdominal fat may be the most critical risk factor for the development of acid reflux and related complications such as esophageal adenocarcinoma.

The researchers also examined data on the effects of weight loss through diet or surgical methods on acid reflux disease. Several studies suggested weight loss through caloric restriction was helpful in reducing GERD symptoms.

F A S T   F A C T: Chronic GERD affects approximately 20 million individuals.