FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

STOMACH ACID IN ESOPHAGUS A HEALTH RISK, MEDICATIONS HELP

Question: I've been taking Prilosec for reflux for about six months. My wife listened to a doctor who said that this was a dangerous drug that no one should take for as long as I have, but my doctor isn't worried. I stopped taking it for a few days, but I got so uncomfortable that I started taking it again. What are your thoughts on taking Prilosec?

Answer: First, I need to explain your "reflux" problem to my readers. The stomach contains strong acid. This acid serves two purposes -- not only does it promote digestion, but it also sterilizes the things we swallow. The lining of the stomach is designed to handle this strong acid. Unfortunately, the esophagus, the tube connecting the mouth with the stomach, isn't as hardy.

The esophagus is designed as a one-way street. A muscular band around the esophagus just above its entrance into the stomach acts as a relatively effective one-way valve. This muscle -- called the lower esophageal sphincter (LES) -- relaxes when you swallow to allow food to go down but then contracts to keep stomach acid from coming up. The job of the LES is made easier by the angle at which the esophagus joins the stomach, and this angle is maintained, in part, by the size of the opening in the diaphragm through which the esophagus must pass.

In reflux, also called reflux esophagitis or gastroesophageal reflux disease (GERD), stomach acid leaks out of the stomach and into the esophagus. This usually happens because the LES relaxes at a time other than when food is passing into the stomach or because the pressure within the stomach simply overpowers it. This can happen because of dietary indiscretions, medicine use, alcohol, anatomical defect such as hiatal hernia, or from obesity.

The consequence of reflux, regardless of the underlying cause, is the same. The strong stomach acid damages the lining of the esophagus and produces a characteristic "heartburn" sensation. A brief episode is annoying but of no long-term health consequence. Persistent reflux, on the other hand, is uncomfortable and also increases the risk of several conditions including esophageal cancer, sinusitis, bronchitis and asthma.

Prilosec is the brand name of the medicine omeprazole, and it is in the family of drugs called "proton pump inhibitors." All the members of this group are very effective at reducing the amount of acid produced by the stomach. This reduced acid is beneficial for healing stomach and duodenal ulcers, reflux esophagitis and several other conditions. It makes your reflux symptoms better but doesn't cure the underlying problem at the LES. Consequently, you are probably going to need this medicine for some time.

The use of proton pump inhibitors usually causes no undesirable consequences. Rash, blood in the urine or dizziness are rare adverse reactions, however. The greatest concern with long-term use is a consequence of having low acid levels in the stomach. This can increase one's risk of developing infection of the digestive tract from bacteria, viruses and yeast. It can also produce decreased absorption of iron that can eventually lead to anemia. One additional theoretical problem is an increased risk of stomach cancer. This risk assessment, however, is based on a study of laboratory rats that were fed omeprazole in doses much higher than humans take. Analysis of the data on people who take the recommended dosage levels, fortunately, has not shown an increased cancer risk in humans.

So, I wouldn't be concerned about taking Prilosec if you need it. On the other hand, you would be better off if you could eliminate your heartburn through lifestyle changes. These changes include getting your weight down to the ideal level as well as avoiding alcohol, caffeine and irritating food. Doing these things can often reduce reflux to the point that many individuals feel comfortable without taking medication.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.