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RUTHAN BRODSKY
SPECIAL TO THE JEWISH NEWS
As more and
more heartburn
medications are
available over
the counter,
doctors warn
that sometimes
the condition
calls for
different
treatment.
I I
ust watching the ads
during prime-time TV
this past year would
convince anyone that
heartburn is a critical
problem, attacking
and debilitating near-
ly all Americans.
Pictures of explod-
ing volcanos, blazing
digestive tracts and 10-second
micro-dramas poi (Allying ageless
actors responding to discomfort
from heartburn were just part of
the pharmaceutical media blitz
advertising new and not so new
heartburn remedies.
The acid indigestion wars were
launched full tilt when the Food
and Drug Administration (FDA)
approved several prescription
medications in lower dose ver-
sions for over-the-counter (OTC)
sale. Included in this battle were
the histamine-receptor blockers
or H2 blockers Tagamet HB
(cimetidine), Pepcid AC (famo-
tidine), Axid (nizatidine) as well
as the anti-ulcer drug Zantac
(ranitidine), one of the world's
largest selling drugs.
"You can't watch a movie or
sports event without seeing these
ads," says Dr. Joel Richer, chair
of the Cleveland Clinic Founda-
tion's gastroenterology depart-
ment.
And that may not be the end
of it. More prescription drugs
may be approved for OTC sales,
considering that 60 million Amer-
ican adults experience heartburn
at least once a month, about 25
million adults suffer daily, and
25 percent of pregnant women
also experience daily heartburn,
according to the American Col-
lege of Gastroenterology.
To remedy the pain, Ameri-
cans spend more than a billion
dollars annually on heartburn
remedies, according to the Uni-
versity of California-Berkeley
Wellness Letter. Competition for
these funds are stiff and the bat-
tles are brutal.
For example, this spring a
Federal judge ordered Tagamet's
SmithKline Beecham and Pep-
cid's Johnson & Johnson-Merck
to either withdraw their exag-
gerated claims or provide evi-
deace supporting them. The pair
had sued each other over boasts
in commercials of how quickly
the medications work and how
long they last.
"In terms of both benefits and
side effects, the differences among
the lining of the esophagus, fre-
quently leading to a burning sen-
sation behind the breastbone and
often accompanied by a sour
taste.
Although not ordinarily a
health threat, the pain can be so
intense that it's mistaken for a
heart attack. The burning, pres-
sure or pain of heartburn can last
as long as two hours and is often
worse after eating.
Those who suffer from heart-
Seltzer, Maalox and Turns, which
relieve heartburn by neutraliz-
ing stomach acid.
For severe heartburn, doctors
prescribe stronger medications
such as Prilosec (omeprazole),
which acts similarly to H2 block-
ers but can actually shut off stom-
ach acid production, helping
to prevent heartburn from
recurring. Made available in
1995, Propulsid (cisapride) also
prevents stomach acid reflux
Dr. Alan Cutler: Heartburn can indicate
serious problems.
the OTC versions of these med-
ications are so minor as to be
insignificant," says Johns Hop-
kins gastroenterologist Dr. H.
Franklin Herlong.
But while the battle wages on,
people continue to suffer from
heartburn.
Also known as acid indiges-
tion, heartburn results from gas-
troesophageal reflux disease
(GERD), a condition in which
stomach acids back up into the
esophagus. GERD is caused by a
backflow of partially digested
food, enzymes, bile and acids
from the stomach into the esoph-
agus, a muscular tube through
which food passes from the back
of the mouth into the stomach.
When food is swallowed, it trav-
els down the esophagus. A valve
(sphincter) at the bottom of the
esophagus relaxes, allowing food
to enter the stomach. Normally,
this sphincter, made up of a cir-
cular band of muscles, only allows
food to move downward.
However, if the sphincter re-
laxes abnormally or becomes
weakened, stomach acid t2 ,-wls to
back up, causing symptoms of
heartburn. These juices irritate
burn vary in socioeconomic
levels, racial and ethnic charac-
teristics. However, those who are
pregnant as well as older people
have a greater propensity to suf-
fer from the condition.
"It's not unusual for seniors to
have heartburn brought on by
the medication they take," re-
ports Dr. David Rosenberg, a
West Bloomfield general practice
family physician with a special-
ty in geriatrics. "My advice is to
find out from your doctor if that's
causing the problem before you
try and treat it on your own."
Recently approved drugs —
known as acid blockers — pre-
vent heartburn by suppressing
the production of stomach acid,
different than the action of drug-
store antacids such as Alka-
by strengthening the lower
esophageal sphincter and stim-
ulating the stomach to contract
and empty faster.
Although there are more treat-
ments available, it is still up to
the patient to seek a remedy
when the over-the-counter med-
ications don't do the trick. If left
unchecked, heartburn or GERD
can develop into many kinds of
problems.
"It may lead to esophageal
bleeding, a narrowing of the low-
er esophagus which makes it dif-
ficult for food to reach the
stomach, or asthma-like symp-
toms," explains Dr. Alan Cutler,
director of gastrointestinal re-
search at Sinai Hospital.
Of course, it all depends on
RELIEF page 68
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