, vesassitatemewerwm ',"WSZVOMWMMS.MITUISM 'Cro ,..\`:$03WOMMW.,"410VMM'n, SS' . . WSW i.% =.1,K IM :,., ======StaMa ..MCW.M W.M ,:st ... 7,= .MMOKM ,X00==r2MVMS20 =1MM OMMWOMS2ZWA MMO.,r2WW.M2,2,70MAMS Spellin 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 C 6