A new approach for treating reflux?
Wednesday, November 25, 2009 17:14 A few weeks ago, I talked about reflux (GERD) in one of my weekly podcast episodes. I heard from several listeners (including a couple of physicians) who were surprised and, I think, a bit skeptical when I suggested that suppressing stomach acid production may not be the most appropriate treatment for chronic reflux.
As I pointed out, when you reduce stomach acid, it causes the ring of muscle that should keep stomach contents from backing up into the esophagus to close less tightly. That would seem to be counter-productive.
In addition, long-term use of acid-suppressing drugs can increase your risk of weakened bones, anemia, food-borne infections, and B12 deficiency. But these concerns have always been trumped by a larger worry: Exposing the esophagus to stomach acid can eventually trigger cellular changes that increase the risk of cancer.
The heck with your bone density: Bring on the acid-suppressing drugs!
Only now, it turns out that GERD may not be caused by stomach acid but by an inappropriate immune response. (Read more about this recent study.) As one researcher is quoted:
"Currently, we treat GERD by giving medications to prevent the stomach from making acid but if GERD is really an immune-mediated injury, maybe we should create medications that would prevent these cytokines from attracting inflammatory cells to the esophagus and starting the injury in the first place."
This reminds me a little bit of when we realized that ulcers were actually caused by bacteria and started treating patients with antibiotics (once) instead of milk of magnesia (forever).
Unfortunately, we're not yet at the point where we can eliminate chronic reflux with a one-time course of drugs. But at least we can start looking in the right direction.
Related Resources:
Body weight, lifestyle, dietary habits and gastroesophageal reflux disease.
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