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Fire in the belly

More people are popping pills to control that burning sensation, which really isn't just their imagination. Doctors suspect diet and lifestyle are increasing heartburn-related problems.

SUSAN ASCHOFF
Published September 16, 2003

Americans are suffering a bad case of indigestion.

Our discomfort has fed a market for heartburn medications that topped $13-billion in sales last year. Prilosec, one of the most familiar, alone tallied $4.6-billion, "twice the profit generated by every McDonald's, Wendy's, KFC, Taco Bell and Pizza Hut combined," said the New York Times.

Some point a finger at drugmakers' relentless pitches. Prilosec, Nexium, Prevacid and other drugs are heavily advertised on television and in magazines.

But doctors say they've seen a startling jump in actual diagnoses.

"I've been in this business for 40 years. I'm pretty sure I wasn't blind and missing it the first 25 years. There's been a real increase," says Dr. H. Worth Boyce, director of the Joy McCann Culverhouse Center for Swallowing Disorders in Tampa. "It's near the top of gastrointestinal disorders."

Heartburn is a symptom. The medical problem is called GERD, forgastroesophageal reflux disease. Something gastric (from the stomach) backs up (refluxes) into the esophagus, says Dr. Paulo Pacheco, co-author of Living with Chronic Heartburn (Healthy Living Books, $15.95).

Reflux happens because a sphincter, or muscle, at the base of the esophagus malfunctions.

GERD likely plagued the caveman who ate too much mastodon, Pacheco writes. But the disorder has garnered much more attention over the past 15 years as the medical community has recognized its potential seriousness and pharmaceutical companies have found drugs to treat it.

Modern man suffers more because of lifestyle, most experts say. Greasy fast food, alcohol and tobacco use, and poor eating habits, from overeating at one sitting to obesity, aggravate GERD symptoms.

At one conference, Boyce says, doctors speculated that the increase in GERD mirrored the increase in the number of McDonald's hamburgers sold.

"We don't really know why there are so many more cases," he says.

Almost everyone suffers symptoms occasionally: chest pain, a burning sensation, nausea, sour taste in the mouth, burping, hiccups, cough, throat soreness.

Severe or repeated symptoms indicate GERD. More than 21-million Americans have the condition. More than 2-million a year go to the emergency room with chest pain they fear is a heart attack. A small percentage develop cancer of the esophagus.

"A lot of the thinking about reflux has changed," says Dr. G. Richard Locke, director of the esophageal group at the Mayo Clinic in Rochester, Minn. "It used to be people would get symptoms and take an antacid, and lots of them. Doctors used to think it was a short-term condition."

Today reflux is treated as a chronic condition, and a daily pill is used to prevent symptoms before they start.

The biggest players in the pharmaceutical battle are proton-pump inhibitors, or PPIs, which block acid production in the stomach. All brands work in similar ways. But direct-to-consumer marketing will continue its onslaught as drugmakers try to distinguish their generics and brand names.

Prilosec, for example, is losing its patent protection and will be sold over the counter beginning this week. Competing drugmaker Novartis is jockeying to sell omeprazole, the drug's generic version. Prilosec's maker, AstraZeneca, has been wooing doctors to switch to Nexium, virtually identical to Prilosec but prescription-only.

Consumers often pay more than $100 a month for GERD medications.

To hold overall drug costs down, the Food and Drug Administration recently announced that it wants to increase by 50 percent switches from prescription to over-the-counter versions of popular drugs. Typically, drug manufacturers make the switch when a drug's patent expires, developing a prescription drug to take its place. The industry contends that FDA-forced switches will remove incentive for research and development, says the Tufts Center for the Study of Drug Development in an impact report released this month.

Some caregivers fear the move to over-the-counter will put patients at risk.

"This is very scary because people will go purchase drugs and they may not have what they think they have," says Bobbi Sheffield, clinical dietitian at Helen Ellis Memorial Hospital in Tarpon Springs.

"They need to be diagnosed by a physician and supervised by a physician."

Boyce also urges GERD sufferers to see a doctor first.

About 10 percent will develop Barrett's Esophagus, a condition in which stomach acid eats away the protective lining of the lower esophagus and raises the risk for cancer.

Esophageal cancer was almost always caused by drinking or smoking 25 years ago, Boyce says.

"Today about 70 percent of the cases are related to Barrett and reflux disease," Boyce says.

A 10-minute examination with a video endoscope threaded down the throat can determine if there is a serious problem, Boyce says. When no cancer is found, GERD medications can stop further damage.

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