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Acid Reflux Fought on Many Fronts You get home from work, late as usual, a pepperoni pizza in your arms. You sit down, shake some chili pepper flakes onto the pizza and sit down to indulge, washing a few slices down with a beer, maybe two. You top it off with a cup of coffee and head straight to bed. Bad move. You may pay for your late-night indulgence, waking up in the wee hours with heartburn, the hallmark of acid reflux, or what doctors call GERD, or gastroesophageal reflux disease. Your biggest mistake? Lying down so soon after eating, which makes it easy for nasty stomach acid still churning around your pizza to burn its way up your esophagus. But the spicy chili wasn't such a hot idea, either, nor was the beer and certainly not the coffee. Everybody gets a little heartburn now and then. But millions of Americans -- estimates vary from the 18.6 million cited on the American Gastroenterological Association website to the 60 million cited by others -- get reflux from once a month to several times a week. The problem lies in a circular muscle called the lower esophageal sphincter, which opens to let food slide down to the stomach but is supposed to close up again afterward. In older people, and those who have an anatomical problem called hiatal hernia (in which part of the stomach sticks up into the chest through the diaphragm), the sphincter works poorly, allowing acid and sometimes partially digested food to back up. Symptoms vary from a little belching to asthma, hoarseness and sore throats to heartburn so bad it sends people to the emergency room fearing they're having a heart attack. Sometimes, GERD can cause damage to vocal cords, or lead to ulceration or scarring of esophageal tissue. The diagnosis and treatment of GERD costs Americans $9.3 billion a year, said Dr. Frank Hamilton, chief of the digestive diseases program at the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. A good chunk of that goes for medications, including over-the-counter antacids such as Tums, Mylanta, Maalox and the like. These drugs neutralize acid, which provides immediate relief, but they don't stop acid production. An often more effective solution is a class of drugs called H-2 blockers, which includes Zantac, Tagamet, Pepcid and Axid. These are available over the counter in lower doses than available by prescription. They reduce acid by blocking receptors on stomach cells for histamine, one of the major chemical signals telling cells to secrete acids. But the biggest guns in the war on GERD are the proton pump inhibitors, or PPIs -- drugs such as Prilosec, which is now available over the counter (for more than $1 per pill); others are still prescription-only. Unlike H-2 blockers, which stop only the acid production triggered by histamines, these drugs block acid production triggered by other mechanisms as well, said Dr. William Ravich, an associate professor in the division of gastroenterology at the Johns Hopkins University School of Medicine. For people who don't mind taking pills daily -- and the side effects are generally minimal -- this can be a simple way to ward off GERD. But for those who don't like pills, other solutions are available. The best, or "gold standard," for severe cases is surgery, specifically laparoscopic fundoplication -- surgery done through small incisions in the stomach wall to wrap part of the stomach around the bottom of the esophagus to tighten the opening. Less invasive, but probably less effective long
term, are four procedures done through an endoscope placed in the
esophagus. These procedures have all become available in recent
years, but some doctors, including Dr. Bennett E. Roth, chief of
clinical gastroenterology at the David Geffen School of Medicine at
UCLA, believe they are "not ready for prime time." In one, a system
called Enteryx developed by the
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