Heartburn Up and Coming
May 26, 2000 (San Diego) -- Twenty years ago, Karna Bardhan, MD, PhD, was
the only stomach specialist in the rough-and-tumble north British mining town
of Rotherham. At first, it just seemed odd that he kept seeing more and more
patients with chronic heartburn -- technically known as gastroesophageal reflux
disease or GERD -- but as patients began to flood his clinic he realized that a
major change was underway.
Bardhan kept careful records, and thus became one of the first physicians to
document the sudden and inexplicable onset of a new epidemic. "The increase
in reflux disease is so colossal that one cannot help but take an
interest," Bardhan says. "I believe that what we are seeing here is a
major Western epidemic that is emerging."
From 1977 to 1981, Bardhan saw only 714 new cases of GERD. From 1992 to
1996, he saw over 3,800 new cases -- a fivefold increase. And he's not alone,
according to fellow panelists addressing a press conference here at the
Digestive Disease Week conference.
"We see this in America as well," says George Triadafilopoulos, MD,
a researcher at Stanford University in Palo Alto, Calif. "This is an
explosion. More and more people are seeking drugs and medical
Currently 7% of the U.S. adult population suffers from GERD. The reasons for
the phenomenal increase of the disease are a mystery. "I haven't the
faintest idea why this has happened," Bardhan tells WebMD. "I have
spoken with physicians in China, and they don't view it as an issue. It may be
that as countries industrialize, this disease increases."
Glen A. Lehman, MD, of Indiana University School of Medicine, suggests that
obesity may play a role. "In the Midwest, we also see a huge epidemic, and
we have an obesity rate that approaches 40%," he says. "I think that is
a factor in reflux."
The GERD epidemic is not widely appreciated, because almost nobody dies
directly of the disease -- although its symptoms are extremely disturbing. Like
normal heartburn, GERD is the result of the rise of the acid contents of the
stomach. Unlike normal heartburn, this happens almost daily to patients with
GERD, who experience frequent and inappropriate relaxation of the muscle that
closes the top of the stomach, allowing the acid to invade the esophagus.
Common symptoms include heartburn, regurgitation, difficulty swallowing,
cough, sore throat, laryngitis, chest pain, difficulty sleeping, bleeding, and
asthma. Moreover, the risk of cancer of the esophagus is eight times higher
than normal for patients with at least one weekly episode of reflux.
Relief often comes from a new generation of drugs known as proton pump
inhibitors, such as Prilosec, Prevacid, and Aciphex. These drugs prevent the
formation of stomach acid. However, they are very expensive and represent the
lion's share of the worldwide $14 billion spent each year on acid-reducing
medications. Unfortunately, the drugs don't always work -- and doctors can't
predict this in advance.