Experts Lay Down the Law on Acid Reflux

Nov. 15, 2002 -- The acid reflux of heartburn comes with a common heartache -- doctors don't agree. They don't agree about treatment. They don't agree about testing. They don't agree about cancer risk. But now there's help.

A panel of experts convened by the American Gastroenterological Association has laid down the law on acid reflux in a 25-page document. It's sure to be controversial, as it contradicts beliefs held by many doctors. Walter L. Peterson, professor of internal medicine at the University of Texas Southwestern Medical Center, chaired the panel. He says he and his colleagues ignored hearsay and looked only at rigorous scientific evidence.

"This group of experts ... produced a document that may be controversial but is definitely factual," Peterson says in a news release.

Heartburn is caused by acid reflux, or GERD -- gastroesophageal reflux disease. Acid reflux happens when the muscle between the stomach and the esophagus gets weak or relaxes at the wrong time. This lets the contents of the stomach, including acid, splash up into the esophagus. The esophagus doesn't have the same kind of protective coating as the stomach, so stomach acids burn it.

Doctors treat acid reflux with over-the-counter drugs, prescription drugs, and surgery. What works? The panel of experts covered seven major questions.

What Over-the-Counter Treatment is Best?

Patients with mild or moderate acid reflux get relief from several different non-prescription drugs. There are several types:

• Antacids neutralize stomach acids. These include drugs such as Tums and Rolaids.
• H₂ receptor antagonists reduce production of stomach acids. These include drugs such as Axid AR, Pepcid AC, Tagamet HB, and Zantac 75.
• One drug -- Pepcid Complete -- combines an antacid with an H₂ receptor antagonist.

The panel finds that all these drugs work to various degrees. It found that Pepcid Complete worked better than either an antacid or H₂ receptor antagonist alone.

"For many patients with no 'red flags' -- experiencing heartburn for periods not exceeding four weeks -- over-the-counter agents provide rapid, effective, and safe relief," says panel member Hashem El-Serag, MD, MPH, in a news release.

What Prescription Treatment is Best?

Drugs known as proton-pump inhibitors are commonly prescribed to treat acid reflux. Proton pump inhibitors block release of stomach acids. These drugs include Aciphex, Nexium, Prevacid, Prilosec (now available in generic form), and Protonix.

The panel found few differences between these drugs. However, they note that Nexium may heal sores in the esophagus faster.

The panel recommends that patients and doctors choose the proton-pump inhibitor that costs the least.