Trailing Thoughts

Peptic ulcer disease is a group of disorders of the upper gastrointestinal tract (duodenal or gastric) which form “bleeding” lesions that are dependent on acid and pepsin for their formation. Patients with ulcers normally have the symptoms of epigastic pain occuring 1 to 3 hours after they finish eating and the pain is relieved by antacids or more food. Sometimes the pain can last for weeks and months and then disappear. GERD is gastroesophageal reflux disease and is defined by chronic symptoms caused by mucosal damage produced by abnormal reflux of the stomach (gastric) content. Heartburn is the classic symptom here… sometimes it is so severe and can radiate to the neck, back or throat. Eating foods high in fat can cause the GERD to be worse, additionally bending over or laying down may bring on the symptoms. Belching and increased salivation, and regurgitation are also classic symptoms.
What can you take for these symptoms when an antacid is just not cutting it? Well there are 2 types of medications, which are the PPI (proton pump inhibitors) and the H2RA (H2 receptor antagonist). PPIs will suppress gastric acid secretion specifically by inhibiting the H+-K+ ATPase enzyme system of the secretory surface of the gastric parietal cell. What does this mean? Basically this means that you are stopping acid production before it starts. H2RA suppress gastric acid secretion by reversibly blocking histamine2 receptors on the surface of the gastric parietal cell. Now what does this mean? To sum up, it means it competes with acid formation and will block some of the acid from forming.
What are the PPIs available? Prilosec (Also available over the counter) Nexium, Prevacid, Aciphex, Protonix… when taking these it is best to take them before eating and it may take a few days before the full power of the medication is seen. PPIs are best for treating ulcers, while H2RA are recommended for GERD.
The H2RAs include Tagamet, Zantac, Axid, Pepcid. When you are taking these make sure you talk to your pharmacist about drug interactions (especially Tagamet). They interfere with the CYP enzyme system and can cause some drugs to act differently on your body. Also, to get the full effect of your medication, avoid antacids 1 to 2 hours before and after you take the pill. With this class, it does not matter when you take the medication, with or without food.
Remember these are not miracle drugs that will start working instantaneously. You need to take them on a daily basis and not a “as needed” basis to get these medications to work for you…. Both of these classes can cause diarrhea, headache or nausea, but they are generally tolerated well.
Before I get off the subject I briefly want to mention the differences between Prilosec and Prilosec OTC. There is not a big difference, but they are different salts (and 1 is a tablet and 1 is a capsule). Personally, though all the literature does not support using Prilosec OTC as the prescription Prilosec, when it comes to saving money, where the big issues are, I would not recommend the prescription. It will cost you about 5 times more for a 30 day supply if you get the prescription. To me, the difference is not worth it, though there is no long term studies backing my claim…. if you need a PPI and have insurance, it is most likely that you will be put on Prilosec because it has a generic available….get the prescription in this case, because the data is there…. This might not be an option with some insurance companies that are making doctors switch their patients to the OTC formulation because it is cheaper for them… these are other issues all in itself…..