GERD Sleep

Until we started investigating why we were having a problem that was previously unknown to us: Acid Reflux or Gastroesophageal Reflux Disease. We started chalking it up to old age. We were just getting to the point where we just had to suffer through it. We thanks to our thirst for knowledge we discovered that in our case the problem was pronounced because we'd be eating "milk" chocolate and adding powdered "milk" to our coffee. You might remember we were promoting the eating of chocolate and the drinking of coffee to improve our health.

What we did not want to do before we knew that we were creating our own misery we didn't want to take any medicine over the counter or prescribed. We're not particularly keen on what are called PPI's (Proton pump inhibitors) even though:

"The PPI's have been shown to be very safe. Most of the information that we have on side effects come from studies where a PPI is compared to a placebo. The most common side effects are headache, abdominal pain, bloating, diarrhea and nausea. They occur in 1-2% of patients given PPI's. Interestingly, the incidence of these "side effects" is the same as when patients take the placebo. It is hard to compare side effect profiles between the medications, but there is no reason to believe that there are significant differences. - About GERD

Our problem is that the information may indeed be true and accurate but the website AboutGERD doesn't seem reputable enough for us. As always when we're in a quandary we head to GOOGLE and search for answers.  AboutGERD said:

"It is important to recognize that GERD is a disease that should not be ignored or self-treated. Heartburn, the most frequent symptom, is so common that its significance may be underestimated, casually dismissed, and not associated with a disease – like GERD. In studies that measure emotional well-being, people with unresolved GERD often report worse scores than those with other chronic diseases, like diabetes, high blood pressure, peptic ulcer, or angina. Yet, nearly half of acid reflux sufferers do not recognize it as a disease. - About GERD"

When we found the more technical information that we've grown accustom to read it was a bit to heady for us as well. We stumbled on the International Foundation for Functional Gastrointestinal Disorders (IFFGD) the umbrella organization for AboutGERD and immediately thought less of them. We finally stumbled on information we could use. The acid reflux was beginning to make it difficult to sleep and no it wasn't all the coffee. We stop drinking coffee after 2pm. So it couldn't have been the java!

"Sleep-Related Gastroesophageal Reflux: Evidence Is Mounting - Therefore, sleep-related GER disrupts sleep, causes insomnia, and is associated with daytime impairment. The relationship between sleep-related GER and sleep disturbances appears to be a bidirectional one. Furthermore, common medications used to manage insomnia depress the arousal response that is vital to esophageal refluxate clearance. The data are impressive." - Clinical Gastroenterology and Hepatology (CGH) September 2009.

We're not anti-medicine we just aren't comfortable with the current batch of PPIs. We did take a couple of antacids but they weren't TUMS they were discount fruit flavor versions from the dollar store. While the antacids did provide relief they didn't cure our problem. It was appropriate that we discovered the following:

"What Makes Individuals With Gastroesophageal Reflux Disease Dissatisfied With Their Treatment? - Patients who are given prescriptions for PPIs (proton pump inhibitors) tend to be more satisfied than those given H2-receptor antagonists. Partial responders are likely to be more dissatisfied than patients whose symptoms are fully resolved. A decrease in health-related quality of life is associated with greater dissatisfaction. Patients are more likely to be satisfied if they are taken seriously by their physician and if their symptoms are investigated. They are also more likely to be satisfied if the patient-physician consultation is interactive." - Clinical Gastroenterology and Hepatology (CGH) August 2009

We weren't patients and even without using the PPIs we were dissatisfied prior to their use. They should do a study to determine if patients were predisposed to being dissatisfied with acid reflux medications. Though the following study was presented months prior it wasn't published until this month and is probably the most comprehensive study of its kind.

"A population-based, cross-sectional, case-control study was based on 2 large health surveys performed in the Norwegian county Nord-Trondelag in 1984–1986 and 1995–1997. Gastroesophageal reflux disease was assessed in the second survey, which included 65,333 participants (70% of the county's adult population). The 3153 persons who reported severe reflux symptoms constituted the cases, and the 40,210 persons without reflux symptoms constituted the controls. Data on insomnia, sleep problems, and several potential confounders were collected in questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using unconditional logistic regression in crude and multivariable models. Results - In models adjusted for age, sex, tobacco smoking, obesity, and socioeconomic status, positive associations were observed between presence of insomnia (OR, 3.2; 95% CI, 2.7–3.7), sleeplessness (OR, 3.3; 95% CI, 2.9–3.8), problems falling asleep (OR, 3.1; 95% CI, 2.5–3.8), and risk of gastroesophageal reflux disease. These associations were attenuated after further adjustments for anxiety, depression, myocardial infarction, angina pectoris, stroke, and gastrointestinal symptoms, but they remained statistically significant. Conclusions - A large population-based study indicated a link between sleep problems and gastroesophageal reflux disease that might be bidirectional." - A Population-Based Study Showing an Association Between Gastroesophageal Reflux Disease and Sleep Problems (March 2009) - Clinical Gastroenterology and Hepatology (CGH)

It was because of this study and conversations with our physicians that we discovered the lactose GERD connection. We highly recommend keeping a food diary if you suffer from acid reflux and proton pump inhibitors (PPI) don't quite do it for you. Bring all your medications and your diary to your doctor and don't self treated. We self diagnosed that's different. But we're imaginary professionals so don't try this at home!

Flop Flop Fizzle Fizzle

Oh, what a rippoff it is. When the safe and effective turn out to be unsafe and ineffective with lethal consequences we've got problems. When it comes to over the counter and prescription medications for gastroesophageal reflux disease (GERD) what you get isn't always what's good for you. US News & World Report reports that: "In 2008, proton pump inhibitors were the third largest-selling therapeutic class in the United States, ringing up $13.9 billion in U.S. sales, according to IMS Health, a Norwalk, Conn.-based health-care data company. With 113.4 million prescriptions, they were the 6th most widely dispensed retail prescription medications, IMS reported."

The recently released research in this month's American Academy of Otolaryngology -- Head and Neck Surgery was presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, San Diego, CA, October 4-7, 2009. The research precedes the release of Dr. Jonathan Wright's book: "YOUR STOMACH: WHAT IS REALLY MAKING YOU MISERABLE AND WHAT TO DO ABOUT IT" which finds that: "Shockingly, the problem may not be too much stomach acid, but too little! Stomach and other maladies—heartburn, bloating, constipation, and indigestion—may all be the result of too little acid. Antacids and acid blockers may be making the problem worse."

Consumer Reports reported Proton pump inhibitors or: "(PPIs) have been heavily promoted, which has led to overuse in people with garden-variety heartburn. Nexium, one of the most widely-prescribed PPIs is also the most expensive at $240 per month (the cash price you would pay if your insurance did not cover it). Not surprisingly, Nexium was also a top-selling drug in 2008 at a whooping $4.8 billion."

When things are considered safe and effective you don't expect anything else. The question we posed to the FDA is how the heck can that happen especially in a billion dollar industry whose product is not safe or effective. MEDIndia reported this about the study: "PPIs are not effective at treating all cases of gastroesophageal reflux(GERD) and laryngopharyngeal reflux (LPR). In addition to the evidence that acid isn't the only contributing agent in reflux disease, the new study has revealed that there are many unexpected consequences and side effects from this class of drugs."

Until release of the research all news focus has been on the cost to consumers and relative ineffectiveness of the available consumer products both over the counter and prescription. We replaced the loud commercial ridden news report by NBC 9 News Colorado and replaced it with a Consumer Reports video. This another of the studies that demonstrates harm caused by use. While U.S. Food and Drug Administration (FDA) has begun its "Safe Use Initiative" the concern for drugs considered safe and effective that are neither creates a category not likely considered in a cooperative public and private interest environment. With this much money at stake in this financial environment decisions are not likely to fall in favor of the consumer. Be warned. Be forewarned.

GERD! James Gerd!

We used a college homecoming weekend dinner to hold a staff meeting and the question of why no GERD stories arose. We couldn't think of any reason other than the lack of recent studies on the subject. Lo and behold we find a recent H1N1 death attributed to symptoms that included GERD:

"A 52-year old man is Santa Rosa County’s first confirmed death associated with H1N1 Swine Flu, according to the county’s health department."

"The man died September 11, according to information released Tuesday from the Santa Rosa County Health Department. Health officials were notified of his death September 28, when the results of additional lab tests were received. The man had hypertension and GERD (gastroesophogeal reflux disease). In keeping with Florida Department of Health policy, no additional information was released."

“The death of a loved one under any circumstances is always a tragedy,” said Sandra Park, A.R.N.P., interim administrator for the health department. “Our hearts and prayers go out to his family and friends at this difficult time.”

"The man was admitted to the hospital on September 4. At that time, a rapid flu test for H1N1 was performed and the result of that test was negative. Additional testing, however, confirmed that the man was ill with H1N1."

We're not trying to be the "flu police." We're concerned about the lack of information being presented to us by our local jurisdictions when we have proof positive that the information is false in relations to the flu. What we don't understand is why the jurisdictions refuse to give us the full and unvarnished truth. Reading daily obituaries shows deaths that the local health departments don't or refuse to report. Most disturbing are the reports that the standard H1N1 test return negatives when autopsies reveal positives results. That type of information is better presented to the living than the dead.

CBS News reports what a doctor tells his patients in this two (2) week old report from Dr. Jonathan LaPook: "Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help."

Research physician, Dr. Ronnie Fass, reported in Renal and Neurology News on the latest drug treatment for GastroEsophageal Reflux Disease: “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication...”

The new drug treatment evaluated by the doctor: "...Metozolv ODT, which rapidly melts on the tongue, gives these patients a new choice that may be more convenient than traditional metoclopramide tablets, Ronnie Fass, MD, Professor of Internal Medicine at the University of Arizona added. “Patients with diabetic gastroparesis and symptomatic documented GERD may have trouble adhering to treatment because of difficulty swallowing, the need for treatment when they do not have water available, or the need for a portable way to take medication.”

The National Post's Dr. Yoel Abells writes that: "Gastroesophageal reflux disease (GERD) is quite common. Epidemiologic studies suggest incidence rates are increasing and that up to 20% of the adult population suffers from this condition to varying degrees..."

"...Complications associated with acid reflux disease arise from the irritating effect the stomach contents have on anatomical structures. For example, the acidic contents can inflame the vocal cords, resulting in hoarseness, or spill into the lungs causing hyperreactivity of the airways and an ensuing cough. Asthma can worsen as a consequence of GERD. Up to 5% of individuals suffering from chronic GERD develop Barrett's esophagus, characterized by changes in the cells lining the esophagus. Although rare, over time, this condition can lead to esophageal cancer."

That such a common occurrence can be present in an uncommon virus seems more than a matter of chance. From its first typing by the World Health Organization (WHO) and the Center for Disease Control and Prevention (CDC) have maintained that pre-existing conditions can present opportunities for the relatively harmless virus can cause complications that could lead to death. Originally the time line for infections to complications that could lead to death was over ten (10) days. Current deaths have reduced that timeline from ten to five (5) days with the fifth day being the date of death for some individuals. Most individuals do survive - this isn't about the relatively healthy - this is about those who are most susceptible. You and I.