Acid reflux

[TSandM]

Harry, you are correct in saying that there is no "true" sphincter. A true sphincter is visible anatomically with circumferentially oriented muscle fibers, and such does not exist at the gastroesophageal junction. It has been posited that the diaphragmatic hiatus holds the esophagus at an angle that creates a sphincter-like function. It is true that many people who have reflux have a malposition of the GE junction with respect to the diaphragm (stomach slid upward). However, some people with that anatomic abnormality have no reflux, and some people with significant reflux do not have a hiatal hernia. Frankly, I'm not sure anybody knows why some people have reflux. There are clear factors that increase it -- overweight, alcohol, eating large meals before bed, etc. -- but there are people without any of those factors who are severely symptomatic.

Stomach wrapping operations that create a stronger sphincter-like function AND replace the stomach in its normal position are effective against reflux. But some recent studies are indicating that the PPIs are just as good.

 

[DocVikingo]

I'm truly curious, Pescador; what motivates you to post what seems to be a lay opinion on a medical question after two physicians have weighed in? I see this on the Scubaboard frequently. Perhaps one of the things that makes these forums so popular is the idea that all opinions are equal?

Hi Vlad,

It is rather astounding, isn't it?

"Perhaps one of the things that makes these forums so popular is the idea that all opinions are equal?"

I suspect that you are largely correct.

Sadly, and as I'm sure you appreciate, all opinions are not equal. The value of an opinion can be weighed using such criteria as the extent to which it:

1. Has been thoroughly researched and is consistent with the body of currently known facts, where such exist.

2. Appears to take an objective rather than narrowly personal point of view.

3. Is offered by a person recognized as knowledgeable in the subject matter area.

4. Is free of irrelevant information and presented in an organized, logical and compelling fashion and otherwise indicates clear and sound thinking.

5. Eschews derogatory, inflammatory and otherwise inappropriate language, as well as defensiveness.

6. Is correct in grammar, spelling, format and other aspects of communication which are important to readability and persuasiveness and show that the offeror cares about his opinion and its effect upon others.

I'm sure there are more.

Opinions which fall short on the above criteria seem particularly dangerous on a forum where one's health, well-being and even life are at issue.

Regards,

DocVikingo

 

[ThatsSomeBadHatHarry]

DocVikingo and TSandM, thanks for the info. i'll be putting it to good use tomorrow night.

 

[DandyDon]

All these YEARS I've been using Tums type products. Dang. Need to look into the suggested OTC Meds

<edit> Just had a nice chat with my pharmacist - who also has heartburn problems, making him doubly qualified to consult. He put onto a OTC wit 160 mg Aluminum hydroxide and 160 mg Magnesium carbonate that he likes.

Brand name: Gaviscon. Cheap, too - penny a tablet, take 2 to 4. Love it: better treatment for under a nickle in this day. Wow...!

 

[DocVikingo]

Hey Don,

If you decide to go with an OTC antacid (e.g., Tums, Maalox) rather than an OTC PPI (e.g., Prilosec), you should be very pleased with Gaviscon.

Best of luck.

DocVikingo

 

[DandyDon]

Hey Don,

If you decide to go with an OTC antacid (e.g., Tums, Maalox) rather than an OTC PPI (e.g., Prilosec), you should be very pleased with Gaviscon.

Best of luck.

DocVikingo

Yeah, we discussed the PPI, but the only times I really have a problem are when I eat shortly before bed or diving - not that common day to day. I wanted something to handle heartburn after onset, and he suggested that I could use this for both a treatment and a preventative. After I atually try this, I may go for the PPI, too. Excerpting from this site

There are five PPI's available in the United States and more are in development. The medications are structurally and chemically similar. There are relatively few comparisons of these drugs with each other. All five medications heal esophagitis in 90-94% of patients. There are no significant differences in overall healing and symptom improvement rates between the five medications. Omeprazole (Prilosec) and lansoprazole (Prevacid) have been available the longest and consequently are the most familiar to physicians and patients. While the newer medications, rabeprazole (Aciphex) and pantoprazole (Protonix) have data to suggest better suppression of stomach acid compared to omeprazole, there is no proof that the differences are clinically important. Rabeprazole and pantoprazole are smaller and may be better for patients who have problems swallowing capsules. Pantoprazole is marketed as being cheaper, and may be better for patients paying for their own medications. Esomeprazole (Nexium), a new and very potent PPI, was approved by the U.S. Food and Drug Administration (FDA) in 2001. Omeprazole is now available over-the-counter.

I have used ranitidine and famotidine at times from uneducated "wonder if this works as good as it says" shopping, but I take it from the above discussion that PPIs are superior...?

My added thanks to DocVikingo and TSandM.

 

[DocVikingo]

Hi Don,

As regards agents for treating severe or chronic heartburn or GERD, like TSandM I'd line them up in terms of effectiveness as first a PPI (e.g., Prilosec), followed closely by an H2 receptor antagonist such as Zantac or Tagamet, and at a distant last a salts of metals based antacid (e.g., Gaviscon).

However, given that one experiences heartburn only when having eaten shortly before bed or diving and that a simple antacid entirely prevents/corrects the condition for the duration of sleep or diving, there seems little reason to take something more costly, sometimes very much more costly (e.g., Protonix).

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Regards,

DocVikingo

 

[oleander1]

I experienced stomach ache during my ocean test dive for scuba cert, probably due to tight weight belt. I felt nauseated on the boat and uncomfortable in the water. The problem is, I still have acid reflux two weeks later. I did eat a scrambled egg for breakfast that I knew was too fatty (butter) before the dive. Next time I will eat oatmeal. But, my question is: can a dive cause longer term acid reflux?

 

[DandyDon]

Hi Oleander1 - welcome to SB. I doubt it could cause long term reflux, but I'll wait to see what some of our physicians say. I'm certainly not qualified. If you'd been googling tho, you probly already know that it's common to the US population and lifestyles.

good luck

 

[TSandM]

No, a dive cannot cause long-term reflux. However, if you had some kind of problem on the boat that aggravated a preexisting problem, the symptoms might be persistent. If you are most symptomatic after eating fatty foods, you might need to have your gall bladder checked.