It happens when acid comes up from the stomach, which is acid-resistant, into the esophagus, which is less acid-resistant.

Dr. James East, a gastroenterologist at Mayo Clinic Healthcare in London, says GERD may be common, but there can be potentially severe complications if it's ongoing and left untreated.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:08) is in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Read the script.

Heartburn — it's the cardinal symptom of GERD. 

"GERD, gastroesophageal reflux disease, is when you get acid and chemical damage to the lining of the esophagus," says Dr. East.

You might feel a lump in the throat, have difficulty swallowing, have chest pain, a cough, or have worsening asthma-type symptoms.

"Complications of GERD include esophagitis, inflammation in the bottom of the esophagus," says Dr. East. "If this is persistent, you can develop scarring and a stricture."

But if it's persistent and heals, the lining of the esophagus can change to a more acid-resistant form, which is Barrett's esophagus. 

"Barrett's esophagus is a reasonably common complication of GERD," he says.

It affects 10% to 15% of people with GERD. And a much smaller group faces another risk, says Dr. East.

"About 1 in 200 patients with Barrett's esophagus per year will develop esophageal adenocarcinoma."

There are innovative treatments for GERD and medications, like proton pump inhibitors. But first, avoid triggers, like coffee, alcohol and smoking. 

"If you have severe or frequent GERD, you should seek medical advice," advises Dr. East.

Learn more about Barrett's esophagus:

• Mayo Clinic Q&A podcast: Barrett’s esophagus requires monitoring and treatment to decrease esophageal cancer risk

  Watch: Dr. East discusses Barrett's esophagus

The post Mayo Clinic Minute: GERD is not ‘just’ heartburn appeared first on Mayo Clinic News Network.

"The risk is pretty low, but it's not zero," says Mayo Clinic gastroenterologist Dr. Ken DeVault. "So it's worth talking to your physician."

The medications are called proton pump inhibitors, sold under brand names such as Prilosec, Nexium and Prevacid, and the generic forms, such as omeprazole, esomeprazole and lansoprazole.

Dr. DeVault says, despite the risks, proton pump inhibitors are the best option for some patients with heartburn. However, he thinks the medications are over used by many people who could find alternatives.

In this Mayo Clinic Radio Health Minute, Dr. DeVault asks two important questions about proton pump inhibitors and offers other ideas for beating heartburn.  To listen, click the link below.

2 questions for people who use heartburn medications

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"The risk is pretty low, but it's not zero," says Mayo Clinic gastroenterologist Dr. Ken DeVault. "So it's worth talking to your physician."

The medications are called proton pump inhibitors, sold under brand names such as Prilosec, Nexium and Prevacid, and the generic forms, such as omeprazole, esomeprazole and lansoprazole.

Dr. DeVault says, despite the risks, proton pump inhibitors are the best option for some patients with heartburn. However, he thinks the medications are over used by many people who could find alternatives.

In this Mayo Clinic Radio Health Minute, Dr. DeVault asks two important questions about proton pump inhibitors and offers other ideas for beating heartburn.  To listen, click the link below.

2 questions for people who use heartburn medications

The post 2 questions for people who use heartburn medications: Mayo Clinic Radio Health Minute appeared first on Mayo Clinic News Network.

"In our study, we found that use of gastric acid suppression medications are associated with a statistically significant increased risk of development of recurrent C-diff in patients with a prior episode of C-diff," says Sahil Khanna, M.B.B.S., a gastroenterologist at Mayo Clinic and senior author of the study.

Dr. Khanna says gastric suppression medications studied include proton pump inhibitors, such as omeprazole, and histamine 2 blockers, such as ranitidine, which are commonly prescribed and consumed over-the-counter medications for gastroesophageal reflux disease, peptic ulcer disease or dyspepsia.

In a systematic review and meta-analysis of 16 studies with 7,703 patients with C-diff, 1,525 developed recurrent C-diff. The rate of recurrent C-diff in patients with gastric suppression was 22.1 percent, compared to 17.3 percent in patients without gastric acid suppression.

Dr. Khanna urges caution in interpreting these findings due to variables not considered in the study, such as the underlying reason why the gastric acid suppressant was needed. However, he says the findings suggest that patients with C-diff who receive gastric acid suppressants may be at increased risk of C-diff recurrence. "It may be reasonable to re-evaluate the need for these medications in patients with C-diff," Dr. Khanna says.

Co-authors are:

• Raseen Tariq, M.B.B.S., Mayo Clinic
• Darrel Pardi, M.D., Mayo Clinic
• Siddharth Singh, M.B.B.S., University of California San Diego
• Arjun Gupta, M.B.B.S., University of Texas South Western

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.

MEDIA CONTACT
Joe Dangor, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

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Heartburn

"The risk is pretty low, but it's not zero," says Mayo Clinic gastroenterologist Dr. Ken DeVault. "So it's worth talking to your physician."

The medications are called proton pump inhibitors, sold under brand names such as Prilosec, Nexium and Prevacid, and the generic forms, such as omeprazole, esomeprazole and lansoprazole.

Dr. DeVault says, despite the risks, proton pump inhibitors are the best option for some patients with heartburn. However, he thinks the medications are over used by many people who could find alternatives.

In this Mayo Clinic Minute, Dr. DeVault asks two important questions about proton pump inhibitors and offers other ideas for beating heartburn. Jeff Olsen reports.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script.

The post Mayo Clinic Minute: 2 questions for people who use heartburn medications appeared first on Mayo Clinic News Network.

A type of heartburn medication called proton pump inhibitors (PPIs) may be linked to long-term kidney damage, according to a new study published in JAMA Internal Medicine.

“This is an important study because millions of Americans are on proton pump inhibitors and have been for many years,” says Kenneth DeVault, M.D., a Mayo Clinic gastroenterologist who was not involved in the research.

Watch Dr. DeVault's interview

Medications like Prilosec, Nexium and Prevacid belong to this class of drugs, which treat heartburn and acid reflux by lowering the amount of acid produced by the stomach. People who use PPIs have a 20 to 50 percent higher risk of chronic kidney disease compared with nonusers, according to the Johns Hopkins study. However, a direct cause-and-effect relationship between the drug and the disease was not established.

“I think more research on this subject will be important,” says Dr. DeVault. “When you have that many people taking a drug, and there’s a small potential risk, it certainly gets both physicians’ and patients’ attention.”

Dr. DeVault cautions patients not to panic over news of the study. “The most important thing is to discuss it with a treating physician and make sure everyone is on the same page and understands the benefits and weighs those against this fairly small, but perhaps real, risk.”

Dr. DeVault says, for some patients, a less powerful acid blocker and lifestyle changes could eliminate the need for PPI medication.

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DEAR MAYO CLINIC:

ANSWER: Proton pump inhibitors (PPIs) are the most effective medications for the treatment of chronic acid reflux (gastroesophageal reflux disease, or GERD) and peptic ulcer. They work by blocking the production of stomach acid — too much of which can cause a burning sensation in your chest or throat (heartburn) — and by giving damaged tissue in your esophagus time to heal.

Proton pump inhibitors come in prescription and nonprescription strengths. These medications are most commonly taken as a pill once a day, usually about an hour before breakfast. Proton pump inhibitors are generally safe when you use them as directed. But as with any medications, there are potential risks with taking them.

Long-term use of proton pump inhibitors has been associated with a greater risk of infections such as pneumonia and a form of antibiotic-associated diarrhea caused by the bacteria Clostridium difficile (C. difficile). However, whether proton pump inhibitors are directly responsible hasn’t been proved.

A recent study by Mayo Clinic doctors found that over time, proton pump inhibitors can change the environment of your gut by reducing the diversity of friendly bacteria (microbiome) normally found within your bowels. These bacteria help you digest food, absorb vitamins and perform other healthy body functions.

Loss of bacterial diversity can make it easier for less friendly germs such as C. difficile to multiply and cause an infection. If you take antibiotics frequently and also require treatment of reflux symptoms, using another type of antacid medication — such as a histamine (H-2) blocker — may reduce your risk of diarrhea. Knowing your medical history will help your doctor make the best decision regarding the need to use a proton pump inhibitor and for how long.

Less stomach acid also can make it harder for your body to absorb nutrients, such as magnesium, iron, vitamin B-12 and calcium.

Evidence suggests an association between prolonged proton pump inhibitor use and a higher risk of bone fractures in older adults, but this is usually in those who are already at increased risk because of other conditions. In many cases, a supplement can help correct nutrient deficiencies. (Adapted from Mayo Clinic Health Letter) — John K. DiBaise, M.D., Gastroenterology & Hepatology, Mayo Clinic, Scottsdale, Ariz.

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ROCHESTER, Minn. — Before reaching for that daily antacid, you might consider what it’s doing to the trillions of bugs living in your gut. A new Mayo Clinic study in the open access journal Microbiome shows that people who regularly take proton pump inhibitors (PPIs) have less diversity among their gut bacteria, putting them at increased risk for infections like clostridium difficile and pneumonia, in addition to vitamin deficiencies and bone fractures.

MEDIA CONTACT: Sam Smith, Mayo Clinic Public Affairs, 507-284-5005, Email: newsbureau@mayo.edu

Journalists: Soundbites with Dr. DiBaise are available in the downloads.

“Evidence has been mounting for years that long-term use of proton pump inhibitors poses increased risks for a variety of associated complications, but we have never really understood why,” says John DiBaise, M.D., a Mayo Clinic gastroenterologist and senior author on the study. “What this study does for the first time is demonstrate a plausible explanation for these associated conditions.”

The gut microbiome consists of trillions of bacteria. Rather than causing disease, most of these bacteria are friendly and aid in everything from digestion and vitamin synthesis to immune system regulation and possibly, mood stabilization.

Diet, genetics and environmental exposure all play a role in maintaining a healthy microbiome, which is critical to overall wellness, says Dr. DiBaise. Significant changes to the microbiome, like those caused by proton pump inhibitors, can put people at risk for over-colonization by such undesirable species as clostridium difficile, he says.

Proton pump inhibitors are primarily used to treat ulcers and acid reflux, and include the generic names omeprazole, pantoprazole, esomeprazole, lansoprazole, rabeprazole and dexlansoprazole.

Many epidemiological studies have linked PPIs to nutritional, metabolic and infectious disorders, despite the class of drugs’ long history of safety and efficacy. Specifically, their prolonged use has been associated with iron and vitamin B12 deficiencies, hypomagnesemia, osteoporosis-related fractures, small intestinal bacterial overgrowth, and community-acquired pneumonia. The Food and Drug Administration has issued several safety communications about use of high-dose PPIs (available through prescription) and long-term use at any dose, including over-the-counter medications.

Safety implications of the study have yet to be determined, and patients should consult a qualified medical professional before changing any drug regimen, says Dr. DiBaise.

“We’re not saying people should stop taking their regular antacids; despite the many health risks associated with PPI use, they have an extensive track record of safety when used as directed,” Dr. DiBaise says. “What we are saying is that the medical and research communities should consider these medications in the context of the patient’s microbiome. This is an area that needs further study.”

In patients with mild reflux symptoms, lifestyle changes may be sufficient to curb discomfort, Dr. DiBaise says. Non-pharmacological methods to control acid reflux include:

• Eat smaller portions at meals
• Consume less fat
• Avoid laying down for at least 2 hours after eating (avoid late-night snacks)
• Wear loose fitting clothing
• Elevate the head of the bed about 6 inches (this is best done by placing a block under the headboard, rather than stacking pillows)
• Lose weight (as little as 5 to 10 pounds may help)
• Avoid alcohol, tobacco and foods that trigger symptoms

Daily medications become necessary in those whose reflux symptoms persist and impair their quality of life despite these lifestyle modifications, says Dr. DiBaise. Whether less potent acid inhibitors like histamine H2 antagonists, cause similar changes to the microbiome is unknown.

Coauthors of the study are Charlie Seto of the University of Minnesota, and Patricio Jeraldo, Ph.D., Robert Orenstein, D.O., and Nicholas Chia, Ph.D., all of Mayo Clinic.

The study was funded by the Mayo Clinic Center for Individualized Medicine and the Minnesota Partnership for Biotechnology and Medical Genomics. Dr. Jeraldo received funding for this project from the University of Illinois at Urbana-Champaign.

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About the Mayo Clinic Center for Individualized Medicine
The Mayo Clinic Center for Individualized Medicine is home to the Individualized Medicine Clinic, the world’s first integrated, multidisciplinary genomics clinic, serving patients with advanced cancer and diagnostic dilemmas. The center discovers and integrates the latest in genomic, molecular and clinical sciences into personalized care for each Mayo Clinic patient. Visit http://mayoresearch.mayo.edu/center-for-individualized-medicine/ for more information.

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