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Is Aciphex the best drug?

Some people always seem dismissive about heartburn or indigestion as a serious medical problem. Perhaps it’s something about the name. People are always more impressed by gastroesophageal reflux disorder (GERD), probably because they don’t know what it means. Whatever the reason, heartburn tells you this is a burning sensation in the chest that can spread up to the neck and throat. It also signals the likely confusion because the symptoms are broadly the same for heart disease. Once actual heart disease has been excluded, the first line response is a proton pump inhibitor (PPI). This is so even though these drugs are only effective in about half the cases with irritable bowel syndrome being an equally important cause of heartburn. The medical profession has decided to treat everyone as having a weak sphincter first. If the PPI does not work, then they will look at other options. While this is great for the manufacturers of the PPIs, it’s not making the patients front and center. So let’s take the chance to have the missing debate here. Which is better? To go for the PPI regardless or to try diagnosis.

This means getting into what the PPI does. In one sense, it’s easy to explain. For your stomach to break down the food you eat, there has to be acid, hydrochloric acid to be precise. The pump decides how much to make. By partially shutting it down, there’s less acid around and so, even if some of the contents of your stomach do leak back into the esophagus, there’s going to be less pain. If you listen to the manufacturers, they tell you this is a safe drug and there are no real adverse side effects. Except. . . Except all this does is to reduce the risk of pain. The real problem producing GERD is physical. It may irritable bowel syndrome or the sphincter separating the stomach from the esophagus is not operating properly. These two underlying causes remain in play no matter how long you take the PPI. Just as important is what happens to your digestive system if there’s consistently less acid inside to process the food. Naturally, the whole process slows down and you may find you get constipated more often.

Yet, if you look at the post-marketing studies for the PPIs, it seems almost all the patients who have defective sphincters report the heartburn cured. The result is that almost 112 million prescriptions are written for PPIs every year. Aciphex and the other drugs in this class are very big business. There’s just one problem. The FDA only licensed them for short-term use. There’s some evidence that there’s an increased risk of fractures if the use continues beyond a year. So Aciphex is the right drug in half the cases but, if you want a long-term cure, you may have to consider surgery. That’s the only way you can get the sphincter repaired. If you do have irritable bowel syndrome, that’s a completely different problem and taking PPIs will not help.