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Acid reflux disease basics

Acid reflux disease is not enjoyable for those who suffer from it. But acid performs an important function in the body. This week on WRVO's weekly health and wellness show "Take Care," hosts Linda Lowen and Lorraine Rapp speak with Dr. Rajeev Jain, the chief of gastroenterology at Texas Health Presbyterian Hospital in Dallas about what causes acid reflux and how to treat it.

Lorraine Rapp: Before we talk about acid reflux disease, would you explain exactly where acid comes from, and what its role is in the body?

Dr. Rajeev Jain: The main function of acid really is two things: to kill bugs, and to help break down protein.  If you think of early man out there foraging and eating stuff off the land directly without cooking it, its [acid’s] main job was to kill infections.

Linda Lowen: Could we live without stomach acids?

Dr. Jain: You can live without it, but acid also is needed for absorption of important vitamins like vitamin B12.  What’s interesting is when we think of acid reflux, most people think of it as they’re making too much acid, and that’s what’s causing the problem.  Rather, it’s not an overproduction of acid.  The real defect in acid reflux is this muscle between the esophagus and the stomach called the lower esophageal sphincter, or LES.  What makes acid reflux a problem is when that muscle relaxes either too long, and/or too often, and then allows acid contents from the stomach to come up back into the esophagus.

Lorraine Rapp: If it’s simply acid going to places where it doesn’t belong, then what relationship is there to food, because I know that there are some foods that trigger in different people—is that what causes that muscle to relax?

Dr. Jain:  We all tell our patients that things like alcohol, smoking, chocolates, and fatty foods would make acid reflux worse.  What’s interesting is when you look at really high-quality studies, they’re not able to show a clear connection between improved symptoms.  If there are certain food triggers that make you feel bad then cut back, but I don’t think patients should go across the board and eliminate all potential triggers of acid reflux.

Linda Lowen: Is there anything that you do, any sort of testing that you do?  Is there a point at which you do have to prescribe medication?

Dr. Jain: The first thing is that having the classic symptoms of burning in the chest and/or regurgitation is usually the way we make the diagnosis.  It’s in those patients that are having more frequent symptoms [that] we always try to find out what their triggers are and limit that.  If they’re still having symptoms that don’t respond to antacids or other over-the-counter remedies, or [if] they’re having to take the antacids several times a day daily, I will give them a trial of a stronger medicine that we call proton pump inhibitors, or PPIs.  Examples of those include Omeprazole and Lansoprazole.  These are medications that came out in the late 80s and they’re very strong in terms of suppressing acid in the stomach.  We’re not improving the muscle to minimize the reflux.  All we’re doing is trying to take out the acid or the burn injury from the contents that are coming up.    

More of this interview can be heard on "Take Care," WRVO's health and wellness show Sunday at 6:30p.m. Support for this story comes from the Health Foundation for Western and Central New York.