For years, anti-heartburn medication was prescribed like candy. Proton-pump
inhibitors (PPIs) seemed to cure the symptoms of heartburn, indigestion
and acid reflux without any side effects.
Or so we thought more than a decade ago.
Now it seems as though every year researchers discover a new area of the
body that has been negatively affected by PPIs. Osteoporosis, pneumonia,
infectious diarrhea, and even an increased risk for heart attacks have
all been linked to prolonged PPI use. Most recently, a study suggests
that PPIs are associated with an increased risk of developing chronic
While the drugs are not proven to cause these conditions, the associations
are strong enough that we should stop thinking of PPIs as harmless and
start thinking of them as what they are: Temporary relief for symptoms
of a chronic and progressive disease.
An estimated 15 million Americans use PPIs, and for good reason. PPIs revolutionized
the medical treatment of reflux, and for mild or intermittent symptoms,
But they have worked so well at masking symptoms that people too often
take the drugs longer than they should. Sold by prescription as well as
over-the-counter under a variety of brand names, these pills were never
intended for prolonged daily use.
Instead of constantly reaching for that little purple pill, it's time
to seriously consider the underlying cause of acid reflux and attack the
problem, not the symptoms. Gastro-esophageal Reflux Disease (GERD) is
caused by a weakened lower esophageal sphincter, a little bundle of muscles
between the stomach and the esophagus that allows food in and is supposed
to keep stomach acid, digestive enzymes, and food from coming back up.
The gold standard for treating this weakened sphincter is surgery. I'm
a surgeon, so perhaps it's not a surprise that I'm extolling the
virtues of surgery.
But my convictions are backed up by facts. Historically, surgery has proven
over 90% effective in stopping GERD, which is why physicians have been
performing surgeries to reinforce the lower esophageal sphincter since
The most common procedure is called a Nissen fundoplication. In this laparoscopic
surgery, the surgeon wraps the top of the stomach around the lower esophagus.
This reinforces the lower esophageal sphincter, making it less likely
that acid will back up into the esophagus. Surgery is not without its
side effects. Many people experience bloating, an inability to burp or
vomit, as well as other symptoms.
As a solution to those side effects, in 2012 the FDA approved a new device
for GERD called the LINX Reflux Management System. It is a small flexible
band or bracelet of interlinked titanium beads with magnetic cores that
is placed around the lower esophageal sphincter. It augments the natural
function of the sphincter, limiting acid, digestive enzymes, and food
from refluxing into the esophagus from the stomach.
Along with other surgeons at Hoag, I have been involved in several studies
that have confirmed the efficacy and safety of the LINX device. I have
seen how the LINX device is dramatically changing the way we surgically
treat and manage GERD. Several patients who were part of the initial clinical
trial are still doing well, having had the LINX device for over eight
years now. Their symptoms of GERD are dramatically improved without the
side effects that are commonly found in patients who undergo the traditional
Unfortunately, despite the success of surgery, a major barrier remains:
Many patients are misinformed and are not aware that their GERD will progress
over time. They often look at GERD or reflux as a benign symptom and not
a true disease. If not treated appropriately, prolonged GERD can cause
severe changes and damage to the esophagus that can eventually lead to
I'm hoping that every time a new study comes out linking PPIs to another
disease or condition, it will spark a conversation between patients and
their primary care providers and/or gastroenterologists about going beyond
the symptoms and attacking the problem at its source.
NIKOLAI BILDZUKEWICZ is esophageal and Gastric surgeon at Hoag Hospital
and an assistant professor of clinical surgery at USC's Keck School