Question: I have terrible acid reflux and have a hard time sleeping at night, even when I take a Pepcid. My doctor is advising that I take prescription Prisolec, but I’ve read that prescription GERD medicines can raise risks for heart attack. What do you think?
Dr. Hibberd's answer:
GERD (gastro-esophageal reflux disease) can be very uncomfortable. Persistent unchecked reflux can be disabling to some as it exposes your sensitive esophageal lining to the corrosive effects of stomach acid. Unlike healthy gastric lining cells that are protected by design from harmful acid effects, your esophageal lining cells are easily damaged by recurring reflux, predisposing you to stricture formation, rings, and ulcerations that may predispose you to swallowing problems.
Recurring reflux can also lead to Barrett's esophagus, a condition that sets the stage for chronic inflammatory changes that in some may include the development of esophageal cancer.
PPI medications such as Prilosec have revolutionized the medical approach to GERD, and have been far more effective than H2 blockers, such as Pepcid, at controlling damage from reflux disease. Remember that whether you obtain your PPI (such as Prilosec) by prescription or not, the same cautions apply to over the counter PPI medications.
Recent studies involving mice and humans have shown that PPIs can cause increased constriction of blood vessels, interfering with the ability of the blood vessels to relax. This occurs because the blood vessels appear to have reduced ability to produce nitric oxide when PPIs are used. Nitric oxide is known to protect arteries and veins, and can relax blood vessels. The reduced nitric oxide production may impair vascular health and predispose some people to hypertension. PPIs appear to slightly increase the risk of a second heart attack. That is, regular PPI use poses an increased risk for those with pre-existing vascular disease, and the use of such medications in at-risk heart patients must be reviewed by a personal physician who can consider risks and benefits.
While there here is no evidence that PPIs cause vascular disease by itself, you should talk with your physician if you intend to use them regularly for long-term reflux control. I would personally have no problem with short-term PPI use, but long-term PPI use may need modifications in some of us who have risks for or existing vascular disease. Discuss your concerns with your personal physician and work out a suitable plan of attack that will alleviate your concerns and manage your reflux efficiently.
Severe GERD can also be managed surgically using minimally invasive techniques. Other treatments for GERD include food portion control, weight management, and avoiding certain acidic foods that can cause heartburn or relax the lower esophageal sphincter that in turn worsen reflux. Above all stop smoking, if you use tobacco. Raise the head of your bed when sleeping. Avoid large meals, and eat small frequent meals. Avoid foods known to relax the lower esophageal sphincter that in turn worsen reflux.
But it is critical that you consult with your personal physician in weighing your options. You may want to ask your physician for a referral to a gastroenterologist and, if surgery is a possibility, you will be referred to a general surgeon.
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