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Say 'Aaah' | THE HEALTHY MAN

Are You an Aging Fire Eater? Try the Acid Test

March 12, 2001|Timothy Gower

My wife and I are at a large newsstand, one of those places that sells every magazine published on the planet. We drift apart, browsing. I wander over to a certain section, where I spy a publication that piques my interest, though I don't want anyone to see me reading it. I turn my back, leaf through the pages, wide-eyed. I've never seen anything quite like this.

Suddenly, I'm startled by my wife's voice. "Honey," she asks, "why are you reading Digestive Health and Nutrition?" Well, it sure wasn't for the pictures, I told her.

The fact is digestion has become something of an adventure for me in recent months. I used to be able to wolf down a bucket of five-alarm chili with a side of jalapeno peppers and still sleep like a newborn. Now I buy antacids in bulk and think twice about every morsel I put in my mouth. In short, I've become a guy with GERD. That's the acronym for gastroesophageal reflux disease, the fancy phrase doctors use for frequent heartburn.

I guess I should have seen this coming. After all, isn't it always the husband in TV commercials who can't sleep because he has flames leaping out of his mouth? Aren't men more prone to digestive trouble--ulcers, excess gas, and the like--than women?

It may seem that way sometimes, though it could be that men are simply less discreet when it comes to dealing with certain digestive problems. In fact, women are more likely to develop irritable bowel syndrome. And according to a recent article in the Journal of Family Practice, older women are nearly twice as likely as older men to have heartburn every day. However, chronic heartburn may be more serious for some men. But before we go there, let's review some basics.

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According to gastroenterologist Steven Peikin of the Robert Wood Johnson Medical School in Camden, N.J., as many as 80 million Americans suffer from heartburn on occasion, some every day. Normally, when you swallow food, a one-way valve at the bottom of your esophagus opens to allow your meal to drop into the stomach. When you finish eating, the valve shuts tight. Heartburn occurs when something causes that valve to relax and open when it shouldn't. That allows stomach acid to splash upward, or reflux, burning the tender lining of the esophagus.

Many things can cause this valve to slack off, but certain food and beverages are the most common culprits. These "triggers" can vary in people. For me, it's tomato sauce and spicy dishes. Greasy foods, chocolate, peppermint, alcohol, coffee, juices and carbonated drinks, ketchup, mustard or vinegar may produce that sizzle in the sternum for other GERD sufferers. Aspirin and ibuprofen can act as triggers, too.

Aging is another cause of GERD. Hiatal hernias are common in people older than 60. This condition occurs when part of the stomach bulges through the opening in the diaphragm that the esophagus passes through. As the opening stretches out, the valve in the esophagus weakens, explains Peikin. Heartburn caused by a hiatal hernia feels like any other type of heartburn, and responds to the same treatments, such as the following:

Gastroenterologists will often tell a GERD patient to avoid foods that can cause heartburn and to elevate the head of his or her bed 4 to 6 inches, to let gravity keep stomach acid from creeping upward.

But Peikin, author of "Gastrointestinal Health" (HarperCollins, 1999), is a realist. "Lifestyle changes are hard to do," he says. "And they're often not enough."

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Fortunately, he's quick to add, the vast majority of GERD sufferers can find relief at the pharmacy. Antacids work fast by neutralizing stomach acid, but they wear off quickly. Histamine blockers--Tagamet HB, Zantac 75 and the like--slow down acid-producing cells in the stomach for a few hours. These medications, however, can take up to a half-hour to kick in.

Peikin recommends a new product, Pepcid Complete, that contains an antacid and a histamine blocker. In theory, these pink tablets should provide fast, long-term relief, though there's also no reason you can't simply pop an antacid and an acid blocker at the same time.

If over-the-counter drugs don't help, it's time to see your doctor. He or she will likely put you on a stronger class of drugs known as proton pump inhibitors, which pretty much shut down acid-making in the stomach. People who don't want to take drugs for the rest of their lives can even opt for surgery. But most people who have heartburn can treat it on their own, says Peikin, without consulting a doctor.

Here's an important exception: If you're a white male older than 50 who has chronic heartburn, tell your doctor about the problem, even if you can manage it with over-the-counter drugs. Men in this category are unusually susceptible to an ulcer-like condition called Barrett's esophagus, says Peikin, which in rare cases leads to cancer. Barrett's can be detected with a tubelike probe known as an endoscope.

If I'm still fighting flames at 50, I'll talk to my doctor about getting 'scoped. For now, I take an acid blocker before eating tomatoey or spicy foods, and my heartburn barely flickers. The pills cost a few bucks, but their price is a pittance compared to a life without pizza.

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Massachusetts freelance writer Timothy Gower is the author of "Staying at the Top of Your Game" (Avon Books, 1999). He can be reached by e-mail at tgower@mediaone.net. The Healthy Man runs the second Monday of the month.

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