Question

I have been told that I have acid reflux. The doctor prescribed Prevacid, but I can't afford this medication. I've started taking cimetidine. Is there anything wrong with this?

Answer

Gastroesophageal reflux (GERD) is a very common disorder. Most people will have the symptoms of GERD at some time. These include heartburn, reflux, and chest pain. The discomfort typically occurs after eating and especially after lying down at night.

GERD occurs as a result of stomach acid refluxing into the esophagus by going through the normal barrier valve between these two structures.

The diagnosis of GERD is often made based on symptoms. In mild cases of reflux (symptoms not severe, or infrequent) medications that suppress the production of stomach acid are often tried first; these include the H2 blockers - e.g. cimetidine (Tagamet) and ranitidine (Zantac) - that have been around for about 25 years. These are often very effective in mild to moderate cases of GERD.

Some patients have very frequent and severe symptoms, and may only get partial or short-lived relief from H2 blockers. More potent medications used in preventing stomach acid are the proton pump inhibitors (PPI's). There are several drugs in this class, including omeprazole (Prilosec) and lansoprazole (Prevacid), among others. Generally when someone does not respond to an H2 blocker or only has partial relief, a PPI is given.

It is also important to know that more frequent doses of H2 blockers may be needed for certain patients - often four doses per day of an H2 blocker are used to get total relief, versus typically one dose for the more potent and long-lasting PPI's.

Another important consideration in deciding which drug to use is whether the GERD has led to complications. Although most patients simply have symptoms of GERD, some will also have damage to the esophagus as a result of chronic inflammation by the acid, that may show up as erosions or even ulcers in the esophagus. Over the long-term, healing may lead to scarring (strictures) leading to narrowing of the esophagus.

Chronic GERD can also lead to a change in the lining of the esophagus, known as Barrett's esophagus, that is a premalignant condition that can lead to esophageal cancer.

Any patient with a complication of GERD should be on a PPI medication. The search for such complications is why gastroenterologists perform endoscopy on patients with GERD.

You should discuss your case with your doctor and maybe visit a gastroenterologist. They will be able to tell you whether you can simply take cimetidine(Tagamet) or whether you need to be on lansoprazole(Prevacid).

Links

• GERD or GORD - It's Still a Pain