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From: werner3343@aol.com
Date: 5/4/00
Time: 2:23:26 AM
Remote Name: 152.163.204.63
antacida and Barrett's (was:help with medication)
("reply" doesn't work for me , so I start a new thread) (posting also takes several minutes , is that normal ?)
at first , here is the full article:
---------------------------------- USC Foregut and Pulmonary Surgery - p.2 Gaining New Insight Into Reflux Disease
The link between reflux disease and Barrett's esophagus has been known for some time. However, recent research by members of the Foregut Pulmonary Group into the actual contents of the reflux has resulted in some fascinating findings. Their research has shown that about 50 percent of people reflux both gastric (acid) and duodenal (bile) contents- and these individuals are the patients who tend to get Barrett's metaplasia, as opposed to those people who only reflux acid. (annals of Surgery, October 1995, Vol. 222, No. 4, 523-533). Members of the Foregut-Pulmonary Group took this research one step further. "When we caused the reflux of both bile and acid in animal models," says Dr. DeMeester, "we found a high incidence of both Barrett's and adenocarcinoma. In addition, this research indicated that when acid is not present in the reflux, the incidence of tumors dramatically increases-indicating that the noxious agent in reflux is duodenal juice, and that acid can play a protective role. The animals that had acid present had a lower incidence of tumors." (Annals of Surgery, September 1996, Vol. 224, No. 3).
Dr. DeMeester says that these findings have important ramifications for those who depend on acid-suppression therapy, which may ease the symptoms of reflux but does not address the cause of the problem-thereby allowing reflux to injure the esophageal lining year after year. Chronic acid-suppression therapy may not be in the patient's best interest if he or she has both acid and duodenal juice in the reflux, because the acid suppression unleashes the duodenal contents, perhaps placing the patient at increased risk for Barrett's or adenocarcinoma. Chronic acid suppression also reduces one's protection against the ingestion of bacteria. "Not only does acid help with digestion, but it also protects us from food contaminated with bacteria. So if you shut off the acid, you have a higher chance of contracting an intestinal infection," he says.
Another consequence of these findings relates to what Dr. DeMeester refers to as the "bile-acid" sink. Dr. DeMeester explains that "in most cases nature has used acid as a protective mechanism against our own bile-one of the components of duodenal juice." In fact, bile has always posed many mysteries as it can be very detrimental to the body in its dissolvable form, but when it comes back into the acid environment of the stomach, it flocculates out like sand and cannot be redissolved - even if the pH levels are changed. "However,: he says, " if you shut the acid down by taking a medication, or if you have so much bile coming back that you neutralize the acid, then you increase the pH and it doesn't precipitate out. It stays in solution and can cause destruction of the esophageal lining, and may even induce metaplasia."
Dr. DeMeester believes that for these reasons, the increasing reliance on powerful acid suppression medication is directly linked to the rise in Barrett's esophagus and the cancer related to it. Although he is concerned that increasing availability of over-the-counter H 2 blockers may exacerbate the problem even further, he cautioned that the acid- suppression therapy link with Barrett's is not necessarily a cause-and- effect relationship. "However," says Dr. DeMeester, "all the data we have on lung cancer and smoking is based on the same kind o relationship, and I cannot dispense this relationship as being unimportant. ---------------------------------------------------------------
Hawk commented:
>Dr. DeMeester is a well respected doctor and researcher, so, his >observations do carry a lot of weight. But, one has to remember, >this is the field of research.
yes, but he had published already a lot of studies on this subject before 1996. So , I interpreteted it as a summary of long time results.
>Studies, as far as I am aware,have all been with animal subjects.
only the last one , which was cited. There had been many studies with humans before , all indicating that acid+bile is much worse than acid alone.
>The language of the article is full of words like maybe, perhaps...
indeed , that's always the problem with doctors , also with politicians,lawers,etc . A bit less with scientists but even mathematicians use them. WHY CAN'T THEY JUST GIVE A NUMBER FOR THEIR ESTIMATED PROBABILITY ????
>and Dr.DeMeester includes the following statement: >Dr. DeMeester believes that for these reasons, the increasing >reliance on powerful acid suppression medication is directly linked >to the rise in Barrett's esophagus and the cancer related to it.
This a pretty strong formulation , which makes me assign a probability of 90% to it.
>Although he is concerned that increasing availability of >over-the-counter H2 blockers may exacerbate the problem even further, >he cautioned that the acid-suppression therapy link with Barrett's is >not necessarily a cause-and-effect relationship.
I don't understand this. If it exacerbates the problem , then it causes a negative effect to it.
>"However," says Dr. DeMeester, "all the data we have on lung cancer >and smoking is based on the same kind of relationship, and I >cannot dispense this relationship as being unimportant."
noone doubts the relationship between lung cancer and smoking AFAIK. He seems to suggest that the relationship between antacida and EC is just as obvious.
>So, we will have to wait and see what further research shows.
how long will we have to wait ? We might get cancer in the meantime. These studies were from 1996. What happened since then ? Has the pharma-industry succeeded to keep him quiet or what ?
Using the comparison above , should the same be suggested to smokers (waiting ,what further research shows) ?
>If anything I would say that this would indicate that one should >be checked via endoscopy on reasonable schedule.
It DOES also suggest to decrease the use of antacida. And to prevent duodenogastric reflux , if possible.
As to endoscopy , how often would be "reasonable" ? If I have Barrett's , what's my chance to die of EC a) without endoscopies b) with endoscopy each 6 months c) with endoscopy each 2 years
If I'd ask this a doctor , I wouldn't expect to get a number as answer. Will you give me one ? Just your personnal, subjective estimate .
And, if I were female , and thus 3 times less likely to get EC , were reasonable intervals 3 times those of males ?
Werner.