Health: Got A Bad Gut Feeling?

After 40 years as a truckdriver, Cecil Albertson is pretty tough. But three years ago he began to dread going to sleep at night. When he lay down, says the 77-year-old Albertson from Blue Springs, Mo., stomach acid would back up into his throat. His doctor told him to take Rolaids, but the problem only got worse. Then a gastroenterologist diagnosed his condition as reflux disease and switched him to a prescription drug called Aciphex. Now he's sleeping soundly.

You may not have heard of reflux or some new prescription antacids like Aciphex. But chances are, if you've read a magazine or watched TV lately, you've seen ads for similar drugs, including Prevacid, Protonix and those "purple pills" (as the ads call them), Prilosec and Nexium. Last year these drugs racked up sales of $10.2 billion, second only to cholesterol-lowering statins. Nearly 75 million prescriptions for these medications were dispensed in 2001. Some HMOs now balk at covering the pricey pills--costing as much as $8 a day--and suggest they're overprescribed. The drug companies counter that ads have merely raised awareness of a condition. Who's correct--and when do you really need the pills?

The cause of most chronic heartburn is gastroesophageal reflux disease (GERD). Normally, when a person swallows, the muscle at the bottom of the esophagus opens to allow food into the stomach. But the muscle can weaken, letting food and acid back up, particularly when a person is lying down. Chronic exposure to acid can inflame the esophageal lining and may even lead to a precancerous condition.

Drugs like Prilosec and Prevacid inhibit the formation of stomach acid and are most commonly prescribed for GERD. Given the increase in prescriptions, one might think GERD is on the rise. But according to Dr. Prateek Sharma of the American Gastroenterological Association, it's remained fairly constant over the last 30 years, with 20 percent of the adult population experiencing weekly heartburn. In the old days, though, few people sought a physician's help. The ads have helped change that.

Not every bout of heartburn calls for an Rx pad. For occasional symptoms, an old-fashioned antacid like Tums may neutralize enough acid. But for heartburn that occurs twice or more a week, drugs like Zantac, Tagamet and Pepcid (available over the counter and by prescription at higher strengths) are better. Popular since the 1980s, they clear up symptoms in about half of patients by reducing acid formation. But to be effective, they must be taken daily. If a patient's GERD persists, the newer drugs like Aciphex will usually take care of it. These eliminate more than 90 percent of acid by blocking the final step of its production in the stomach.

Side effects are generally minor; the most common are headaches and diarrhea. But doesn't the lack of acid affect digestion? "No," says Dr. Stuart Spechler, chief of gastroenterology at the Dallas V.A. Medical Center. "The acid's main function is to kill bacteria in food." In patients on antacids, there seems to be enough acid left to do the trick. But these drugs, to the dismay of insurers, also must be taken regularly.

The good news is that Prilosec's main patent expired in October, and, assuming FDA approval later this year, an over-the-counter version could be available by early 2003. Before that happens, Prilosec's maker, AstraZeneca, is trying hard to switch Prilosec patients to Nexium, the new, more refined (and still patented) version of the same drug. In two of four studies, Nexium was slightly more effective. But the greater advantage, say skeptics, is not to patients but to shareholders, since the company can continue selling an exclusive drug. After all, the prospect of losing billions in revenue is enough to give you--what else?--heartburn.