The Latest The American Gastroenterological Association (AGA) last year sorted through the many controversies about managing the Condition Formerly Known as Heartburn, now called gastroesophageal reflux disease (GERD). In GERD, stomach acid escapes into the esophagus, causing discomfort and potentially damaging the esophageal tissue. The AGA says antacids (like Tums and Rolaids) and H2 receptor antagonists (like Tagamet HB and Pepcid AC) are effective at managing symptoms in mild cases, and a combination of both is better than either alone.
Proton pump inhibitors (PPIs) like Prilosec and Prevacid are deemed equally effective at relieving discomfort; unlike the other remedies, these prescription drugs heal sores in the esophagus. Nexium is slightly faster but no better than the other PPIs at healing erosions.
While earlier research suggested a strong connection between GERD and esophageal cancer, the AGA's review of the latest research suggests that this link may be quite tenuous.
Barrett's esophagus -- a condition affecting about 5 percent of those with GERD, in which cells similar to those in the stomach grow in the esophagus, where they're not protected by the stomach's inner coating and are vulnerable to damage from stomach acids -- was previously thought a common precursor to cancer. But of those with the ailment, only 0.5 percent per year -- a quarter or half as many as previously believed -- will develop esophageal cancer, the AGA notes.
Irritable bowel syndrome (IBS) sufferers saw the reintroduction this year of Lotronex, hailed by many as the only treatment available for the form of the syndrome characterized by frequent diarrhea but reviled by others because it was implicated in several deaths before it was voluntarily withdrawn from the market in 2000. Since the drug's re-approval by the Food and Drug Administration (FDA) in June, it is available only under tight controls. Those with the form of IBS characterized by constipation welcomed the first-ever drug treatment, Zelnorm tablets, which received FDA approval in July.
Research published in March found that women who had a parent or sibling with colorectal cancer and whose diets included little folic acid were 2.5 times as likely to develop the disease as those with no family history, while women with family histories who consumed 400 micrograms of folic acid daily and kept alcohol intake to a minimum were no more likely to develop the disease than women with no family history.
And researchers reporting in the December issue of Gasterenterology found that women who drank four cups of coffee daily had a 25 percent lower risk of needing gallstone surgery than those who drank no coffee.
Recommendations For GERD: You can view the new treatment guidelines at the AGA Web site, www.gastro.org/.
For colon cancer: As of last summer, the U.S. Preventive Services Task Force (USPSTF) now "strongly" recommends -- rather than simply recommends, as it had since 1996 -- that everyone over 50, men and women, get screened annually. The task force says there's not enough evidence yet to recommend one screening method over another, so physicians and patients should decide together whether to go with colonoscopy, sigmoidoscopy, at-home fecal occult blood test or barium enema. GI groups have shifted emphasis to screening as the best defense against colorectal cancer after research in 2000 showed that, contrary to longstanding medical belief, dietary fiber does not help prevent the disease.
The Next Thing Antegren, the first in a new class of drugs called selective adhesion molecule inhibitors, is in Phase III clinical trials as a treatment for Crohn's disease (an often debilitating inflammation of the GI tract that leads to diarrhea and abdominal cramping). The drug could reach the market by 2004 or 2005.
Worry Index GERD: 61 million cases in the United States. (AGA)
Esophogeal cancer: 13,100 Americans diagnosed annually; 12,600 die. Most cases occur in men. (National Cancer Institute)
IBS: 54 million Americans, two to three times as many women as men. (American College of Gastroenterology)
Colorectal cancer: 143,300 U.S. adults diagnosed in 2002; nearly 57,000 die (USPSTF); second only to lung cancer as cancer killer.
Peptic ulcer: Approximately 500,000 new cases reported in the United States each year; 5 million affected in any given year. (Johns Hopkins Gastroenterology & Hepatology Resource Center)
Stomach cancer: 21,600 new cases in 2002; 12,400 deaths. (American Cancer Society)
Crohn's disease: Affects half a million Americans. (CCFA)
Hype-O-Scope Heavily advertised as "the new purple pill," Nexium isn't substantially better than its older cousin, Prilosec, at treating GERD or healing esophogeal erosions, says the AGA. The two drugs' maker, AstraZeneca, introduced Nexium in the midst of patent disputes threatening Prilosec's market exclusivity and the company's bid to make Prilosec available over-the-counter. With U.S. sales of $3.7 billion in 2001, Prilosec is the world's leading prescription GERD drug and one of the best-selling Rx drugs ever.
For More Information American Gastroenterological Association: www.gastro.org/
American College of Gastroenterology: www.acg.gi.org/
Johns Hopkins Gastroenterology & Hepatology Resource Center: www.hopkins-gi.org
Crohn's and Colitis Foundation of America: www.ccfa.org
-- Jennifer Huget