What is acid reflux relief?

In medically oriented terms, antonyms of the word relief include pain, distress or damage. That links its meaning to both subjective and objective aspects. Subjective, denoting sensations experienced by the sufferer such as pain and objective, meaning physical findings detected by specialists which are either functional distress or organic damage. Actually relief is related to control measures and it quantitatively signifies removal of an unpleasant existence or reduction of its magnitude. The definition of relief, therefore encompasses alleviation of pain, relaxation of distress and healing of damage. Acid reflux on the other hand has two sides; the subjective side (symptoms) which reflects the symptom of heartburn and the objective side (signs) that reflects the functional and/or organic signs of esophageal changes. Acid reflux relief is therefore a broad term that covers all the measures used to control symptoms and signs of acid reflux disease. Normally, the lower esophageal sphincter remains closed except during swallowing. This prevents the passage of food and acid from the stomach into the esophagus. If the lower esophageal sphincter becomes weakened or relaxed, stomach acid may back up into the esophagus. Frequent acid reflux can irritate and inflame the lining of the esophagus, causing symptoms and signs of acid reflux. A better understanding of relief would thus entail knowledge of some aspects of normal structure and function, so that changes in the disease and its control could be easily considered. Actually acid reflux relief involves both preventive and curative measures, and in addition to treatment; orientation with the causes, symptoms and complications of acid reflux are essential for proper management. Acid reflux relief includes: dietary changes,lifestyle modifications, specific medications and surgical operations.Basic knowledge of the underlying causes and progression of acid reflux and answering frequently asked questions about its relief; add to the depth of understanding.

Monday, July 16, 2007

Acid Reflux Relief logoThe role of Proton Pump Inhibitors in acid reflux relief

What are proton pump inhibitors?
A pump is a utility that moves a substance against a gradient.
A well known example is the water pump which lifts water up against gravity.
In our case, there are cells in the membrane lining the stomach lumen, these cells produce acid and pump it against the concentration gradient set by the previously formed acid into the stomach lumen.
That means the concentration of acid in the stomach lumen is higher than that inside the cell and this gradient would favor movement of acid into the cell; however the cellular wall prevents this and at the same time pumps more acid into the lumen.
Just like the water pump needs electric enrgy to lift water upwards; the cellular wall utilizes chemical energy to pump acid outwards.
Acid is produced in the form of a positively charged subatomic particle called proton. The proton is the nucleus of the lightest chemical element, hydrogen. Actually the hydrogen atom consists of a proton as the nucleus, to which a negatively charged single electron is bound as opposite charges attract. Because the proton is 1836 times heavier than the electron, the proton is considered to constitute almost the entire mass of the hydrogen atom.
So how proton pump inhibitors affect this mechanism?
They accumulate on the luminal surface of the acid producing cells and inhibit the enzymes involved in the process of synthesis of chemical energy , essential for the pumping action.
Consequently; no energy, no pump activity and no acid production (no proton flow into the lumen of the stomach).
The above figure illustrates this cellular mechanism and also shows the receptor sites at which signals triggering acid secretion interact. These triggers are Histamine, Gastrin and Acetylcholine. They are chemical substances delivered around acid producing cells and are released from local cells, intestinal cells or nerve endings.

mechanism of acid secretion image

Mechanism of action of proton pump inhibitors image
The above figure also demonstrates how the acid pump is blocked and acid production consequently inhibited.
Examples of Proton Pump Inhibitors:
Omeprazole (Prilosec)
Lansoprazole (Prevacid)
Rabeprazole (Aciphex)
Pantaprazole (Protonix)
Esomeprazole (Nexium)
Proton Pump Inhibitors are used for both diagnosis and treatment. In the Omeprazole test: a dose of 40mg is given in the morning and another 20mg in the evening for 7days to a heartburn sufferer. If symptoms are relieved following this regimen, the diagnosis of acid reflux is confirmed. It is considered a noninvasive and easily available test with reasonable cost.
For acid reflux relief, they are considered the most effective agents and the standard medical therapy. All of them are effective but response may vary from patient to patient.Proper timing of intake is critical for efficacy, it should be 30minutes before breakfast or other large meal. For some patients with partial response or severe symptoms, the physician may advice a second additional dose before the evening meal. Being long acting (duration of action of a single dose is 24hours), they allow time for damaged tissues to heal. They have a healing rate of 80% in moderate to severe cases and relief of symptoms in up to 90% of patients. In comparison to Histamine type2 receptor antagonists, they are more effective and faster in promoting healing.