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Heartburn and wheezing may have something in common.

A report at the recent meeting of the American College of Gastroenterology suggests that some forms of asthma may be related to heartburn, that painful sensation beneath the lower breastbone that actually has nothing to do with the heart.

Doctors examined a group of 26 asthmatic patients in a Springfield, Illinois, pulmonary clinic to see what was causing their symptoms. Was the same gastric juice that had been causing some of the patients to have heartburn also irritating their airways? Gastric juice is produced in the stomach (the lining of which is impervious to its acid content), but sometimes it backs up into the esophagus. The esophageal lining then cries out in pain as the acid attacks its tender cells. This "gastroesophageal reflux" perhaps irritates the airways by one of two mechanisms: small amounts of gastric juice directly aspirated into the lungs from "burping," or indirect irritation resulting from some reflex mechanism.

A probe placed in the middle portion of the esophagus measured changes in acid level over a 24-hour period. Seventeen of the 26 patients showed significant increase in esophageal acidity, and all but two of the 17 reported previous problems with heartburn. When treated for their gastroesophageal disease, 40 percent of the patients noted improvement in both their heartburn and pulmonary symptoms. The study was small, to be sure, but it suggest that some asthmatics who also have heartburn may obtain relief from their wheezing when treated for their reflux problem.

Acid-suppressing medication helps most patients with chronic heartburn, but for some, the lining of the esophagus has become severely inflamed and even ulcerated by the reflux of stomach acid. One group of drugs, called H2 antagonists because they block a specific acid receptor in the stomach known as the histamine 2 receptor, is very effective in healing stomach ulcers. However, they have been less so in esophagitis patients due to stomach acid reflux. By using much larger doses of famotidine, a very potent H2 antagonist, researchers have recently obtained much better results in treating esophagitis.

Patients experienced the best relief from heartburn, particularly at night, when treated for a 12-week minimum on doses as high as 40 mg twice a day. These more potent drugs are expensive, however, and the rare patient with ulcerative esophagitis would do well to try preventive measures as well. Careful choices of food, abstinence from alcohol and smoking products, and elevation of the head of the bed are just some of the ways to relieve and heal this serious disease.
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Publication:Medical Update
Date:Sep 1, 1991
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