Heartburn Hints: When to Get on Medication, How to Pick the Right Medication, And How to Stop

A bit of heartburn after a bit of food indulgence is not unexpected, when it becomes chronic it might need medication. Most women have not learned that there is considerably more to selecting heartburn (GERD) medication than they thought as often we wind up taking these medications for longer period of times than intended, and with potentially longer term effects. Bone loss, increased for inflammatory bowel disease, and pneumonia are reported side effects of long term PPI use. So when selecting a medication, there are many factors you probably have considered, but there is the newest factor, your genetics, that few have taken into consideration.  

Like any medical  condition, with heartburn as a symptom we have to decide: why do I have this? How uncomfortable am I, should I take a medication and then as important how do I get off the medicine. As gynos we get many lectures on prescribing, but fewer on de-prescribing. If yo uare selecting the right medication and using it properly, it may be that you will be able to get de-prescribed and get taken off you medication soon than you might have.

Heartburn physiology is complex, but there are some simple explanations. A bit of acid refluxing up (being pushed up backwards) from the stomach, where acid is made and where the lining can withstand acid into the esophagus through the valve that is supposed to keep those acids out of the esophagus can cause heart burn. Over production of acid or over consumption of food can be the two biggest causes of heart burn. Women who experience regular (greater than once a week) can control heartburn through over the counter medications called PPIs. The treatment PPI or “proton pump inhibitor,”  prevent acid from being produced in the stomach.the less you produce, regardless of diet, weakness in the valve, or other factors, the less there is acid to reflux back and cause symptoms.

Being a woman may cause increased problems with heartburn. Specifically the hormones estrogen progesterone are related to heartburn.Hormone therapy in menopausal women with estrogen can increase heartburn. Progesterone treatments for common menstrual problems, early miscarriages, and contraception can even be linked to worse heartburn in susceptible women. In fact the  high estrogen and progesterone blood levels concentration during pregnancy and in the post partum time the high progesterone levels can not only decreases lower esophageal sphincter tone and cause more heart burn, it can slow the all sorts of smooth muscle function and decrease small bowel and colonic motility causing constipation, gallbladder emptying causing gall bladder troubles, and slow the movement of urine through the ureters so that stones are more likely to form! 

But how to pick the right one? Coupon? Always appealing to us. Packaging? We are all susceptible to great packaging, but really tell a book by the cover is not even up for discussion! Familiarity? To some extent that is just marketing! Friend recommendation, how do you know her physiology is like yours!? How about being able to pick your medication after sensible recommendation? According to research over the past decade and published in Pharmocogenetics, in March of 2004, by Furuta Proton pump inhibitors (PPIs), such as ones we commonly reach for, including,  omeprazole, lansoprazole, rabeprazole, esomeprazole, and pantoprazole, are metabolized by  a specific enzyme of digestion called  CYP2C19  (2C19cytochrome P450 isoenzymein) that functions in thee liver. . The genetic differences will effect  how your gene for CYP2C19 are classified into three groups: normal, lower and inability to metabolize.  Depending on your genetics the acid level response to the individual medications can vary widely. With the right medicine your acid levels in your stomach will improve greatly.

The how you metabolize and respond to currently available  PPIs differs based on your individual CYP2C19 genetics that you have. With the wrong genetics, the acid levels in your stomach will not improve.
Your blood levels of the PPI medicine that you take, and the resulting proper stomach acid pH levels during PPI treatment are the lowest in those that have  homEM group and the highest in the PM group. These CYP2C19  differences  PPIs are reflected in the cure rates for heartburn also known as  gastroesophageal reflux disease(GERD)  and common cause of stomach pain which is Helicobacter pylori infection both of which require PPI-based therapies. The CYP2C19 genotyping test is a useful tool for deciding on the optimal treatment regimen using a PPI, including a dual (PPI plus antibiotic) therapy.

How can you find out if you have these genetic individualized changes. that can be responsible for ineffectiveness or prolonged treatment? It's currently done by testing you for what genes you have and how those genes behave. Call Women's Health Practice for consultation.

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