By Dr. W. Gifford Jones
Are you taking antacid tablets you don't need? Or using anti-ulcer drugs that don't ease your stomach troubles? I recently discussed this perplexing problem with Dr. Michel Boivin, Professor of Medicine at the University of Montreal. His answer threw new light on the cause of gastrointestinal disorders and suggested a new way to treat them.
Stomach ulcers have always been associated with excess production of hydrochloric acid in the digestive system. To combat the painful symptoms doctors routinely advised frequent small feedings and liberal amounts of milk to soak up excess acid. They also ordered antacids to counteract the irritating actions of gastric juices. Or prescribed anticholinergic drugs which decreased the activity of the nerves stimulating cells to produce hydrochloric acid.
A major breakthrough occurred when H2 receptor antagonists became available. These new drugs acted directly on stomach cells and prevented the formation of histamine which stimulates production of hydrochloric acid. Doctors believed that many gastrointestinal disorders would be relieved by these drugs.
For many long-suffering peptic ulcer patients H2 receptor antagonists were a gift from Heaven. Their stomach cells quickly decreased production of hydrochloric acid and the patient's gnawing pain disappeared in a few days. Within six to eight weeks the ulcer was completely healed.
But in recent years it's become increasingly apparent some of the bloom is off the rose. Gastroenterologists began to see that acid suppression with the H2 receptor antagonists did not always resolve G.I. symptoms in the long run.
Dr. Boivin explains there's good reason why some patients fail to respond to this treatment. Their problem is not due to excess production of hydrochloric acid. Rather, the symptoms are due to "dysmotility", a lazy gastrointestinal tract. The peristaltic waves that normally move food along the tract have become rusty and sluggish.
DR. Boivin's own research reveals that about 50 per cent of patients seeking medical help for G.I. complaints have dysmotility of either the esophagus, the tube that carries food to the stomach, the stomach itself or the lower bowel. He says many of these patients have been taking antacids or H2 receptors without finding relief.
The Montreal researcher claims there are three types of dysmotility. The most common, reflux esophagitis, is associated with heartburn and regurgitation. Dyspepsia, another common problem, causes bloating, indigestion and a curtailed appetite easily satisfied by small meals. Patients with gastroparesis (lazy stomach) also share some of these symptoms ,but suffer from nausea and vomiting as well.
Delayed emptying of the stomach can be caused by anatomical factors, diseases that affect the stomach wall, drugs and diabetes. Studies show that diabetes has an adverse effect on the autonomic nervous control of the stomach.
Patients with a lazy gastrointestinal tract can be treated in several ways. Those who have suffered for years with heartburn and indigestion due to esophagitis can be helped by a change in lifestyle. Weight reduction, tossing away cigarettes, decreasing the intake of fat, caffeine and alcohol may be all that's needed. Elevating the head of the bed, not eating for two hours before retiring and an antacid may also be helpful. About 60 per cent of patients will respond to this treatment. The other 40 per cent need an H2 receptor antagonist to reduce acid production in the stomach.
If bloating and regurgitation is the main problem, patients need a prokinetic agent to stimulate the peristaltic action of the gastrointestinal tract. In addition they should eat smaller meals, consume less fatty foods, avoid nonsteroidal anti-inflammatory drugs and say no to acetylsaliyclic acid.
I'm sure prokinetic agents will add another dimension to the treatment of gastrointestinal disorders. But remember, you also can't get blood out of stones. It's impossible to lead a faulty lifestyle, continually abuse your stomach with the wrong foods and expect to obtain miracles from medication. If so you'll eventually agree that Nietzsche, the German philosopher, was right when he wrote, "The belly is the main reason why man does not mistake himself for a God."
How many people will develop lazy stomachs in the future? We know that every 60 seconds a new diabetic is diagnosed in North America. 90 per cent of these cases is due to obesity and I don't foresee a rapid decrease in this disastrous trend. You don't need a crystal ball to see that more people will develop diabetic degeneration of the nerves controlling the gastrointestinal tract. Regrettably the neglected and overworked stomach is here to stay.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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