WebGerd.com went offline a couple years ago
and no longer belongs to Dr. M. Farivar. The material that was presented
in that website is now available to you here at www.web-gerd.com. Moreover,
Dr. Farivar has created a separate new website dedicated to Irritable
Bowel Syndrome (www.GERD-IBS.com).
We hope you will find the new website just as helpful.
The information on this page will keep you apprised
of significant new developments as they arise.
March 11, 2013
Since the last update in 2005 much has been written
about diagnosis and treatment of GERD. Webgerd went off line for a while
but believe it or not, you have
not missed much. There has been multiple trials of new devices and procedures
to strengthen the lower esophageal sphincter, none has been what I can recommend
to my patients requiring surgical intervention. In a recent multi-center study,
using a magnetic device to augment the lower esophageal sphincter, however,
improved symptoms and reduced use of PPIs in 60% of patients. (Ganz R A
et al. N Engl J Med, vol 368, no 8, pages 719-727, Feb 2013) I believe laparoscopic surgery using this magnetic device will be easy
enough alternative to a more complicated but definite treatment of
and it will be useful for the right patient.
July 1, 2005
Several new topics have been added as follows:
June 27, 2005
Zantac (Ranitidine) 150 mg is over the counter now; last
time I checked the cost of 60 tablet package was $22 at my local pharmacy.
The usual dose is 150 mg twice daily.
Prilosec 20 mg is also over the counter and 14 tablets cost
$11. Therefore one month supply of both costs about $22. In patients who need
to take 2 Zantac tablets daily it is more convenient and more effective to
take one Prilosec OTC.
Indeed, in my experience Prilosec 20 mg (omeprazole) is
as effective as Prevacid 30 mg (lansoprazole) and in most patients as effective
as Nexium 40 mg (esomeprazole) and Aciphex 20 mg (rabeprazole) and more effective
than Protonix 40 mg (pantoprazole).
Most of the time patient co-pay is equal or more than the
cost of one month Prilosec OTC. Again based on my experience, Protonix (panntoprazole)
that is the least effective of all PPIs has the lowest co-pay and is preferred
by most HMOs.
Zantaz 150 mg and Prilosec 20 mg, do not require prescription
In treating Barrett’s esophagitis patients who are found
to have high grade dysplasia or superficial carcinoma on biopsy specimens and
are not candidate for surgery and esophagectomy, new endoscopic therapeutic
modalities have been proven effective and approved by FDA. (check treatment
of dysplasia in Barrett’s)
Diagnostic studies: Impedance 24 hour pH studies is, in
my opinion, the most useful test developed to date for diagnosis and treatment
of difficult to diagnose and treat GERD patients.
Electron microscopic studies show that patients who have
Non-Erosive reflux disease (NERD), exhibit dilated intercellular spaces in
the superficial esophageal mucosa, which returns to normal after effective
June 24, 2005
The best news
for chronic reflux sufferers is Prilosec going over-the-counter. Prilosec(Omeprazole)
has been around for a long time and has an excellent safety record similar
to other PPIs (Omeprazole=Prilosec, Esomeprazole= Nexium, Lansoprazole=Prevacid,
Pantoprazole=Protonix, and Rabeprazole=Aciphex). It is offered however, for
reasons unkown to me, much cheaper than prescription PPIs (typically $1 vs.
$3-4/tablet or capsule of similarly effective PPI) even though it is as strong,
as good and as safe.
Prescribed Medication page has been updated. The following new topics
- Recommended Strategy for Using PPIs
- Points to Remember about PPIs
- Potential Side Effects of Long-Term PPI Therapy
Breakthroughs in Barrett’s
(Photodynamic Therapy, Argon Plasma Coagulation, Multipolar Electrocoagulation,
Endoscopic Ultrasound, Treatment of high grade dysplasia and superficial carcinoma)
section was added to Endoscopy Surveillance
in Patients with Barrett’s Esophagus.
June 22, 2005
A new section titled "Benefits of Breastfeeding for Infants with Reflux" has
been added to GERD in Infants and Children page
as well as GERD Treatment Options in
Infants and Children.
March 6, 2003
The FAQ section has been updated with recent findings concerning the effectiveness
of the various PPIs in GERD treatment.
A Clinical Survey Comparing the Effectiveness of Esomeprazole and Pantoprazole to Traditional PPIs (Omeprazole and Lansoprazole)
in Relieving Severe Heartburn.
For your information, we have posted a letter
from a practicing physician who has visited our site regarding the Relationship between the combination of GERD and atopy - causing Eustachian
tube dysfunction - with progress to recurrent early OM and middle ear effusion. Please
send us you comments about this observation.
July 30, 2002
In a preliminary study presented at the 2002 Digestive Disease week in San
Francisco, Cleveland Clinic researchers have shown that telomerase activity
is upregulated in the area of intestinal metaplasia up to 10 years prior to
development of high grade dysplasia and adenocarcinoma by using a telomerase
enzyme immunostaining technique. Patients with Barrett’s that do not express telomerase
activity in their nuclei do not develop dysplasia.
October 29, 2001
Due to public demand we have added a new section about GERD diagnosis and
treatment options in infants and children. Appropriate information is provided
for both patients and physicians under their respective buttons.
August 17, 2001
US Food and Drug Administration (FDA) approved in March 2001 the first
IV PPI, Pantoprazole. IV Pantoprazole is useful in patients who are unable
to take PPI oral therapy, including hypersecretory states, ICU patients with
risk factors for stress ulcer, prevention of ulcer bleeding after endoscopic
treatment, prevention of aspiration pneumonia and pts with severe GERD who
are unable to take oral meds. The recommended dosage is 40 mg once daily,
given via intravenous infusion. The infusion should be given over a period
of 15 minutes at a rate not greater than 3mg/min. However, the studies have
shown that in order to keep intragastric pH around 7 in patients with ZE,
one has to give an 80 mg rapid IV bolus followed by infusion of 8 mg / hour
(seven vials of 40 mg). In practice, IV Pantoprazole is given in a dose of
80 mg bid.
May 6, 2001
Surpass (an antacid chewing gum) - Recently, Wrigley
Healthcare has released a chewing gum that is coated with 450mg of calcium
carbonate. Calcium carbonate neutralizes the acid and relieves heartburn
immediately. While continuing to chew gum will produce saliva, and since
Saliva's pH is alkaline, the swallowed saliva will continue to neutralize
the remaining acid. Like Tums, Surpass may be used as calcium supplement
Wrigley Healthcare is recommending www.web-GERD.com as the
resource for patients with GERD (slide).
April 15, 2001
Two new medications have recently been released
that provide improvement over previous medications prescribed for relief
of heart burn. They are:
Pepcid Complete (over-the-counter) - a combination of
Pepcid AC (Famotidin) and a calcium carbonate antacid. Famotidin is an H2-blocker
which reduces acid secretion within 45 minutes to an hour of ingestion. The
calcium carbonate acts immediately to neutralize the acid already present
in the stomach. This combination provides both short term and long term relief.
Esomeprazole, the recently released S-isomer of Omeprazole
(Prilosec), has been shown to provide improved acid control (slide
1), healing (slide 2), and
symptom resolution in reflux esophagitis patients, when compared to Omeprazole.