GERD (acid reflux) symptoms can be eradicated in most cases by “the purple pill” or it’s cousins (Proton pump inhibitors – PPI’s). These meds have therefore entered our top 10 lists of most prescribed drugs. So as I previously asked –what’s the problem? There are several problems all related to function. First, the cause of GERD is rarely, if ever. excess acid. The malfunctions resulting in reflux are slow stomach emptying and lack of tight closure of the lower esophageal sphincter. Some have also argued that overgrowth of bad bacteria in the small bowel is a big contributor. Acid produced by the parietal cells of the stomach plays an important role in digestion. It activates enzymes needed for protein digestion and initiates rhythmic contractions of the small bowel for the movement of food among other functions. PPI’s have been shown in the scientific literature to reduce vitamin B12 levels and reduce absorption of magnesium and calcium. Bone loss and increased fracture rates have been observed in recent studies. Also, it is hard to discontinue PPI’s once started due to a rebound of acid production. It therefore doesn’t make sense to prescribe PPI’s to shut down acid production as a primary treatment for reflux. Proper usage is when other treatments fail and the consequences being experienced are severe such as in folks with esophageal stricture or Barrett’s Esophagus (pre-cancer of the lower esophagus). In the last 3 years, I have discontinued PPI’s 10-1 over starting them and my patients are delighted. How is this done? Details Friday.