By Lisa Marshall

It’s a sensation that more than half of us experience now and then, often rising up in our chest after a day of overindulging in Grandma’s favorite recipes or a night of spicy food. But for an increasing number of Americans, the hot, painful rush of heartburn has morphed from an occasional distraction into an almost daily occurrence that can impair sleep, sour breath, lead to chronic upper respiratory infections, and, if left unchecked, increase the chance of cancer of the esophagus eightfold.

According to the American College of Gastroenterology, as many as 15 million Americans suffer from gastroesophageal reflux disease (GERD), a chronic condition that results when caustic stomach juices regularly rise out of the stomach into the more sensitive esophagus, producing a chronic burning sensation.

While the true cause is a matter of some debate (suspected culprits range from diet and lifestyle choices to genetics or structural problems in the digestive system—see “Plumbing Problems” , conventional medicine has met the disease largely with the same approach for decades, prescribing medication to either neutralize or minimize stomach acid.

First came acid neutralizers, like Tums, that offered some relief but caused diarrhea and constipation. Then came H2 antagonists, like Zantac, which only partially suppressed the acid and were recommended only for temporary relief. Then, in 1988, came proton pump inhibitors (PPIs), a potent new class of drugs that suppress stomach acid production for more than 24 hours and are commonly prescribed for long-term use.

Since their invention, the PPIs have become the second most popular class of prescription drug in the US, according to the market research firm IMS Health, bringing in more than $12.5 billion in sales in 2004 alone. Thanks to a $260-million-per year advertising campaign that has made the “little purple pill” a household word, AstraZeneca’s Nexium is now the fastest growing drug in America. And because its pre-cursor, Prilosec, is now available over-the-counter, many are popping the pills without ever consulting a doctor.

That concerns David Scrimgeour, LAc, a practitioner of oriental medicine in Boulder, Colorado.

“Any time you disrupt a necessary bodily function (like acid production) you are going to have issues down the road,” says Scrimgeour.

A growing body of research has shed light on the long-term risks of using PPIs—increased susceptibility to infection and an inability to absorb nutrients being two—and many in the health care community now urge patients to steer clear of them and try a more holistic approach instead.

“These drugs are not dealing with the root of the problem,” says Scrimgeour. “If you can get everything back into balance, get their diet right, and cut down the stress, you can cure this.”

The value of stomach acid
Anil Minocha, MD, director of digestive diseases and nutrition at University of Mississippi Medical Center, says that PPIs have proven helpful in offering symptom relief to GERD sufferers and in giving the esophagus a chance to heal. But he fears that the constant stream of advertisements promoting them is leading to overuse—even among people who don’t have GERD.

“With all this direct-to-consumer advertising, people have become more aware of the drugs,” says Minocha, author of Natural Stomach Care: Treating and Preventing Digestive Disorders with the Best of Eastern and Western Healing Therapies, (Avery, 2003). “The question now is whether they are taking more pills because they are