Corrosive Stomach Acid

By Shawn Vuong


A wise pharmacology professor once told me, "All substances are poisons; there is none which is not a poison.  The right dose differentiates a poison and a remedy."  


This week Dr. Holm talks about drugs, particularly in the context of heart burn.  In our pharmacology class, we are learning about how all types of drugs interact with the body.  Prescription drugs, over-the-counter drugs, herbals, and even supplements all effect the body in different ways.  The key to prescribing drugs correctly is weighing the risk of toxicity of a drug versus the benefit gained. 


Each substance has it's own toxic effect when given at too high of doses.  But we must make the dose high enough to see a benefit.  In effect, we get a titer-totter like scenario where we are trying to balance the correct dose to see benefit while trying to limit toxic effects (also known as side effects).  Some drugs are easy to give, since they have a high benefit but low toxic effects such as statins.  Other drugs have medical health professions constantly walking that fine line between lethal effects and benefit to the patient such as chemotherapy agents or anesthetics.  


So remember, every substance has toxic effects when given at incorrect doses.  Even water can cause lethal effects if you drink too much.  So, please work with your doctor to correctly dose your medications, because they can sometimes give you nasty side-effects.  




_________________________________________________________________________




By Richard P. Holm MD


It has always amazed me that the stomach can produce large amounts of a very corrosive hydrochloric acid. Of course, we do that in order to breakdown food so our bodies can absorb nutrients.


In response to food stretching the stomach and esophagus, tiny proton-pumps in special cells that line the stomach make acidic stomach juice. The resultant strength of gastric acid during digestions can be not as corrosive as battery acid, but almost.


Fortunately, a special layer of mucus protects the stomach from the acid, and as food moves on into the small intestine, the corrosive juice is neutralized by sodium bicarbonate produced by the pancreas.


When something goes wrong: the stomach-mucus layer fails; the acid rolls up into the unprotected esophagus; or there is not enough sodium bicarbonate to neutralize the acid… then symptoms occur. People can be pretty miserable as digestive juices are eating away at their own tissue, rather than the food they just ate.


Fortunately we have very effective medications to reduce acid production when something goes awry. One group of antacids, which reduce acid quickly are the H2 blockers with ranitidine (Zantac) as an example. Another group, which reduce acid slower but more effectively, are the proton-pump inhibitors, with omeprazole (Prilosec) as an example.


These two types of powerful antacids have been a blessing for many people who truly suffer from excess acid stomach. A major drawback with both types of medicines, however, comes when trying to stop them, which can result in rebound acidity.


A recent study provided two months of omeprazole to people who at start had never been troubled with heartburn. When the medicine was stopped, however, the volunteers had rebound acid symptoms.


People need to be warned when using these stomach acid medicines that short-term use is safe and can be very helpful. However, getting off of them after prolonged use can be a challenge and may require a gradual reduction over two to three months. Certainly some people should never be off of them, but that should be discussed with your doctor.


Take home message: we have good medicines to counter the corrosive battery-like acid made in our stomachs, but they need to be used with caution.