Digestive Health Institute

I recently read an interesting article on prescription medications to treat gastrointestinal disorders in children. The article is based on analyses by Medco Health Solutions, a recent spin-off from Merck & Co that, ironically, operates the nation’s largest mail-order pharmacy operation. It turns out the number of children taking prescription medications to treat gastrointestinal disorders has increased significantly in the past five years. Looking at prescription drug claims of more than 575,000 insured children they found that the “number of infants and preschoolers (4 and under) taking medications to treat gastrointestinal conditions rose almost 56 percent from 2002 to 2006, and the prevalence (the proportion of children) of elementary school-age children (5-11 year olds) using these drugs increased by 31 percent during that time frame”. Based on the analysis, they estimated that more than 2 million children in the U.S. used these drugs in 2006. Not surprisingly, the most commonly prescribed gastrointestinal medications were proton pump inhibitors (PPIs) used to treat chronic acid reflux. These drugs are the second leading class of drugs sold in the U.S., trailing only lipid lowering medications in sales.

There was even an increase in the use of PPIs and H-2 blockers for infants, according to Dr. Robert Epstein, chief medical officer for Medco. "While there are babies that do require drug treatment for extreme cases of GERD and other gastrointestinal problems, in some cases parents and physicians may be looking to medications when non-drug treatments might be adequate."

Obesity, stress and life style were cited as possible causes of this dramatic increase in kids with GERD and other intestinal ailments. Non-drug treatments cited for GERD included eating smaller, more frequent meals; avoiding food 2 to 3 hours before bed; using an elevated sleep position with the head at a 30 degree angle; and no carbonated drinks, chocolate, caffeine, and food that are high in fat or are very acidic or spicy.

New Research on the Root Cause of GERD

The book Heartburn Cured presents a strong case that carbohydrate malabsoption may be at the root of GERD for infants, children and adults. The idea is that certian carbohydrates (like lactose and various starches) tend to be more difficult to digest and escape absorption in the small intestine. These carbohydrates are then available to feed intestinal bacteria. When the bacteria overgrow, they produce huge amounts of gas. Thirty grams of starch can give rise to ten liters of hydrogen! The gas pressure builds up in the intestines and stomach and that is what drives acid reflux! This key concept led to the development of a glycemic index based diet to treat GERD. The diet is also presented in the book Heartburn Cured. The glycemic index - based approach can be used in conjuntion with many other tried and true remedies, some of which are mentioned above (By the way, I don't believe fats cause reflux. For more details, check out my article on Trigger Foods and A Unifying GERD Theory that discusses why fats got a bad rap in GERD).

Ironically, the same process of carbohydrate malabsorption and bacterial overgrowth has been advanced as a major contributor to Irritible Bowel Syndrome or IBS. To read more about it, check out Mark Pimentel's book, A New IBS Solution. The book is very well written and makes a strong case including a good deal of clinical research on the subject conducted by Dr. Pimentel and his colaborators over the last decade. The thing that surprised me a bit is the recommendation of antibiotic treatment as the first line of defense. The reason is that antibiotic treatment is considered to be the gold standard for small intestinal bacterial overgrowth. Still, my reasearch leads me to believe that a glycemic index based diet approach should be tried first for both IBS and Acid Reflux. The overuse of antibiotics leading to antibiotic resistant bacteria is a growing global crisis. There is actually very little current research dedicated to new antibiotic discovery and what will we do when the bad bacteria are resistant to all the antibiotics we have. In some cases, like Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant enterococci (VRE) we appear to already be there..

The malabsoption concept is very new on the scene of GERD (and other GI) research and unfortunately, was not considered as an alternative treatment for GERD in the article discussed above. New concepts are often times slow to be broadly implemented, particularly in light of the tremendous marketing barrage from the widely suscribed prescription medicines used in patient treatment. The most popular meds are the PPI blockers like Nexium and Prilosec.. Given the many problems with these meds (increased risk of bacterial overgrowth in the stomach, increased risk of osteoporosis and increased risk of pneumonia) based on the permanent blocking of virtually all stomach acid production, alternative treatment options are desparately needed.

It's not surprising that so many children are suffering from chronic acid reflux symptoms. It fits the malabsoption concept well. Think about it. The amount of junk food that kids eat is amazing. The key ingredient in junk food is the huge amount of starchy carbohydrates. Spreading the word about the causative role carbohydrate malabsorption in acid reflux as well as IBSs and how to best treat it is a slow process because it challenges current advice from the majority of doctors and the marketing blitz by big pharmaceutical companies designed to sell as many drug prescriptions as possible, even for infants.