Nexium and the other proton-pump inhibitors are great at reducing stomach acid, but that might have some unintended consequences.

 Madison Avenue has given stomach acid a bad name, but it's really kind of a bum rap. Dip into any physiology textbook, and you'll find that stomach acid serves several constructive purposes. Pepsin, an enzyme that is essential to the preliminary digestion of protein, needs an acidic environment in the stomach to be effective. The strongly acidic hydrochloric acid pumped out by cells in the lining of the stomach also plays a direct role in the early digestion of some foods. And stomach acidity is a built-in barrier to infection: many bacteria and other pathogenic fellow travelers don't make it out of the stomach alive because of the low pH levels they encounter there.

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Doctors call it gastroesophageal reflux disease, or GERD. Millions of men call it heartburn, and many others have coughing, wheezing, or hoarseness without realizing that GERD is to blame. By any name, GERD is common, bothersome, and sometimes serious. It is also expensive, draining the American economy of more than $9 billion a year. But once you know you have GERD, you can control it and prevent complications.

Q. I've been taking Prilosec for many years for GERD. Recently, I once read that long-term use of proton pump inhibitors could increase the risk of stomach cancer. Your opinion?

A. Prilosec is a pump inhibitor (PPI). These drugs have revolutionized the treatment of gastroesophageal reflux disease (GERD), in which stomach acid flows back into the esophagus and causes heartburn.

Small Intestine

H. pylori Infection May Aggravate GI Injury in Patients Taking Low-dose Aspirin

Doctors commonly prescribe low-dose aspirin for the prevention of heart disease, but it may also be responsible for some potentially serious side effects when taken frequently. Among the most common of these are gastrointestinal erosions and ulcers.

A recent study in The American Journal of Gastroenterology sought to determine whether certain people taking low-dose aspirin — specifically, people infected with Helicobacter pylori, a common bacterium that can cause ulcers — are more susceptible to gastrointestinal erosions and ulcers than people who are not infected with H. pylori.

Study Links Smoking to Colorectal Cancer

Lung, mouth, and bladder cancers, among others, are well established as cancers caused by cigarette smoking. A recent study from the American Cancer Society, published in the Journal of the National Cancer Institute shows that cigarette smoking also raises the risk of dying from colorectal cancer, which is cancer of the colon or rectum. Indeed, the study notes that as many as 12% of colorectal cancer deaths in the United States may be associated with smoking.

Researchers analyzed data from 312,332 men and 469,019 women enrolled in the Cancer Prevention Study II. They found that for both men and women, risk of colorectal cancer increased after 20 or more years of smoking. Among men, current smokers were 31% more likely to die from colorectal cancer than nonsmokers; female smokers were 41% more likely than nonsmokers to die from the disease. The risk of death from colorectal cancer rose with the number of years cigarettes were smoked, the number of cigarettes smoked per day, and the number of packs smoked over the years. In addition, the risk of death was higher the younger a person was when he or she started smoking. The association was not confined to cigarette smoke. Those who smoked pipes or cigars also faced a significantly increased risk of death from colorectal cancer.

The bright spot of the study was that it showed a benefit from quitting. Twenty years after quitting, men's risk of colorectal cancer death returned to normal. And women who had stopped smoking 10 or more years earlier had the same risk as nonsmokers. The take-home message: If you smoke, stop. If you don't smoke, don't start.

H. pylori Infection May Aggravate GI Injury in Patients Taking Low-dose Aspirin
Doctors commonly prescribe low-dose aspirin for the prevention of heart disease, but it may also be responsible for some potentially serious side effects when taken frequently. Among the most common of these are gastrointestinal erosions and ulcers.

A recent study in The American Journal of Gastroenterology sought to determine whether certain people taking low-dose aspirin — specifically, people infected with Helicobacter pylori, a common bacterium that can cause ulcers — are more susceptible to gastrointestinal erosions and ulcers than people who are not infected with H. pylori.

Irritable bowel syndrome (IBS) is a chronic disorder characterized by recurrent bouts of constipation, diarrhea, or both, as well as abdominal pain, bloating, and gas. IBS is a functional disorder, which means that it's not attributable, as far as we know, to any underlying disease process or structural abnormality. It's thought to involve various, often interacting, factors — infection, faulty brain-gut communication, heightened pain sensitivity, hormones, allergies, and emotional stress.

The good news is that IBS doesn't increase the risk for more serious conditions, such as ulcerative colitis or colon cancer. On the other hand, a disorder resulting in (at best) annoying and (at worst) debilitating and worrisome symptoms with no known cause can be difficult to diagnose and treat, not to mention live with. Managing IBS typically involves some trial and error, which can be challenging for patients and clinicians alike. Various tests or procedures may be ordered to rule out other conditions. Many diverse therapies, not all of them proven, are used in treating the symptoms, including antibiotics, antispasmodics, antidepressants, dietary changes, relaxation techniques, and psychotherapy, as well as drugs to relieve constipation and diarrhea.

Gallstones

Questions to Discuss with Your Doctor:

• Do you have pain in the mid- or upper-right portion of your abdomen?
• Do fatty meals worsen the pain?
• Does the pain occur after eating?
• Do you have nausea, vomiting, or bloating?
• Does the pain ever go through to your back?
• Is the pain steady or intermittent?
• Have you had fevers?
• How long does it take for the pain to go away?
• Do you take any medications (for example, birth-control pills or hormone therapy)?
• Have you had any rapid weight loss?
• Have you noticed darkening of your urine or yellowing of the eyes?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Blood tests of liver function
• Complete blood count
• Abdominal ultrasound
• Cholescintigraphy (HIDA scan)