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(October 1999)


Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"


1.    Nocturnal acid breakthrough: Some patients have heartburn symptoms at night despite being on PPI. They may be refractory to increasing doses of proton pump inhibitors (Prilosec, Prevacid, Aciphex). These patients respond better to an additional dose of H2-anatagonists (Zantac, Pepcid, Axid) at night rather than an additional dose of PPI which is expensive. The mechanisms of this phenomenon are not understood.


2.  Surgery for heartburn (GERD) may get simplified further. Instead of laprascopic Nissen's Fundoplication (already a simple surgery), same results may be done by stapling or use of radiofrequency ablation endoscopically. These techniques are still in their infancy.


3.  New PPI for heartburn has been released. It is Aciphex. The other two available are Prilosec and Prevacid.


4. Very soon we may have a drug for Irritable Bowel Syndrome. A drug for diarrhea predominant IBS from Glaxo is likely to come out in 2000.


5. Every 8 weeks of Remicade infusion helps maintain remission longer and prevent relapse of Crohn's disease.


6. Twice a day yogurt in patients started on antibiotics significantly reduces the incidence of antibiotic induced diarrhea.


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