Digestive Care Expert Brenda Watson

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Physician Bias, or Pharmaceutical Influence?

 

A team of researchers at Mayo Clinic recently uncovered an interesting physician bias regarding the diagnosis of the upper digestive conditions gastroesophageal reflux disease (GERD) and functional dyspepsia (also known as indigestion). The two conditions can overlap, but each condition has its own distinct symptoms.

The researchers uncovered a bias on the part of physicians who diagnosed the two conditions. Although the number of GERD diagnoses has increased in the last 20 years, the reported GERD symptoms have decreased. When symptoms of both conditions are present, the most common diagnosis is GERD. Further, when only symptoms of functional dyspepsia are present, diagnosis of GERD is still more likely.

I believe this is due to the influence of the pharmaceutical industry over doctors when it comes to treating upper GI conditions with proton-pump inhibitors (PPIs), among the most commonly prescribed drugs today. Proton pump inhibitors were first used to treat peptic ulcers until it was discovered that peptic ulcers are not the result of too much stomach acid, but instead the result of infection with a bacterium known as Helicobacter pylori. Without a condition to treat, the focus of these drugs was turned to heartburn. Thus began widespread belief that heartburn was simply the result of too much stomach acid. To the rescue: Proton pump inhibitors and acid blockers.

As the Mayo Clinic study shows, functional dyspepsia is also now transitioning into a category in which proton pump inhibitors come to the rescue. But PPIs are not FDA approved to treat functional dyspepsia. Instead, doctors are seeing its symptoms—incomplete digestion, bloating, belching, excessive fullness, delayed stomach emptying—as those of GERD, a condition for which they have a well-known drug to treat it with.

The findings of this study are not surprising. The pharmaceutical companies have a lot of influence—on us (who hasn’t seen a pharmaceutical commercial or magazine ad lately), and on physicians (many of whose pockets are lined by these companies, in one way or another). Fortunately, when it comes to digestion, there are many dietary and lifestyle changes that can be made to improve the condition. If you are dealing with these conditions, or trying to avoid them, educate yourself!

It is true that functional dyspepsia can be difficult to treat. I have found that digestive enzymes are very helpful with easing the symptoms associated with this condition, which often result from poor diet, poor eating habits, and insufficient digestive enzyme production, all of which can be helped by digestive enzymes.

acid blockers, belching, bloating, delayed stomach emptying, dietary, Digestive Enzymes, drugs, fullness, functional dyspepsia, gastroesophageal reflux disease, GERD, GI conditions, Heartburn, Helicobacter pylori, indigestion, lifestyle, pharmaceutical industry, physician bias, PPIs, proton pump inhibitors, stomach acid, symptoms, upper digestive condition

 

The gut-brain connection is an interesting one because it travels in two directions—from the brain to the gut and from the gut to the brain. For the longest time this connection was thought to only travel in one direction, from the brain to the gut, like when strong emotions trigger an upset stomach. But researchers now know that what happens in your gut has an effect on your brain.

One recent study at the Stanford University School of Medicine tried to elucidate this connection. According to one of the researchers, “Gastric irritation during the first few days of life may reset the brain into a permanently depressed state.” Genetic susceptibility also plays a role, of course, since not all stomach upsets will lead to depression, but this connection is interesting.

The gut is connected directly to the brain by the vagus nerve, and even has a nervous system of its own—the enteric nervous system. This connection between the gut and the brain allows for close communication. Many studies are finding that the gut has a major effect on the brain. I have blogged about it before. More than once.

The researchers used an animal model of functional dyspepsia, also known as indigestion, to determine that stomach irritation early in life can lead to depressed and anxious behaviors that last much longer than the indigestion itself. Their findings will lead to more studies to investigate how this gut brain connection works, and if new ways can be found to treat depression and anxiety in humans, based on the gut-brain link.

anxiety, anxious, brain, depression, emotions, functional dyspepsia, gastric, gut, gut-brain connection, humans, indigestion, nervous system, upset stomach, vagus nerve

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