Dr. Roach: If it’s not acid reflux, what might it be?
Dear Dr. Roach: In a recent column, you wrote: “The acid reflux you have been treating might be something more concerning.” What else could it be?
Dear C.P.: The symptoms of gastroesophageal reflux disease vary widely. Some people have heartburn and an acid taste in their mouth after eating a provocative meal, such as one that’s large or has a lot of fat. However, other people may cough or experience a small amount of regurgitation; still others note chest discomfort. Since the symptoms vary so widely and GERD is so common (20% of the Western world), symptoms are often attributed to GERD that might actually be coming from other conditions.
Angina pectoris, the sensation of chest discomfort or pain from poor blood flow to the heart, is often misattributed to GERD. Esophageal and gastric cancer can be misdiagnosed by both patient and physician as GERD. Diseases of the esophagus may also be incorrectly ascribed to GERD, such as mechanical blockages of the esophagus (rings and webs) and neurological abnormalities (motility disorders like achalasia).
Both patients and physicians need to be aware that what seems like reflux might not be. People with symptoms that recur, last too long or have atypical characteristics should consider a diagnostic test, including an upper endoscopy.
Dear Dr. Roach: Can you write about the risk/reward of taking 1 mg finasteride daily for life. I’m 68 and now see thinning of my hair and less hair per inch, front and top. I’m considering going the way of my brother and some friends and trying it. Supposedly, this product stops hair loss and prompts new growth in over 80% of users, rarely with side effects. With boomers aging, finasteride/Propecia is becoming more popular.
Dear J.J.: Finasteride, sold as Propecia 1 mg for hair loss, is also used (as Proscar 5 mg) for enlarged prostate. It blocks the formation of a type of testosterone, dihydrotestosterone, which is responsible for both hair loss and enlargement of the prostate in men.
Eighty percent benefit is a bit better than the data actually show. About 2/3 of men on finasteride showed overall improvement (only 1% actually lost hair) in a placebo-controlled study; 7% of the placebo group got better, and a third had significant loss. The hair tended to be darker and thicker, and about half of men were satisfied with their hair after treatment.
The major side effect affects sexual function — about 1.5% of men noted this side effect. In some cases, the sexual side effects persisted even after stopping the medication. Other side effects were rare.
The cost is an issue, but many physicians prescribe the 5 mg tablets with instructions to break into 1/4 tablets.
Dear Dr. Roach: In common with some women over the age of 65, I find that my hair is thinning a lot. I have tried various shampoos and conditioners with no positive results. Will Propecia work for women?
Dear E.H.: The studies on finasteride (Propecia) in women have shown conflicting results, with the best study showing no benefit at 1 mg, but smaller studies appearing to show benefit at higher doses, such as 2.5 or 5 mg. The drug seems to be well-tolerated in women.
Finasteride should not be used in any dose by a pregnant woman or a woman who might become pregnant.
Minoxidil (Rogaine) is effective and often used for both men and women as a topical treatment.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.