Dear Dr. Gott: I was prescribed omeprazole 20 milligrams daily following an upper endoscopy. I have been taking this medication for almost a year and have been told that it inhibits the absorption of calcium. I was diagnosed with GERD and a hiatal hernia, plus two small stomach ulcers. I'm a 62-year-old female and have in the past been prescribed Evista, which my doctor took me off after one year and a sufficient bone-density test. Should I continue to take the omeprazole? I have severe stomach cramps that are debilitating for about three days and also vomiting about once a month, even with the medication.

Reply: Gastroesophageal reflux disease occurs when the muscle that separates the stomach from the oesophagus fails to close properly or is weakened, allowing a backwash of stomach acid into the oesophagus.

Hiatal hernia occurs as a result of increased abdominal pressure caused by sudden physical exertion, vomiting, coughing, obesity, increased abdominal pressure and excess fluid in the abdomen.

A small 2002 study of 18 women over the age of 65 reported the concomitant use of omeprazole with calcium carbonate when taken without food decreased calcium absorption in elderly women. It contradicted a study a few years earlier from Tufts in which omeprazole was found not to interfere with calcium, zinc or phosphorous absorption. The medication your physician recommended is to reduce the amount of acid produced. Common symptoms of GERD include chest, neck and arm pain, breathing difficulties, dry cough, difficulty swallowing, burning or pressure and bad breath. Debilitating stomach cramps and vomiting are uncommon. Speak with your physician to rule out other possible causes or health conditions and to determine whether you should continue or discontinue the omeprazole. Then request a referral to a gastroenterologist for further testing if appropriate.

To provide related information, I am sending you a copy of my Health Report 'Hiatal Hernia, Acid Reflux & Indigestion'. Other readers who would like a copy should send a self-addressed stamped number ten envelope and a $2 cheque or money order to Newsletter, PO Box 167, Wickliffe, Ohio 44092-0167.

Dear Dr. Gott: What can you tell me about relapsing polychondritis? I can't find much help on the Web. I've had flare-ups three times a year for years, affecting one ear and sometimes both at the same time. Surprisingly, my last episode was three years ago, and it lasted six weeks, but now I am dealing with it again. Two different specialists have been of no help. The condition gets painful before it gets better.

Reply: Polychondritis is a chronic, progressive, inflammatory autoimmune reaction of cartilage in various tissues of the body, including the ears, nose, spine, trachea and joints. The eyes, blood vessels, skin and heart, while not formed by cartilage, have a similar makeup and can also be involved. The condition generally affects men and women in middle age. Symptoms typically begin with one or both ears becoming red, swollen and painful.

Diagnosis is made when a healthcare provider observes eye inflammation, hearing or balance problems, bilateral ear inflammation, painful swelling in more than one joint and damage to cartilage in the respiratory tract. Laboratory testing to include an ESR (erythrocyte sedimentation rate) can provide pertinent evidence when inflammation is present.

Exacerbation of symptoms can last a few weeks, subside and occur again. Over time, the supporting cartilage can become damaged, resulting in hearing, vision and balance difficulties, floppy ears and a sloping nose.

Mild relapsing polychronditis is commonly treated with NSAIDs (nonstereroidal anti-inflammatory drugs). As symptoms become more troublesome, they are treated with daily prednisone on a tapering basis.