Frequently Asked Questions About Heartburn and Reflux

1. When should I take an antacid vs. a Famotidine(Pepcid-AC) or Omeprazole (Prilosec)-like product?

Let's start with the basics. Antacids neutralize excess stomach acid to relieve heartburn, sour stomach, acid indigestion, and stomach upset. They are sometimes prescribed in addition to other meds to help relieve the pain of stomach and duodenal ulcers. Some antacids also contain simethicone, an ingredient that helps eliminate excess gas.

You should take antacids exactly as directed by your doctor, or according to the manufacturer's directions. For stomach or duodenal ulcers, take the medicine for as long as your doctor tells you. If you are using the tablets, chew them well before swallowing for faster relief.

Serious side effects can occur with an overdose or overuse of antacids. Side effects include constipation, diarrhea, change in the color of bowel movements, and stomach cramps. Products containing calcium may cause kidney stones and are more likely to cause constipation.

Products like Pepcid-AC are called histamine-2 blockers or H2 blockers. These drugs reduce production of stomach acid. Pepcid AC and other H2 blockers such as Tagamet HB, Zantac 75, and Axid AR are available in prescription-strength or in lower doses in over-the-counter varieties. These products are for relief of heartburn, acid indigestion, sour stomach, and other conditions, such as stomach ulcers.

The newest type of heartburn medication to become available without a prescription is omeprazole (Prilosec). Prilosec belongs to a family of drugs called proton pump inhibitors or PPIs. This type of drug is often used when antacids or H2 blockers fail. PPIs block the secretion of acid from the stomach. Lansoprazole (Prevacid) and esomeprazole (Nexium 24HR) can be bought over the counter. Pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant), and esomeprazole (Nexium) are examples of other PPIs that are available only by prescription.

PPIs generally cause few side effects, but they do interact with other common drugs such as warfarin (Coumadin), some heart medications and antibiotics, so it is important to review all medications with your doctor.

Antacids work the quickest to relieve occasional heartburn. For patients who do not respond to antacids, H2 blockers and PPIs are alternatives. Remember, though, that frequent or severe episodes of reflux should always be discussed with your doctor.

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Your doctor may want you to take antacids when you start taking H2 blockers to help control your symptoms until the H2 blocker takes effect. If your doctor prescribes an antacid, take it an hour before or an hour after H2 blockers. Take H2 blockers regularly for as long as directed by your doctor, even if you do not have any pain or your symptoms improve.

Possible serious side effects that need to be reported to your doctor right away include confusion, chest tightness, bleeding, sore throat, fever, irregular heartbeat, weakness, and unusual fatigue. Other less serious side effects include mild headache, dizziness, and diarrhea, which are usually temporary and will likely go away on their own.

2. It seems that my husband has heartburn every night. I think he should see a doctor. He thinks he should just continue taking antacids. Who's right?

Occasional heartburn is common and generally not serious. However, prolonged heartburn can be a symptom of a serious problem, such as esophagitis. Esophagitis is an inflammation of the lining of the esophagus, the food tube. Esophagitis occurs when stomach acid repeatedly comes into contact with the lining of the esophagus. If esophagitis is severe, the person can develop Barrett's esophagus and even cancer. Over time, this condition can narrow the passageway from the esophagus to the stomach. Your husband should consult his doctor for further evaluation. When a person requires more than twice-weekly over-the-counter drugs for heartburn, a doctor should be consulted. An endoscopy to visualize his esophagus may also be recommended.

3. I am a 55-year-old male who is about 30 pounds overweight. Lately, I've been experiencing frequent heartburn and have an acid taste in the back of my throat. Now, my doctor is telling me I have a hiatal hernia. Is this a serious problem? Will it require surgery?

A hernia is the pressing of an organ through an opening in the muscle wall of the cavity that protects it. With a hiatal hernia, a portion of the stomach pushes through the hole where the esophagus and the stomach join.

The most common cause of a hiatal hernia is an increase in pressure on the abdominal cavity. Pressure can come from coughing, vomiting, straining during a bowel movement, heavy lifting, or physical strain. Pregnancy, obesity, or excess fluid in the abdomen also can cause hiatal hernias.

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A hiatal hernia can develop in people of all ages and both sexes, although it frequently affects middle-aged people. In fact, the majority of otherwise healthy people over age 50 have small hiatal hernias.

Many people with a hiatal hernia never have any symptoms. In some people, acid and digestive juices escape from the stomach into the esophagus (gastroesophageal reflux). This causes:

  • Heartburn
  • A bitter or sour taste in the back of the throat
  • Bloating and belching
  • Discomfort or pain in the stomach or esophagus
  • Vomiting

Most hiatal hernias do not cause problems and rarely need treatment. Successful treatment of hiatal hernias usually involves treating the symptoms of gastroesophageal reflux disease (GERD) that are triggered by the additional pressure in the abdomen.

Treatment includes:

Making lifestyle changes, such as:

  • Losing weight, if you are overweight, and maintaining a healthy weight
  • Having a common-sense approach to eating, such as eating moderate to small portions of foods, and limiting fatty foods, acidic foods (such as tomatoes and citrus fruits or juices), foods containing caffeine, and alcoholic beverages
  • Eating meals at least three to four hours before lying down and avoiding bedtime snacks
  • Elevating the head of your bed by 6 inches (this helps allow gravity to keep the stomach contents in the stomach)
  • Not smoking
  • Wearing looser clothing, especially around the waistline
  • Taking medications, such as over-the-counter antacids or H2 blockers or PPIs. Note: If you take over-the-counter drugs and see no improvement or take them for longer than two weeks, see your doctor. He or she may prescribe a stronger medication.

If medications and lifestyle changes are not effective in treating your symptoms, diagnostic tests may be performed to determine if surgery is necessary.

People with a hiatal hernia who also have severe, chronic esophageal reflux may need surgery to correct the problem if their symptoms are not relieved through these management techniques. Surgery may also be needed to reduce the size of the hernia if it is in danger of becoming constricted or strangulated (so that the blood supply is cut off). During surgery, gastroesophageal reflux is corrected by pulling the hiatal hernia back into the abdomen and creating an improved valve mechanism at the bottom of the esophagus. The surgeon wraps the upper part of the stomach (called the fundus) around the lower portion of the esophagus. This creates a tighter sphincter so that food will not reflux back into the esophagus.

Hiatal hernia surgery can be performed either by opening the abdominal cavity or laparoscopically. During laparoscopic surgery, five or six small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs on a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.

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4. I am pregnant and have terrible heartburn. Is there anything I can do to get relief?

More than half of all pregnant women report heartburn, particularly during their third trimester. Heartburn occurs during pregnancy, in part, because your digestive system works more slowly due to changing hormone levels. Also, your enlarged uterus can crowd your stomach, pushing stomach acids upward.

Here are some ways you can reduce your heartburn during pregnancy:

  • Eat several small meals each day instead of three large ones.
  • Eat slowly.
  • Avoid fried, spicy, or rich foods, or any foods that seem to increase your heartburn.
  • Don't lie down directly after eating.
  • Keep the head of your bed higher than the foot of your bed.
  • Ask your doctor about trying over-the-counter heartburn relievers such as Tums or Maalox.

If your heartburn persists, see your doctor. He or she may prescribe drugs that are safe to take during pregnancy.

5. What foods should a person avoid if he or she has heartburn, GERD, or Barrett's esophagus?

What's on your plate can impact heartburn, GERD, and Barrett's esophagus. Eating certain foods, including onions, peppermint, and high-fat foods, as well as drinking alcohol, can cause the lower esophageal sphincter muscle, which controls the opening between the esophagus and the stomach, to relax. Usually, this muscle remains tightly closed except when food is swallowed. However, when this muscle fails to close, the acid-containing contents of the stomach can travel back up into the esophagus, producing a burning sensation commonly referred to as heartburn.

Caffeinated beverages and foods (such as coffee, tea, colas, and chocolate) can also aggravate heartburn and gastroesophageal reflux disease (GERD). Tomatoes, citrus fruits, or juices also contribute additional acid that can irritate the esophagus.

In addition, smoking relaxes the lower esophageal sphincter, contributing to heartburn and GERD.

Improving your eating habits can also reduce reflux. After eating, keep an upright posture. Eat moderate portions of food and smaller meals. Lastly, eat meals at least three to four hours before lying down, and avoid bedtime snacks.

6. What is Barrett's esophagus and how is it treated?

Barrett's esophagus is a change in the lining of the lower esophagus that develops in some people who have chronic GERD or inflammation of the esophagus.

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The symptoms of Barrett's esophagus are the same as those of GERD, although often more severe. These symptoms include a burning sensation under the chest and acid regurgitation. These symptoms generally decrease with drugs that reduce acid in the stomach. Some people with Barrett's esophagus may not have any symptoms at all.

The only way to confirm the diagnosis of Barrett's esophagus is with a test called an upper endoscopy. This involves inserting a small, lighted tube (endoscope) through the throat and into the esophagus to look for a change in the lining of the esophagus. While the appearance of the esophagus may suggest Barrett's esophagus, the diagnosis can only be confirmed with small samples of tissue (biopsy) obtained through the endoscope.

The treatment of Barrett's esophagus is similar to the treatment of reflux. This includes lifestyle changes, such as avoiding certain foods and eating late in the evening, smoking cessation, and wearing loose-fitting clothing, along with using medications that will decrease acid production by the stomach.

Patients with Barrett's esophagus typically need PPI drugs to reduce acid.

Barrett's esophagus may lead to the development of cancer of the esophagus in some patients, although this risk is smaller than once thought. Up to 0.5% of those with Barrett's esophagus will develop esophageal cancer each year.

Esophageal cancer develops through a sequence of changes in the cells of the esophagus known as dysplasia. Dysplasia can only be detected by a biopsy. Patients with Barrett's esophagus should talk to their doctors about having regular screening exams to detect cancer at an early and potentially curable stage.

Studies are in progress to develop a more effective treatment for Barrett's esophagus. One treatment, known as ablation therapy, removes the abnormal cells with heat or laser light. Other new treatments are also under development.

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