Friday, December 19, 2014

Definition

Heartburn is a common condition that affects more than 70 million Americans annually. It typically begins with a burning sensation that starts in the upper abdomen and moves up into the chest, often making its way to the back of the throat, and sometimes up into the jaw, arms and back. It usually feels worse when lying down or bending forward.

Heartburn gets its name from chest pains caused by stomach acid that washes up into the esophagus. This chest pain can be confused with angina, but the heart has nothing to do with it.

Description

Distress from heartburn is common after a meal of fat-laden or acidic foods, after taking aspirin, drinking alcohol, smoking, or eating chocolate. Obesity, pregnancy, emotional turmoil, and tension can also trigger heartburn. In general, there is no cause for concern with frequent heartburn.

The ads for antacid pills like Tums, Gelusil and Maalox call heartburn "acid indigestion," but actually the problem is more complicated than that. In the vast majority of cases, heartburn is a symptom of Gastroesophageal Reflux (GERD), in that stomach fluids containing acid and digestive enzymes back up past the valvelike sphincter that separates the stomach from the esophagus, causing pain.

Heartburn can also be triggered by lying down, prescription medications, diabetes, hiatal hernias, and some autoimmune disorders.

Treatment

Over-the-counter (OTC) drugs that neutralize stomach acid are, for most people, the first line of defense against heartburn. Antacids come in tablet, liquid, or foam, and in regular and extra-strength formulations.

The active agents in antacid compounds usually consist of one or more of the following ingredients: magnesium, aluminum hydroxide, sodium bicarbonate, or the centuries-old standby, calcium carbonate.

Antacids should bring relief almost instantaneously. These active compounds buffer the accumulated acid in the stomach. This helps reduce or eliminate the burn that is felt in the esophagus. Antacids do not reduce any further acid buildup or eradicate feelings of fullness in the stomach.

A recommended dose one to three hours after eating should provide varying degrees of relief. If a single dose does not work, the problem may be more severe, and consulting a doctor should be considered.

What actually determines the overall effectiveness of an antacid depends on what and how much was ingested, and the overall state of the gastrointestinal tract.

In addition, those who have high blood pressure or who are on a sodium-restricted diet should not take antacids containing sodium bicarbonate because of its high sodium content. Also, those bothered by kidney stones should not take calcium carbonate antacids because the calcium can accelerate the problem. Calcium carbonate antacids will initially quell acid buildup, but because they contain calcium, this antacid will soon cause an increase in stomach acid.

Contrary to popular belief, milk is not a recommended antidote to heartburn. A glass of milk does provide immediate relief as it goes down, but milk contains calcium and protein, and these eventually stimulate even more acid production in the stomach. This can cause a more severe heartburn that can return in as little as a half an hour.

In some cases, antacids and certain drugs do not mix. Tetracycline, indomethacin, and buffered and nonbuffered aspirin, iron supplements, digoxin, quinidine, Valium, and corticosteroids can adversely mix with acids in the stomach, causing problems that are more serious than heartburn. Always check with your pharmacist if you take a medication regularly and are considering using antacids.

Questions

What is causing the discomfort?

Is it caused by hiatal hernia?

Is it related to any other medical problems?

How can this be treated?

Would antacids help?

Are any specific antacids contraindicated?

Should I have an endoscopy (a camera placed through the mouth to look at the esophagus and stomach)?

Am I at risk of complications if I have reflux disease or heartburn? Do these complications change if I do or do not treat my symptom(s)?

Self-Care

Relief from heartburn has been provided for more than a century by antacids that include such familiar brand names as Tums, Rolaids, Maalox, and Mylanta. These antacids, which bring relief in minutes, work by neutralizing the stomach acid that causes heartburn. But because the stomach continues to produce acid, they remain effective only for a few hours.

Beginning in the late 1970s, pharmaceutical companies started offering drugs such as ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid) and Axid, available only by prescription for those with serious heartburn or ulcers. Now these are available over the counter.

What separates the new OTC preparations from antacids is that antacids only neutralize the acid that migrates upward from the stomach. Acid blockers, like Tagamet and Pepcid, on the other hand, go to the root of the problem by suppressing the production of acid in cells lining the interior of the stomach without interfering with normal digestion.

These cells normally produce acid when a form of histamine called H2 "docks" with receptors in the cell walls, much like a key fitting within a lock. But acid blockers, called H2 antagonists, prevent that production by seeking out and fitting snugly into the stomach cell receptors, denying access to H2. Depending on the size of the drug dosage, acid production can be curtailed for as long as 1 to 2 hours.

As for side effects, several studies have shown that both antacids and blockers may mask the symptoms of bleeding ulcers among people with rheumatoid arthritis. These patients often take the pills thinking that they will relieve bleeding that can occur with high doses of rheumatoid arthritis drugs like ibuprofen. While neither H2 antagonists nor antacids cause bleeding they may keep those with ulcers from recognizing the need to seek help.

H2 blockers still have fewer side effects than antacids. Meanwhile, calcium-based antacids like Tums and Rolaids can occasionally contribute to kidney stones. The aluminum- and magnesium-based ones like Mylanta and Maalox can sometimes be dangerous for people with kidney problems. On the whole, the risk-benefit profile for H2 blockers is excellent, and they represent an advance over what was previously available.

For more frequent or severe symptoms, proton-pump inhibitors such as Prilosec, Prevacid, Aciphex, Protonix, Zegerid, or Nexium may be presribed by your physician. These PPIs are more powerful in blocking acid production than the H2 blockers. They are usually taken in the morning, prior to breakfast. Prilosec has recently become available over the counter for frequent heartburn and is also available as a generic form.

Prevention

Some simple precautions to take in order to avoid heartburn are:

  • If certain foods or drinks regularly bring on discomfort, avoid them
  • Do not smoke; avoid caffeine and alcohol
  • Cut back or eliminate chocolate and chocolate-based desserts
  • Try to lose weight
  • Eat slowly; avoid foods or drinks that are excessively hot or cold
  • Do not eat a major meal less than four hours before bedtime
  • Find ways to reduce stress
  • Sufferers of night-time heartburn can sometimes be helped by placing 6-inch blocks under the head of the bed. This often helps better than trying to use extra pillows which can shift during the night.