What you should know about heartburn

Health Watch by Vanessa Goins Brown

The North Jefferson News




Heartburn is estimated to be a problem for approximately 45 percent of the people in the United States.

The typical symptom of heartburn is the burning sensation that starts in the lower chest and moves up toward the neck and throat. One may also feel pain, warmth and heat along with the burning sensation. In some circumstances, heartburn may produce a sour taste in the mouth.

Other terms associated with heartburn are indigestion, acid regurgitation, sour stomach or pyrosis.

Postprandial (after eating) heartburn usually occurs approximately two hours after a meal. Nocturnal (night time) heartburn occurs during sleep.

The most common type is “simple” heartburn which is associated with diet and lifestyle. Others may experience more frequent symptoms that occur two or more days a week.

Heartburn is labeled severe if it occurs every day and if other problems (e.g., bleeding, trouble swallowing or weight loss) develop. Persistent heartburn may be a sign of a more serious problem such as gastroesophageal reflux disease (GERD).

GERD is defined as symptoms, esophageal damage, or both resulting from abnormal reflux of gastric contents into the esophagus. The esophagus is the tube that leads from the throat to the stomach.



Heartburn causes

Heartburn arises when food and stomach juices back up into the esophagus. There are several risk factors listed below that can contribute to heartburn.

• Diet: Spicy foods, fatty foods, chocolate, table salt, garlic, onions, spearmint, peppermint, alcohol, caffeinated beverages, carbonated beverages, citrus fruit or juices and tomatoes

• Lifestyle: Exercise (e.g., weight lifting, cycling or sit-ups), smoking, obesity, stress, lying on your back, tight-fitting clothing and pregnancy

• Diseases: Gastroparesis (food is not digested properly), Scleroderma (inflammation causing the stomach acid to back flow up into the esophagus), Peptic Ulcer Disease (a hole in the lining of the stomach, duodenum or esophagus) and Zollinger-Ellison syndrome (a tumor that causes increased production of gastric acid)

• Medications: Aspirin, Ibuprofen, Prednisone, Iron, Potassium, Antihistamines, Digoxin, Theophylline, Erythomycin, Ampicillin and sleeping pills

• Genetic factors



Treating heartburn

The treatment of heartburn depends on the severity and the symptoms. Mild to moderate heartburn usually can be treated with lifestyle modifications and nonprescription medications. It is advisable to consult with your doctor if you are experiencing persistent heartburn.

Lifestyle changes should always be a treatment approach for heartburn. For example, eating smaller meals, avoiding fatty or fried foods, avoiding alcohol and carbonated beverages and limiting acidic and spicy foods could aid in the prevention of heartburn.

Other lifestyle changes include wearing loose clothes, avoiding medications that could cause heartburn, stopping smoking, and losing weight.

Medications include antacids, histamine2-receptor blockers (H2 blockers) and proton pump inhibitors (PPIs).

Antacids and H2 blockers are usually recommended for mild and irregular heartburn. Antacids provide rapid relief but have a shorter duration of action when taken on an empty stomach compared to H2 blockers.

Antacids provide relief for one to two hours while H2 blockers provide relief up to 12 hours. H2 blockers can be used to prevent heartburn when given one hour prior to a heavy or spicy meal and exercise.

A combination product containing an antacid and an H2 blocker may be optional if rapid relief and longer duration are desired.

Antacids such as Tums, Mylanta, Maalox, neutralize the stomach acid and Pepto-Bismol acts as a barrier to the reflux acid by coating the esophagus. Some examples of H2 blockers include Cimetidine, Ranitidine, Famotidine and Nizatidine. These products work by reducing the acid produced in the stomach.

PPIs also work by reducing the acid in the stomach. This drug class is recommended for individuals experiencing heartburn two or more days a week and for those who do not respond to H2 blockers.

Some examples of PPIs include Omeprazole, Nexium, Prilosec and Protonix. It may take up to four days once a PPI is started before the symptoms are relieved. However, this drug class provides great symptom relief and a longer effect than H2 blockers.

It is best to take a PPI 30 minutes before breakfast. It is recommended that antacids, H2 blockers, and PPIs should not be taken more than two weeks unless the individual is under the supervision of their doctor.



When to see a doctor

• Elderly patients, pregnant women and children under the age of 12 should consult their doctor before self-medicating for heartburn.

• Frequent heartburn for more than three months

• Heartburn while taking an H2 blocker (such as Ranitidine) or a PPI (for example Omeprazole)

• Heartburn that continues after two weeks of treatment with a nonprescription medication

• Severe heartburn

• Heartburn that occurs while sleeping

• Difficulty or pain on swallowing solid foods

• Vomiting up blood or black material or black tarry stools

• Chronic hoarseness, wheezing, coughing or choking

• Unexplained weight loss

• Nausea, vomiting, or diarrhea

• Chest pain accompanied by sweating, pain radiating to shoulder, arm, neck, or jaw and shortness of breath

• Nursing mothers

Vanessa Goins Brown is a student at the McWhorter School of Pharmacy at Samford University and a Pharm. D candidate, working at The Pharmacy in Mt. Olive. The Pharmacy can be reached at 631-1201.