Holiday help for heartburn

It's that time of year when food and wine merchants thrive, tons of hors d'ouevres are consumed at office parties, families convene for feasts, glasses are raised to "Auld Lang Syne," and heartburn remedies fly off pharmacy shelves.

About 20 percent of people in the U.S. suffer at least once a week from symptoms of acid reflux, or heartburn (also known as dyspepsia, indigestion, sour stomach, or agita), and another 20 percent have it less frequently. A smaller but substantial percentage of the population has heartburn often enough (two or more times a week) to have earned the diagnosis of GERD (gastroesophageal reflux disease). No wonder the sales of heartburn remedies add up to billions of dollars a year.

Causes and complications
The food and drink you swallow are transported by strong, involuntary contractions of the muscular esophagus into your stomach through an opening guarded by a powerful muscle called the lower esophageal sphincter. The closure of that sphincter prevents stomach acid from backing up, or refluxing, into the esophagus. Those involuntary mechanisms are so powerful that you can swallow quite well while doing a headstand.

But when the sphincter doesn't close properly, whether because of a genetic weakness, excessive fat ingestion, obesity, or reasons unknown, acid reflux can wreak havoc on the relatively delicate esophageal lining, causing inflammation, irritation, and, sometimes, ulceration. Victims feel it as a distinctive burning sensation located under the breastbone, which may or may not be related to meals and commonly occurs at night.

Long-standing reflux into the lower part of the esophagus can cause changes in the appearance of the lining cells, a condition called Barrett's esophagus that can turn into esophageal cancer in about 1 of every 200 cases. If the reflux reaches the upper portions of the esophagus, it can irritate adjacent structures and cause wheezing, coughing, hoarseness, or chronic sore throat, which often leads to misdiagnoses, especially when the usual reflux symptoms are minimal or absent.

What to take
Since heartburn is an easily recognizable symptom (although at times it can be confused with angina pectoris, or heart pain), it is a natural for self-medication. And there are many over-the-counter products to treat it. Those products can be divided into three categories--antacids, histamine-2 receptor blockers (H2 blockers), and proton-pump inhibitors (PPIs)--that vary in how they work, how quickly they work, how long they work, and how well they work.

If your heartburn occurs occasionally and unexpectedly, as is apt to happen to many of us once or twice this holiday season, your best bet is a simple antacid such as generic or store-brand versions of Maalox, Mylanta, Rolaids, or Tums. They come in various dosage forms--liquid suspensions, tablets that you chew or swallow, effervescent solutions, and chewing gum--from which you can choose. They all work in a few minutes by neutralizing the acidity in the esophagus. Their effect lasts up to a few hours, plenty long enough for reflux symptoms to have ceased.

If you know from bitter experience to expect heartburn in certain situations ("I love pizza, but it always gives me agita"), take an H2 blocker beforehand, which stops histamine from stimulating stomach acid production. There are four available, formerly only by prescription but now over the counter as well as generically: cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75, Zantac 150). They all start working in 30 minutes to 1 hour and one dose can last up to 12 hours. One product, Pepcid Complete, combines famotidine with an antacid for both immediate and longer-term relief.

When heartburn happens more than once or twice a week, taking antacids several times a day is much too labor-intensive, and even continuous twice-daily use of H2 blockers may not be very effective. At that point, more complete blockage of stomach acid production is called for. Enter PPIs, which actually block the mechanism in the stomach cells that releases acid into the stomach. The first of those to be approved, omeprazole, is available over the counter as Prilosec OTC. It may take days for these medications to provide complete relief, so they are not appropriate for occasional or intermittent heartburn. If there is no improvement from Prilosec OTC or your symptoms recur after a 14-day course, medical evaluation is mandatory.
—Marvin M. Lipman, M.D.

Dr. Lipman has been Consumers Union's chief medical advisor since 1967. He is a diplomate of the American Board of Internal Medicine (certified in endocrinology and metabolism) and is clinical professor of medicine emeritus at New York medical College.

Comments

[B. Teller]

Having suffered with GERD for decades, I developed metclopramide-induced Tardive Dyskinesia because none of the doctors or the pharmacist I contacted about the bizarre symptoms I was having recognized them as extra-pyramidal in nature.
Just over two year ago, I went through extremely thorough GI testing, including an EGS. I was given a choice of 5 drugs: one was approved for use for only 14 days; one contained talc; one contained aspartame, an acknowledged migraine trigger--hardly appropriate for a migraine sufferer; one contained some other unacceptable ingredients; and the fifth I had already been taking and wasn't working.
For an organization that cautions about the dangers of prescription drugs, I am surprised that you made no mention of something called 'Super Digest Tablets'--an all-natural compound of seven digestive enzymes that cannot possibly do any harm; is even kosher; is a fraction of the cost and works better than any of the H2 blockers or PPI's on the market.
I would be interested in your comments.

[Irma Gámez]

My cousin is overweight and almost every day suffers for heartburn. I think that he`s taking too much antiacids because if he eat meat or spicy food, he can´t stay without those pills. Now he have a diet based in grains and vegetables and he feels better but sometimes he takes Tums and he feels fine

[Healthy Johan]

Also people who suffer less than once a week should take notice of it and make sure they will look out for negative evolution of the symptoms! Be aware people!

[Sue Bump]

My husband teaches at a university which changed insurance plan options which in turn changed mail in drug plan. This plan insisted that we change from Protonix which my husband and I both took once a day, 40 mg, to Nexium. The result is that we now have to take Nexium morning and night, when the Protonix worked well once a day. So, who is saving money where here?

[ruoklondon123]

I go to gym typically 1 hour (+/-) after I've eaten.
If I run, or work out with weights and take water breaks,
I notice that after a number of water breaks, I get acita.
If I don't drink water, I'm typically ok. Can u help?