Written By: Abier Hamami. RPH. CPHQ
What is Heartburn?
Heartburn is a burning sensation in the chest or a bitter taste in the mouth. It occurs because of a poorly functioning lower esophageal sphincter (LES), a muscle resembling a one-way valve that lies between the esophagus and the stomach, so acid flows back into the esophagus and irritates it's lining.
How frequent does it happen, and how long it lasts?
Most people only suffer from heartburn on an occasional basis, and it lasts for up to two hours. However, if you suffer from heartburn for more than two days a week, you may be suffering from a condition known as gastrooesophageal reflux disease (GERD, also known as acid reflux).
What causes Heartburn?
Eating too much food, or eating just before sleep.Eating fatty, spicy foods, chocolate, peppermint, citrus fruits, and tomato products. Drinking beverages as carbonated, caffeinated drinks, tea, citrus and tomato juices, and alcohol.Smoking.Some medications can either decrease the function of the LES as (drugs used for anxiety, high blood pressure, and angina), or can cause direct irritation as (Aspirin, tetracycline, and medication to treat osteoporosis).Medical conditions as hiatal hernias where a small part of the stomach sticks out above the diaphragm into the chest. This prevents the LES from working properly.Pregnancy due to both hormone activity and pressure placed by the baby.Obesity.
What treatments are available?
Most heartburn treatments are over-the-counter medications, but you should keep in mind possible drug interactions and side effects. If symptoms are not completely eliminated even with the use of medication a physician should be consulted.
Antacids
Antacids treat mild to moderate heartburn, they work locally to neutralize the acid in the stomach. Among known antacids are Tums, Maalox, Mylanta, Riopan, and Rolaids. Antacids should be taken 1-3 hours after meals and at bedtime.
Magnesium-based antacids can cause diarrhea, and those with aluminum can cause constipation. Antacids also may decrease the effects of certain medications if taken at the same time, therefore they should be separated from other medications by at least 2 hours.
Alginates
Some Antacids as Gaviscon contain Sodium alginate which forms a thick foam that covers the stomach contents and helps protect the esophagus from irritation.
Acid blockers (Histamine H2 Blockers)
Acid blockers (H2 Blockers) block the secretion and release of acid by blocking the release of chemical known as histamine. They are best taken before a meal, and their effect lasts for 12 hrs. These medications include Cimetidine, Ranatidine, Famotidine, and Nizatidine.
Side effects include headache, nausea, and diarrhea. Drug interactions are minimal. Cimetidine, however, may interact with drugs such as warfarin (a medication used as a blood thinner), phenytoin (used to treat seizures), and theophylline (used to treat asthma).
Proton Pump Inhibitors
Proton Pump Inhibitors block the action of the stomach’s proton pump, which pumps hydrogen ions into the stomach, making the stomach acidic. Among known proton pump inhibitors are omeprazole, esomeprazole, lansoprazole,rabeperazole, and pantoprazole.
Side effects include headache, nausea, rash, dizziness, pruritus, cough, and diarrhea. Omperazole may interact with other medications as warfarin (a medication used as a blood thinner), phenytoin (used to treat seizures), digoxin (used in heart failure), diazepam (a drug used for sedation), and ketoconazole (a medication used for fungal infections).
Pro- Kinetic Agents
Pro-kinetic agents increase the movement of the stomach. They work by increasing the pressure of the lower oesophageal sphincter (the point where the oesophagus joins the stomach) and promote emptying of the stomach. They include metoclopramide, domperidone and bethanechol.
Side effects of metoclopramide include, nausea, diarrhea, confusion, jumpiness, and trembling.
How can you prevent or reduce Heartburn?
You may find it useful to keep a diary of your symptoms and the food you eat, so that you can see which foods affect you.Avoid eating too close to bedtime. Try to leave at least two to three hours after a meal, before you go to bed.Avoid lying down after meals.Eat small regular meals.If you are overweight, try to lose weight.Do not wear tight clothing which may increase the pressure on you stomach.Raising the head of your bed by four to six inches may help reduce night time heartburn.
References:
Drug Information Handbook, Lexi-Comp.http://www.patienthealthinternational.com/article/501912.aspx
Accessed Jan 2006
http://www.bupa.co.uk/health_information/html/medicine/proton_pump.html#3 Accessed Jan 2006
http://www.mayoclinic.com/health/heartburn-gerd/DS00095/DSECTION=1
Accessed Jan 2006
