Heartburn

Heartburn is a painful, burning feeling in the chest. It is caused by stomach acid that escapes the stomach and flows back into the esophagus. Heartburn can sometimes be a symptom of indigestion. (Read about "Indigestion") It is important to note here that sometimes people mistake a heart attack (Read about "Heart Attack") for heartburn. If you have chest pain, that could be a heart attack, seek immediate medical help. Call 911, do not attempt to drive yourself to the doctor or the hospital.

When you have heartburn, it's tempting to reach for an over-the-counter pill or tablet to make the symptoms go away. But as with any drug, heartburn remedies are not for everyone. According to the Food and Drug Administration (FDA), even though many are now sold over-the-counter, you still need to take precautions.

For example, FDA says some heartburn drugs interact with other medications. (Read about "Drug Interaction Precautions") Others should be avoided by those with certain medical conditions, such as high blood pressure. (Read about "Hypertension: High Blood Pressure") Therefore, it's important to read the label and consult with your healthcare provider before taking these medications, especially if you find the symptoms of heartburn are recurring regularly. Constant heartburn can be an indication of a much more serious condition called gastroesophageal reflux disease or GERD. (Read about "GERD")

Types of medications

According to the National Digestive Diseases Information Clearinghouse (NDDIC), heartburn medications generally work by either reducing the amount of stomach acid produced by your body or by neutralizing it.

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach. They can include any of the following:

• Antacids are usually the first drugs recommended to relieve heartburn, according to NDDIC. Many brands on the market use different combinations of three basic salts - magnesium, calcium and aluminum - with hydroxide or bicarbonate ions to neutralize the acid in your stomach. (Read about "Vitamins & Minerals") Antacids, however, have side effects. Magnesium salt can lead to diarrhea (Read about "Diarrhea"), and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids can also be a supplemental source of calcium. (Read about "Calcium") They can cause constipation as well. (Read about "Constipation")
• Foaming agents work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.
• H2 blockers, such as cimetidine, famotidine, nizatidine and ranitidine, impede acid production. They are available in prescription strength and over-the-counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time, according to NDDIC. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.
• Proton pump inhibitors include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. They are available in prescription strength and some are available over-the-counter. NDDIC says proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone. FDA, however, warns that long-term and/or high-dose use of proton pump inhibitors can increase your risk of bone fractures. (Read about "Bone Fractures") You should discuss the benefits and risks of any medication with your doctor.
• Prokinetics is another group of drugs. They help strengthen the sphincter and make the stomach empty faster. This group includes bethanechol and metoclopramide. Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for heartburn.

Again, although these products are familiar on drug store shelves, they should not be taken lightly. For example, FDA says that if you're on a salt-restricted diet, it's important to consult with your doctor before taking antacids. (Read about "Sodium") Depending on the active ingredient, various antacids may lead to kidney problems, constipation, or weakened bones, as well as other problems. Antacid pills or tablets can also interact with other medications you may be taking, so always use precaution before considering these products. (Read about "Medicine Safety")

Prevention

Given the complications that can result from misuse of heartburn medications, probably the best way to deal with heartburn is to avoid it in the first place. The American Academy of Family Physicians has these suggestions:

• cut back on acidic foods
• avoid caffeine and alcohol
• don't lie down right after eating
• don't eat just before going to bed
• avoid clothing that's too tight around the waist

And if you seem to be getting heartburn regularly, see a doctor. Your symptoms could indicate a more serious underlying problem that needs medical care.

Related Information:

    Medication and Digestion

    Digestive System

    Stomach Cancer

    Gastroesophageal Reflux Disease