Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
Tags: heartburn | treatments | ppis | blockers | surgery | antacids

What's the Best Heartburn Treatment?

Monday, 06 August 2012 09:52 AM

Question: What are the causes of heartburn and how can it be treated?

Dr. Hibberd's answer:
Heartburn is a non-medical term for the burning sensation that occurs when stomach acid backs up into your esophagus. But beware, heartburn may also a symptom of heart disease or impending heart attack, as well as other lung, heart, and nerve /spinal conditions, so be sure to consult your doctor if you have heartburn.
Normally when you swallow, a circular band of muscle, the lower esophageal sphincter, around the bottom part of your esophagus relaxes to allow food and liquid to flow down into your stomach. Then it closes again. However, if the lower esophageal sphincter relaxes abnormally or weakens, stomach acid can flow back up into your esophagus, causing heartburn. The acid backup may be worse when you're bent over or lying down.
Many over-the-counter medications are available to relieve the pain of heartburn. Antacids neutralize stomach acid, these include Maalox, Mylanta, Gelusil, Rolaids and Tums that may provide quick relief but are only temporary patches and not definitive treatment. Overuse of some of these can cause side effects such as diarrhea or constipation. Antacids alone won't heal an inflamed esophagus damaged by stomach acid.
See your doctor for proper evaluation and you will likely be placed on a proton pump inhibitor (PPI) drug or H2 blocker to help heal the irritated ares of your esophagus. Possibly your doctor will order an endoscopy to take a look at your esophagus if you remain symptomatic or if malignancy or premalignant condition is suspected. Several surgical corrections are options that essentially reconstruct the lower esophageal sphincter mechanism.
Long term suppression may include H-2-receptor blockers that reduce acid production, and provide longer relief than antacids but not as potent as PPI medications. Over-the-counter H2 blockers include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac).
Proton pump inhibitors will treat the heartburn by blocking acid production and allowing time for damaged esophageal tissue to heal. Over-the-counter proton pump inhibitors include lansoprazole (Prevacid ) and omeprazole (Prilosec). Long-term use of proton pump inhibitors appears to be generally safe but there has been an associated increased risk of fractures of the hip, wrist, and spine in those over 50 years of age as well as some reported drug interactions your doctor should be familiar with.

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Heartburn can be treated with various drugs, proton pump inhibitors, or with surgery.
Monday, 06 August 2012 09:52 AM
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