The Hidden Dangers Of Heartburn
Syndicated columnist, NBC Today contributor and creator of SavvySenior.org
Dear Savvy Senior,
Is regular heartburn or indigestion anything to worry about? My 60-year-old husband eats a lot of Tums or Rolaids throughout the day to help him manage it, but it keeps him up at night too. What can you tell us?
Almost everyone experiences heartburn or acid indigestion from time to time, but frequent episodes can signal a much more serious problem. Heres what you should know, along with some tips and treatments to help relieve your husbands symptoms.
Its estimated that more than 60 million Americans experience heartburn at least once a month, with around 15 million people who suffer from it daily. If your husband is plagued by heartburn two or more times a week, and its not responding well to over-the-counter antacids, he needs to see a doctor. Frequent bouts may mean he has gastroesophageal reflux disease , which can severely irritate and damage the lining of his esophagus, putting him at risk of Barretts esophagus and esophageal cancer if its not treated.
Ppi Failure Due To Ppi Side Effects
Studies have shown acid-related symptoms and rebound acid hypersecretion may occur after PPI treatment . Aside from rebound acid hypersecretion, rare side effects that have been associated with long-term PPI treatment include hypomagnesemia, abdominal symptoms , Clostridium difficile infection, small intestinal bacterial overgrowth and spontaneous bacterial peritonitis . Moreover, PPIs may delay gastric emptying and cause dyspepsia in certain patients . In general, PPIs are safe and well-tolerated medications, but it is important to be aware of their rare side effects that may mimic PPI failure.
When To See A Gastroenterologist
Sometimes its difficult to know when your symptoms are severe enough that you need to make an appointment with a gastroenterologist, and we understand that. Here are some indications that its time to call a gastroenterologist:
- Symptoms that continue for more than two weeks
- Heartburn that persists after taking over-the-counter medications
- Heartburn episodes that change in frequency or intensity
- Nighttime symptoms that affect your sleep quality
- Acid reflux that interferes with your daily activities or affects your quality of life
- Unexplained weight loss or decreased appetite
- Pain or difficulty swallowing
- Heartburn accompanied by nausea or vomiting
- Unexplained weight loss
- Chronic hoarseness or wheezing
If you experience any of the symptoms above, its time to see one of our gastroenterologists. After performing a complete medical exam, your gastroenterologist may recommend that you undergo an upper endoscopy to evaluate your symptoms and see if you have suffered any damage to your esophagus, or provide you with the peace of mind that everything is all right. During your visit, the doctor will examine the lining of your esophagus, stomach and duodenum to determine the cause of your digestive symptoms and the appropriate treatment.
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How Should I Take An H2 Blocker
If you have mild reflux symptoms that occur less than two times a week, you can start with a low dose of or . Ranitidine , another H2 blocker, was recently removed from the market because it was found to contain higher-than-acceptable levels of cancer-causing substances. But to date, FDAs testing has not found this substance in famotidine or cimetidine products.
To prevent reflux symptoms, both famotidine and cimetidine work better when taken 10 to 60 minutes before eating food or drinking beverages that cause reflux. If symptoms persist, you can take one more dose within 24 hours. But remember: H2 blockers are only good for short-term use. Do not take the maximum daily dose continuously for more than 2 weeks, unless directed by your doctor. Once your acid reflux improves, stop the medication. Its very important to know that almost all H2 blockers dont work well after a period of time since the stomach adjusts and they become much less effective.
If your reflux is more frequent or severe, you may have GERD, which is a more severe form of reflux. Your doctor may have you take an H2 blocker twice daily for up to 6 weeks or a proton pump inhibitor , which we will cover next.
Will Heartburn Go Away On Its Own
For many people, occasional heartburn is common. By watching what you eat and avoiding certain triggers , you may be able to prevent heartburn or manage it. If you find that you frequently experience heartburn and that it keeps getting worse, it could be a sign of a medical condition like GERD. In these cases, your heartburn will not go away without treatment. Talk to your healthcare provider so that you can develop a treatment plan.
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Pathogenesis Of Gastroesophageal Reflux Disease
Gastroesophageal reflux disease results from continued exposure of the esophageal mucosa to gastric secretions, particularly acid and pepsin. A number of anatomic and physiologic mechanisms normally prevent reflux from occurring, and derangement in any of these can promote esophageal acid exposure. The most important factors at work in preventing reflux include the lower esophageal sphincter , esophageal clearance mechanisms that limit contact time with noxious substances, and mucosal protective factors intrinsic to the esophageal mucosa.
The LES, a 3- to 4-cm-long region of smooth muscle located at the esophagogastric junction, creates a zone of high pressure separating the esophageal and gastric compartments between swallows. The diaphragmatic crura assist the LES in the maintenance of a tonically closed sphincter. The contribution of hiatus hernia to GERD is well established the hiatus hernia eliminates the contribution of the crural diaphragm to LES function and thereby promotes gastroesophageal reflux. The severity of reflux disease in patients with hiatal hernia has been positively correlated with the size of the hernia sac.2
Fda Cautions Against Common Heartburn Drugs
In September 2019, FDA has communicated about the detection of an impurity, which is a carcinogen , in common heartburn medications available over the counter or by prescription. Several countries have banned these medications.
Minimise or avoid use of OTC medications. Use proper lifestyle modifications to manage and treat your symptoms. Reducing bacteria loads and limiting carbohydrate intake have both been shown to greatly improve, and in some cases completely cure, acid reflux and GERD.
We hope this article helps you make the right choices. Do leave your thoughts in the comments below. For more sessions on how to ease GERD and Acid Reflux, check out Healthy Reads or ask a GOQii Coach by subscribing for personalized coaching here:
About Komilla Pareek
I am a Nutritionist with varied experience, having worked with reputed hospitals, research institutes and educational establishments. Eating right is not a choice but our duty towards our body to keep it moving. Along with diet, right amount of sleep and exercise is essential to look good and feel good. Doing what is right starts with motivation, but lasts with a habit. Therefore, my goal here is to motivate you and make healthy living your favourite habit.
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When Should I Take An Antacid Vs A Famotidine Or Omeprazole
Let’s start with the basics. Antacids neutralize excess stomach acid to relieve heartburn, sour stomach, acid indigestion, and stomach upset. They are sometimes prescribed in addition to other meds to help relieve the pain of stomach and duodenal ulcers. Some antacids also contain simethicone, an ingredient that helps eliminate excess gas.
You should take antacids exactly as directed by your doctor, or according to the manufacturer’s directions. For stomach or duodenal ulcers, take the medicine for as long as your doctor tells you. If you are using the tablets, chew them well before swallowing for faster relief.
Serious side effects can occur with an overdose or overuse of antacids. Side effects include constipation, diarrhea, change in the color of bowel movements, and stomach cramps. Products containing calcium may cause kidney stones and are more likely to cause constipation.
Products like famotidine are called histamine-2 blockers or H2 blockers. These drugs reduce production of stomach acid and are available in prescription-strength or in lower doses in over-the-counter varieties. These products are for relief of heartburn, acid indigestion, sour stomach, and other conditions, such as stomach ulcers.
PPIs generally cause few side effects, but they do interact with other common drugs such as warfarin , some heartmedications and antibiotics, so it is important to review all medications with your doctor.
Eat Drink And Be Wary Chronic Heartburn May Indicate A More Serious Disorder
I cant believe I ate the whole thing.
Weve all been guilty of overindulging at one time or another particularly during the holiday season and have suffered the discomfort that often follows. Sometimes the pain after eating too much is more severe than the typical gas, bloating, or indigestion or it happens frequently and is hard to control with the usual over-the-counter remedies. And sometimes heartburn just happens and has nothing to do with what weve eaten.
Twenty percent of Americans one in five individuals experiences heartburn at least once a week. While its common, dont take heartburn lightly. Frequent indigestion may indicate a serious health problem known as gastroesophageal reflux disease severe or chronic acid reflux that can lead to complications such as sleep disorders, esophageal bleeding or ulcers, and cancer.
Heartburn, or indigestion, is that pain in the chest we feel after overeating. Its caused by stomach acid backing up into the esophagus, the muscular tube that carries food from the throat to the stomach. Overeating isnt the only cause of acid reflux. It can also be triggered by medications, obesity, pregnancy, stress, chronic health conditions such as asthma, diabetes or a hernia or even sleeping in certain positions.
The signs and symptoms for heartburn and GERD are similar the difference is generally the frequency and severity of symptoms.
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Let Your Stomach Loose
Tight waistbands or belts that dig into your stomach place unnecessary pressure on your abdomen.10 Swallowing an antacid and undoing the button of your pants or taking your belt down a notch or two after eating will provide instant relief. Maintaining a healthy weight is, however, a better long-term solution.
If I Only Have Heartburn About Once A Month Is Tums A Better Option Than Something Like Zantac
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Optimization Of Ppi Therapy
According to ACG guidelines, the first step in the management of refractory GERD is optimization of PPI therapy . Thus, improving compliance with PPI treatment is an important initial step for optimization of PPI treatment. The prescribing providers should educate their patients about the importance of taking the PPI daily in order to achieve maximum effect. A recent study has shown that compliance with a PPI was the highest if the medication was prescribed by a gastroenterologist and the lowest if patients obtained their PPI over the counter. Adherence to proper timing of PPI consumption is also an important step in PPI optimization. A study has demonstrated that 100% of the patients who were refractory to PPI once daily were not consuming the PPI optimally . Instead, they were consuming it more than an hour before a meal, during a meal and at bedtime. Thus, it is important to explain to patients about proper timing of PPI consumption for maximum effect.
Identifying Common Symptoms And Causes Of Heartburn
It is important to be able to identify the common symptoms of heartburn to understand what type of action you need to take for treatment. The most common symptoms of heartburn, besides the burning sensation in the center of your chest, can be symptoms like pain in your chest when you lay down or a burning sensation in your throat.3 Other symptoms of heartburn may include difficulty swallowing and a hot, sour, or acidic taste in the back of your throat.4
You may find yourself experiencing these symptoms after consuming certain foods and drinks that can trigger heartburn. For example, citrus fruits, high-fat foods, tomato-based products, and alcohol have been known to cause heartburn.5 Other types of causes to consider can be more lifestyle-based, specifically for those who are active smokers, people who experience high levels of stress, and those who are overweight.6
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Reasons Why Heartburn And Gerd Won’t Go Away
- The most common cause of heartburn is GERD .
- Some other conditions may cause heartburn but are far less common than GERD.
- If you are NOT diagnosed with GERD you should check your doctor to confirm The diagnosis of GERD.
- Up to 40% of GERD patients fail to respond adequately to standard treatment with medications .
- Doctors Consider refractory GERD when you still have symptoms despite taking PPIs twice daily.
- The most common causes include:
- Not taking The right medication.
- Faulty use of the medication.
- A condition called functional heartburn.
- Non-acid reflux .
- Hiatus hernia.
- Your esophagus is hypersensitive .
- wrong diagnosis!
Diagnostic Approach To Refractory Patients
Initial response to PPI therapy should be assessed clinically after four to eight weeks. Failure to respond to a regular dose of PPI is defined as refractory GERD . In patients with persistent symptoms, assessment of the method of administration of PPI is important because patients frequently perform it incorrectly. Doubling the dose of PPI or switching to another PPI may also be beneficial, although the evidence for these manoeuvres is weak. In refractory patients or those with new or worsening symptoms on high-dose PPIs, endoscopy and biopsy are indicated . The current approach to PPI failure is summarized in . Although the majority of patients with GERD are adherent to PPI therapy , PPI failure may occur in patients who take PPIs incorrectly. Failing to take doses 30 min to 60 min before a meal will lead to lower effectiveness because gastric acid production is stimulated by food, and the proton pumps are inactivated by PPI during acid production. A common example is taking PPI at bedtime for night-time symptoms, which is less effective than taking the dose before the evening meal. This is a more important issue for an immediate-release PPIs but less so for a PPI with a dual-dose formulation such as dexlansoprazole. Similarly, failing to take the medication at all or infrequent, as-needed use will significantly reduce the overall benefit from PPI.
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Adopt New Bedroom Habits
Do you have trouble sleeping at night due to heartburn? If so, try sleeping on your left side this position seems to help. Experts also recommend keeping your upper body elevated to make it harder for acids to flow up the esophagus. Raise the head of your bed or use a thick wedge-shaped body pillow when sleeping to keep heartburn at bay.7
* Onset of acid neutralization does not imply the onset of symptom relief.
You Have A Chronic Cough
Coughing can be caused by anything from a cold to asthma, so it can be difficult to determine whether or not its related to your heartburn. But, if you have a persistent cough that wont go away in addition to heartburn, the two may be making each other worse. Because untreated heartburn can damage the lining of your esophagus, it can often lead to heartburn. Likewise, untreated coughing can damage your esophagus leading to heartburn!
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Its Interfering With Your Life
For any symptom, its a good idea to get in touch with your doctor if its having a negative impact on your life. If your heartburn is persistent and isnt helped by medications, is causing you to modify your lifestyle to deal with the pain, or is keeping you from sleeping, working, or relaxing, its time to figure out whats really going on. Not only will it preserve your health in the long run, but youll feel better, too.
Heartburn Is Not Going Away With Ppis
Proton pump inhibitors are The standard treatment for GERD and acid reflux. The most commonly used PPIs are:
- Omeprazole .
- Rabeprazole .
- Dexlansoprazole .
Its as Common as 40% of GERD sufferers dont achieve complete heartburn resolution despite using PPIs. And this can happen for many reasons .
But your heartburn wont go away because you are using the WRONG PPI!
PPs are metabolized and deactivated inside your liver. And people metabolize different PPIs at different rates.
Different people have different enzymatic activities. so people respond differently to PPIs.
You may be taking the wrong type of PPI. And you have to switch to a second or even a third type of PPI group mentioned above.
The rule is to switch between different types of proton pump inhibitors before saying it wont work for my heartburn.
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