What To Do When The Pain Wont Stop
Even if youre doing well on PPIs, its a good idea to have a backup plan to cope with breakthrough symptoms.
About 73% of people with GERD taking prescription PPIs say theyre satisfied or very satisfied with the medication, according to a 2009 survey of 617 patients published in Current Medical Research and Opinion and funded by Takeda Pharmaceuticals, the makers of Prevacid. Nevertheless, more than half56.7% of patients on once-a-day PPI therapy and 65.9% in the twice-a-day grouphad heartburn in the week before they took the survey.
Overall, 40% said they resorted to other medications for acid reflux, mostly over-the-counter antacids or histamine-2 blockers.
The most common reason that they were using the over-the-counter medicationis related to incomplete relief of their heartburn, explains lead author William D. Chey, MD, a professor of internal medicine and the director of the gastrointestinal physiology laboratory at the University of Michigan Health System, in Ann Arbor.
Patients werent reaching for additional heartburn soothers on their own. It turns out that roughly 60% were advised by their doctors to take antacids or H2 blockers to help with residual reflux symptoms, he says.
Things You Must Know If You Dont Have A Gallbladder
Removal of the gallbladder is one of the most common surgeries performed in the USA and Australia today. Gallstones are incredibly common and they occur in 10 to 15 percent of the population. The problem does tend to run in families. Women are more likely to experience gallbladder problems than men and this is partly due to the effects of the female hormone estrogen.
A gallbladder performs several important roles in your body:
- Enables fat digestion
- Enables absorption of fat soluble antioxidants and vitamins A, E, D and K
- Assists the removal of cholesterol from your body
- Assists the removal of toxins that have been broken down by the liver
Obviously you can survive without a gallbladder, but you are more prone to developing certain health problems. In particular you are at greater risk of developing a fatty liver, experiencing indigestion and developing deficiencies of essential fatty acids and fat soluble nutrients
Why Heartburn Drugs Can Fail
Its possible that PPIs arent curing your heartburn because youve been misdiagnosed, says gastroenterologist Joel Richter, MD, the chair of the department of medicine at Temple University, in Philadelphia.
Many conditions cause symptoms that mimic those of gastroesophageal reflux disease , the medical term for persistent acid reflux that damages the esophagus. Muscle contractions, stretching, and non-acidic reflux in the esophagus can all lead to heartburn , as can unrelated conditions such as heart disease. There is a big group of people who get put on these medications and dont get better, and most of the time its because they dont have an acid-related problem, says Dr. Richter.
Many times symptoms arise because people arent taking their medication correctly or at a time that optimizes its effectiveness, Dr. Johnson explains. Typically, the proton pump inhibitors are given 30 to 60 minutes before breakfast, he says. However, some people do better taking two doses a day to stave off nighttime symptoms, he adds.
And missing a pill may readily ignite that familiar burning sensation in the chest and throat and sour taste in the mouth.
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Treating Heartburn And Acid Reflux
Your GP may prescribe a medicine called a proton pump inhibitor . This reduces how much acid your stomach makes. PPIs include omeprazole and lansoprazole.
You’ll usually need to take this type of medicine for 4 or 8 weeks, depending on how serious your acid reflux is.
Go back to the GP if your symptoms return after stopping your medicine. You may need a long-term prescription.
You May Not Need A Ppi
More than half of the people who take PPIs probably do not need them. Simple heartburn can be treated with antacids or other drugs, plus diet and lifestyle changes.
You may only have heartburn every now and thensuch as after a big, spicy meal. This may be uncomfortable, but it is not serious. You can usually get relief from an antacid, like Rolaids or Tums, or an H2 blocker, such as Pepcid AC or Zantac.
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When To Call A Doctor
Antacids can often relieve symptoms of excess stomach acid. However, sometimes these symptoms mean you have a more serious condition.
Antacids can only soothe, not cure, some of the symptoms of these conditions. If you have severe pain that doesnt get better after using the recommended dosage of antacids for two weeks, call your doctor.
Ways To Help Your Heartburn
Fortunately, there are things acid reflux patients can do to help prevent and minimize breakthrough symptoms.
Take your medication as prescribed. If you dont know how and when to take it, call your doctor for specific instructions.
Dont hit the sack on a full belly. Lying down within three to four hours of consuming a large meal, particularly a late-evening feast, could spell trouble. “My big push is to keep the patients away from late eating, large meals and recumbency,” Dr. Johnson says. Such a triple threat may pose too large of an insult on the body, one that even PPIsthe gold standard in GERD treatmentcant handle. For nighttime symptoms , Dr. Johnson suggests elevating the head of the bed with some blocks or using a bed wedge to elevate the upper torso.
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What Do We Know So Far
On September 13, 2019, the FDA announced that preliminary tests found low levels of N-nitrosodimethylamine in ranitidine, a heartburn medication used by millions of Americans. This week, the drug companies Novartis and Apotex announced that they were recalling all of their generic ranitidine products sold in the US.
These announcements came after a Connecticut-based online pharmacy informed the FDA that it had detected NDMA in multiple ranitidine products under certain test conditions.
What Else Should I Know
Early diagnosis and treatment can help reduce or even stop uncomfortable GERD symptoms. Untreated GERD can cause permanent damage to the esophagus.
You’ll probably find that one of the simplest ways to make living with GERD easier is to avoid the things that trigger your symptoms. Some people will have to limit certain foods others may have to give them up entirely. It all depends on your symptoms.
It can be hard to give up sodas or favorite foods at first. But after a while, lots of people discover that they feel so much better that they don’t miss the problem foods as much as they thought they would.
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Can Exercise Be A Cause Of Heartburn
Exercise can trigger heartburn. Sometimes thatâs due to increased pressure on the abdomen, which can increase the risk of acid reflux. In one study looking at different types of exercise, weightlifters had the most heartburn and acid reflux. Runners had milder symptoms and less reflux than weightlifters. Cyclists had the least reflux.
Side Effects Of Antacids
Side effects from antacids are rare. However, they can occur, even when you use them according to the directions.
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Dont Drink Too Much Coffee
Studies have found that coffee temporarily relaxes the lower esophageal sphincter, increasing the risk of acid reflux .
Some evidence also points toward caffeine as a possible cause. Similarly to coffee, caffeine relaxes the lower esophageal sphincter, which could cause reflux .
Nevertheless, although several studies suggest that coffee and caffeine may worsen acid reflux for some people, the evidence is not entirely conclusive.
For example, one analysis of observational studies found no significant effects of coffee intake on the self-reported symptoms of GERD.
Yet, when researchers investigated the signs of acid reflux with a small camera, they found coffee consumption was linked to greater acid damage in the esophagus .
Thus, whether coffee intake worsens acid reflux may depend on the individual. If you find coffee gives you heartburn, its best to simply avoid it or limit your intake.
Evidence suggests that coffee may make acid reflux and heartburn worse. If you feel like coffee worsens your symptoms, consider limiting your intake.
When To Connect With Health Care Provider
Dr. Graf said if these tips dont get your symptoms under control, or if youre experiencing regurgitation, you should talk to your primary care provider or a gastroenterologist. Its important to get treatment because GERD symptoms arent just uncomfortable. Acid can damage the lining of your esophagus. And over time that damage can lead to a condition called Barretts esophagus, which makes it more likely that you could develop esophageal cancer.
To put together a treatment plan, your doctor may start with an upper endoscopy. Thats a procedure where youre sedated, and a surgeon puts a scope through your mouth and into your esophagus and stomach to see if the acid has caused any damage. If theres no damage, you can likely have follow-up endoscopies when you have your colonoscopies. You can try prescription medications to control your GERD symptoms.
If your esophagus is damaged or inflamed, or if medication doesnt get your symptoms under control, your doctor may recommend surgery. Surgical treatments for GERD are very effective. They can give you significant relief and halt the progression of GERD, Dr. Graf said.
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Opt For Cooked Onions Instead Of Raw
Raw onions are a common trigger for acid reflux and heartburn.
One older study in people with acid reflux showed that eating a meal containing raw onion significantly increased heartburn, acid reflux, and burping, compared with consuming an identical meal that didnt contain onions .
More frequent burping might suggest that more gas is being produced. This could be due to the high amounts of fermentable fiber in onions .
Raw onions are also more difficult to digest and might irritate the lining of the esophagus, causing worsened heartburn .
Whatever the reason, if you think eating raw onion makes your symptoms worse, you should avoid it and opt for cooked onions instead.
Some people experience worsened heartburn and other reflux symptoms after eating raw onions.
Causes Of Heartburn And Acid Reflux
Lots of people get heartburn from time to time. There’s often no obvious reason why.
Sometimes it’s caused or made worse by:
- certain food and drink such as coffee, tomatoes, alcohol, chocolate and fatty or spicy foods
- being overweight
- some medicines, such as anti-inflammatory painkillers
- a hiatus hernia when part of your stomach moves up into your chest
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Ppis Can Change The Way Other Drugs Work
PPIs interact with some common prescription drugs. For example, some PPIs can reduce the blood-thinning effect of the drug Plavix , according to the US Food and Drug Administration. This can increase the risk of heart attack and even death. If you take Plavix, talk to your doctor about whether you should take a PPI.
Dont Drink Too Much Citrus Juice
Many types of citrus juice, including orange juice and grapefruit juice, are considered common triggers for heartburn .
These ingredients are highly acidic and contain compounds like ascorbic acid, which could cause indigestion if you consume them in large amounts .
In addition to being acidic, certain compounds found in citrus juice could irritate the lining of the esophagus .
While citrus juice probably doesnt cause acid reflux directly, it could make your heartburn worse temporarily.
Some people with acid reflux report that drinking citrus juice makes their symptoms worse. Certain compounds in citrus juice, in addition to acids, can also irritate the lining of the esophagus.
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How Do Acid Blockers Work To Treat Heartburn
Products like Pepcid AC® are called histamine H2 blockers, or acid blockers. Acid blockers reduce the production of stomach acid. They relieve heartburn, acid indigestion and sour stomach. Always follow the directions on the packaging or talk to your healthcare provider about how to take this medication. Acid blockers you can buy without a prescription include:
- Pepcid AC®.
- Tagamet HB®.
Take your acid blocker medicine regularly for as long as directed by your healthcare provider, even if you do not have any pain or if your symptoms get better.
Stronger acid blockers are prescription medications. These can be used to block stomach acid, treat stomach and duodenal ulcers, erosive esophagitis, and GERD. They work by reducing the production of stomach acid. Your healthcare provider will give you a specific prescription for this type of acid blocker.
The United States Food and Drug Administration recently reported elevated levels of a possible carcinogen, NDMA, in the drugs ranitidine and nizatidine . You should speak to your healthcare provider if you are taking one these medications.
When To See A Pharmacist
Speak to a pharmacist for advice if you keep getting heartburn.
They can recommend medicines called antacids that can help ease your symptoms.
It’s best to take these with food or soon after eating. This is when you’re most likely to get heartburn. They may also work for longer if you take them with food.
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Adjust Your Sleep Position
Elevating your head and chest higher than your feet as you sleep can help prevent and ease acid reflux and heartburn. You can do this using a foam wedge placed under the mattress or by raising bedposts using wood blocks. Beware of piling pillows, as this usually isn’t effective and may even make your symptoms worse. Additionally, sleeping on your left side is thought to aid digestion and may work to limit stomach acid reflux.
What Are The Signs & Symptoms Of Gerd
Often, people who have GERD notice that they regularly have the pain of heartburn in the chest or stomach. This can last up to a couple of hours. Many notice their heartburn is worse after eating.
Regurgitation when food and liquid containing stomach acid comes back up into the throat or mouth is also a sign of GERD. But, like heartburn, occasional regurgitation is common for everyone.
Other symptoms of GERD include:
- a sore, raw throat or hoarse voice
- a frequent sour taste of acid, especially when lying down
- a feeling of burping acid into the mouth
- trouble swallowing
- bad breath
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Heres How To Control Your Symptoms
When your symptoms flare up, there are a few things you can try:
- Avoid foods that trigger your heartburn, especially in the afternoon or evening
- Elevate the head of your bed to enlist gravity to help fight regurgitation
- Take over-the-counter antacids like Tums or Rolaids, or acid suppressors such as Prilosec, Nexium, or Pepcid
Worst Foods For Reflux
In general, anything that is fatty, acidic or highly caffeinated should be avoided. The worst foods for acid reflux list includes:
- Coffee and tea Caffeinated beverages aggravate acid reflux. Opt for teas without caffeine.
- Carbonated beverages The bubbles expand in your stomach, creating more pressure and pain. Choose plain water or decaf iced tea.
- Chocolate This treat has a trifecta of acid reflux problems: caffeine, fat and cocoa.
- Peppermint Dont be fooled by its reputation for soothing the tummy peppermint is an acid reflux trigger.
- Grapefruit and orange The high acidity of citrus fruits relaxes the esophagus sphincter and worsens symptoms.
- Tomatoes Also avoid marinara sauce, ketchup and tomato soup theyre all naturally high in acid.
- Alcohol This has a double whammy effect. Alcohol relaxes the sphincter valve but it also stimulates acid production in the stomach.
- Fried foods These are some of the worst foods for reflux. Skip the french fries, onion rings and fried chicken cook on the grill or in the oven at home.
- Late-night snacks Avoid eating anything in the two hours before you go to bed. Also, you can try eating four to five smaller meals throughout the day instead of two to three large meals.
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Acid Reflux And Proton Pump Inhibitors
What is acid reflux or GERD?
The stomach makes acid to help you digest food and remove bacteria. This is a natural process. In some people, the stomach makes too much acid, which can cause discomfort. When your stomach makes too much acid, you may have symptoms like:
- Burning in your chest
- Regurgitating acid into your throat and mouth
- Sensing a lump in your throat when swallowing
- Burping, bloating, or a feeling of fullness in your stomach
- Chest pains
These symptoms may mean you have acid reflux and heartburn, which can usually be relieved by antacids and no medical treatment. If symptoms become serious and happen more than once a week, it could mean you have gastroesophageal reflux disease . If thats the case, your healthcare provider may suggest changes to your diet and lifestyle.
What lifestyle and diet changes can I try?
For many people, simply changing your diet and lifestyle is enough to relieve symptoms. This may include:
- Removing foods from your diet that could trigger symptoms of heartburn and/or acid reflux. To name a few:
- Acidic foods
- Greasy and high fat foods
- Not eating 2-3 hours before bedtime
If diet and lifestyle changes are not enough, your healthcare provider may put you on a type of medicine called proton pump inhibitors .