The television commercials are hard to miss if you watch any prime-time shows or sports events.
Like the one where the father is shopping with the daughter who wants to fix him a favorite meal containing spicy sausage. Dad declines the offer; that dish gives him heartburn these days, just can’t eat the stuff.
But, wait, the daughter assures him, new over-the-counter heartburn remedies taken before a meal will solve his problem. The father likes the notion and loads up the shopping cart with the sausage and fixings.
The new over-the-counter drugs, known as H2 blockers or acid reducers, go by brand names Tagamet HB and Pepcid AC. A third major brand, Zantac 75, is due on the market in the coming months. The drugs have been used at prescription strength for about 20 years, dramatically improving the lives of heartburn sufferers who found no relief in antacid tablets.
While they last six to eight hours more in the body’s digestive system, the H2 blockers take longer–45 to 90 minutes–than antacids to work on heartburn, which is caused by stomach acid traveling back up the esophagus in what’s called a reflux action. The acid burns as it splashes against the sensitive lining of the esophagus, which passes just behind the heart.
To prevent such unpleasantries–and possibly more serious complications–the ads suggest taking the tablets before eating.
But that message may be too simplistic.
“It’s a reasonable treatment for occasional heartburn,” said Dr. Sheldon Sloan, a gastroenterologist at Rush-Presbyterian-St. Luke’s Medical Center. “But it’s not a good practice for chronic heartburn. People with ongoing problems should see a doctor.”
Some of those problems, according to a Northwestern University Medical School alert: taking an antacid more than twice a week; waking up with heartburn during the night; regular discomfort eating spicy foods; and difficulty swallowing.
Research shows about 10 percent of the U.S. population suffers from heartburn daily, and 44 percent of Americans experience symptoms at least once a month. Eighty percent of pregnant women have it and the incidence of heartburn doubles in people older than 50.
“It’s common but that doesn’t mean it’s normal,” said Dr. M. Michael Wolfe, a gastroenterologist at Brigham and Women’s Hospital in Boston and co-author of the new book “The Fire Inside: Extinguishing Heartburn and Related Symptoms” (W.W. Norton).
Wolfe said he has some problems with the growing use of the over-the-counter versions of H2 blockers, which he does consider useful.
“Don’t pop them in place of going to the doctor,” he said. “Many of these excellent drugs are used at the wrong dosage or the wrong time of day. A physician can help individualize the program.”
Gastroenterologists also can provide stronger prescription drugs for more severe cases–including a breakthrough category of drugs called “acid pump inhibitors” such as Prilosec–but not before doing a thorough survey of eating patterns.
“What you eat can make a difference,” said Sloan. “I see a lot of patients whose bad eating habits are causing not only heartburn but more serious damage to the esophagus, such as scarring that makes it hard to swallow.”
In his book, Wolfe identifies a number of foods implicated in acid reflux, explaining that they cause the one-way door or valve at the base of esophagus (called the sphincter) to “relax” or open at the wrong times. The most common items are anything containing chocolate or caffeine. Coffee and soft drinks are especially troublesome for many patients, and decaffeinated coffee is no exception. Dairy products also bother many people; same goes for citrus fruits, tomatoes and onions.
More surprising is the adverse effect of mints, including peppermint oil. Breath fresheners and mint herbal teas can be equally turbulent.
Another post-meal tip is to avoid lying down. About half of those with chronic heartburn pump more acid into the esophagus from a reclining position. Sloan suggested elevating your upper body–not just the head but the entire upper digestive tract–about three to six inches while sleeping at night.
One final but important point: Wolfe said about half of people who suffer from acid reflux won’t experience heartburn. Their symptoms include hoarseness (stomach acid reaching the vocal cords) and asthma caused by an inflammed esophagus. There are even cases of severe chest pain that turns out to be severe acid reflux rather than the suspected heart attack.
“About 180,000 Americans have cardiac procedures (such as clearing the arteries) performed on them each year that are unnecessary and actually due to acid reflux,” said Wolfe.
