Heartburn

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Introduction

Heartburn also known as pyrosis refers to the painful burning sensation felt in the upper part of the food tube near the breastbone. The pain is felt in the chest and it also extends up to the throat. Numerous over-the-counter (OTC) medications are available for relief of heartburn. Pregnant women and children should take medical advice before taking any of these medications.1–3

OTC Medications

The common OTC medications for heartburn can be grouped as follows:2–4

Antacids

Antacids help in the neutralization of the excess acid in the stomach and provide a fast but short-term relief from heartburn. Some of the common antacids include the following:

  • Aluminum hydroxide.
  • Magnesium carbonate.
  • Calcium carbonate.
  • Magnesium hydroxide (milk of magnesia).
  • Sodium bicarbonate.

Contraindications

  • Allergy to the drug.
  • Sodium bicarbonate is contraindicated in individuals with heart disorders and hypertension.

Side-Effects

  • Constipation.
  • Stomach discomfort.
  • Loose motion.
  • May affect absorption of certain drugs.

Most of the OTC antacids contain a combination of above-mentioned drugs and are effective for casual heartburns. Some of the antacid combinations include digene, gelusil and milk of magnesia.

Bismuth Subsalicylate

It helps in relieving heartburn by balancing the way fluid moves through the bowels. It is also used as an antidiarrheal and antiemetic agent and is also known to kill germs in the stomach or bowel.

Contraindications

Allergy to the drug

Side-Effects

  • It can affect the functioning of the drugs such as blood thinning agents, drugs for gout, arthritis or diabetes.
  • It can cause temporary darkening of the tongue and stools.

H2-Blockers

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These agents reduce the amount of gastric acid being produced in the stomach. Although H2-blockers do not provide instant relief, they help in relieving the pain for a longer period of time. Some of the common H2-blockers include the following:

  • Cimetidine.
  • Famotidine.
  • Ranitidine (Rantac).

Dosage

  • Cimetidine: 200-400mg once or twice–daily.
  • Famotidine: 20 mg twice-daily/40 mg once at bedtime.
  • Ranitidine: 150 mg twice-daily/300 mg once at bedtime.

The H2-blockers are advised for individuals in whom heartburn persists for a long time and are usually advised to be taken for about 4–8 weeks.

Contraindications

Allergy to the drug.

Side-Effects

  • Headache.
  • Dizziness.
  • Constipation.
  • Diarrhea.

Proton Pump Inhibitors

These agents stop the production of gastric acid in the body to a certain extent and hence need about 1–4 days to relieve heartburn. This group of drug is helpful for the people who have frequent heartburn (at least 2 days in a week). The only one proton pump inhibitor, which is available as OTC medication is omeprazole (Omez).

Dosage

Omeprazole 20 mg once-daily for 4 weeks.

Contraindications

Allergy to the drug.

Side-Effects

  • Headache.
  • Dizziness.
  • Constipation.
  • Diarrhea.

When to Seek Medical Help

Prompt medical attention should be sought in the following cases:

  • Frequent episodes of heartburn that is not relieved with OTC medication for a few weeks.
  • Unintentional weight loss.
  • Difficulty in swallowing.
  • Presence of other symptoms along with heartburn.
  • Worsening of symptoms after taking antacids or H2-blockers.
  • Consumption of medications that may be causing heartburn.

References

  1. DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005; 100: 190–200.
  2. Smith L. Updated ACG Guidelines for Diagnosis and Treatment of GERD. Am Fam Physician. 2005; 71(12): 2376–2382.
  3. American Academy of Family Physicians. Antacids and Acid Reducers: OTC Relief for Heartburn and Acid Reflux. [homepage on the Internet]. Leawood, KS: American Academy of Family Physicians. Available at: http://familydoctor.org/online/famdocen/home/otc-center/otc-medicines/854.htm. Accessed on: 6 August 2008.
  4. McCarthy D. Living with chronic heartburn: Insights into its debilitating effects. Gastroenterol Clin North Am. 2003; 32(3 Suppl): S1–S9.

Written by: healthplus24.com team
Date last updated: May 10, 2015