HEARTBURN TREATMENTS

Drugs

Occasional heartburn is probably best treated with over-the-counter antacids. These products go straight to the esophagus and immediately begin to decrease acidity. However, they should not be used as the sole treatment for heartburn sufferers who either have two or more episodes per week or who suffer for periods of over three weeks. There is a risk of kidney damage and other metabolic changes.

H2 blockers (histamine receptor blockers, such as Pepsid AC, Zantac, Tagamet) decrease stomach acid production and are effective against heartburn. H2 blocker treatment also allows healing of esophageal damage but is not very effective when there is a high degree of damage. It takes 30–45 minutes for these drugs to take effect, so they must be taken prior to an episode. Thus, they should be taken daily, usually two to four times per day for several weeks. Six to twelve weeks of standard-dose treatment relieves symptoms in about half the patients. Higher doses relieve symptoms in a greater fraction of the population, but at least 25% of heartburn sufferers are not helped by H2 blockers.

Proton-pump inhibitors also inhibit acid production by the stomach, but are much more effective than H2 blockers for some people. They are also more effective in aiding the healing process. Esophagitis is healed in about 90% of the patients undergoing proton-pump inhibitor treatment.

The long-term effects of inhibiting stomach acid production are unknown. Without the antiseptic effects of a consistently very acidic stomach environment, users of H2 blockers or proton-pump inhibitors may become more susceptible to bacterial and viral infection. Absorption of some drugs is also lowered by this less-acidic environment.

Prokinetic agents (also known as motility drugs) act on the LES, stimulating it to close more tightly, thereby keeping stomach contents out of the esophagus. It is not known how effectively these drugs promote healing. Some of the early motility drugs had serious neurological side effects, but a new drug, cisapride, seems to act only on digestive system nerve connections.

Surgery

Fundoplication, a surgical procedure to increase pressure on the LES by stretching and wrapping the upper part of the stomach around the sphincter, is a treatment of last resort. About 10% of heartburn sufferers undergo this procedure. It is not always effective and its effectiveness may decrease over time, especially several years after surgery. Dr. Robert Marks and his colleagues at the University of Alabama reported in 1997 on the long-term outcome of this procedure. They found that 64% of the patients in their study who had fundoplication between 1992 and 1995 still suffered from heartburn and reported an impaired quality of life after the surgery.

However, laparoscopy (an examination of the interior of the abdomen by means of the laparoscope) now provides hope for better outcomes. Fundoplication performed with a laparoscope is less invasive. Five small incisions are required instead of one large incision. Patients recover faster, and it is likely that studies will show they suffer from fewer surgical complications.

HEARTBURN ALTERNATIVE TREATMENTS

Prevention, as outlined below, is a primary feature for heartburn management in alternative medicine and traditional medicine. Dietary adjustments can eliminate many causes of heartburn.

Herbal remedies include bananas, aloe vera gel, chamomile (Matricaria recutita), ginger (Zingiber officinale), and citrus juices, but there is little agreement here. For example, ginger, which seems to help some people, is claimed by other practitioners to cause heartburn and is thought to relax the LES. There are also many recommendations to avoid citrus juices, which are themselves acidic. Licorice (Glycyrrhiza uralensis) can help relieve the symptoms of heartburn by reestablishing balance in the acid output of the stomach.

Several homeopathic remedies are useful in treating heartburn symptoms. Among those most often recommended are Nux vomica, Carbo vegetabilis, and Arsenicum album. Acupressure and acupuncture may also be helpful in treating heartburn.

Sodium bicarbonate (baking soda) is an inexpensive alternative to use as an antacid. It reduces esophageal acidity immediately, but its affect is not long-lasting and should not be used by people on sodium-restricted diets.