Tuesday, October 23, 2012

3 Ways to Cool Heartburn Heat

By: Dr. Louis O. Jeansonne IV, MD
Associate Medical Director for Surgical Specialties

Note:  Specific medications are mentioned in this article.  These medications are safe for most patients, however, they may not be appropriate for some patients due to health conditions, allergies, or interactions with other medications.  Please consult your physician before starting a new medication, and always read all package insert materials.  Dr. Jeansonne is not affiliated with any pharmaceutical company or medical device company.

Gastro-esophageal reflux disease (also known as GERD, acid reflux, or heartburn) affects 40% of Americans.  In most cases, the symptoms can be controlled with lifestyle choices and medication.  Anyone who experiences heartburn symptoms twice a week or more should discuss this with their physician.  However, mild or less frequent heartburn can be managed by the patient.  This should be done in the following order:

Step 1:  Lifestyle Changes

These mainly involve avoiding factors that cause reflux or increase the amount of acid produced by the stomach.

  • Avoid tobacco, caffeine, and alcohol.  These all increase the amount of acid produced in your stomach.
  • Avoid NSAIDs.  This is a group of medications that includes ibuprofen (Advil), naproxen (Aleve), aspirin, and certain other pain medications.  Acetaminophen (Tylenol) is not in this category and will not cause acid reflux.
  • Decrease stress.  Obviously if this were possible we would all do it, but some patients find that if their life changes in a way that leads to decreased stress, their heartburn may go away.
  • Dietary modification.  This basically involves moving away from the standard Louisiana diet and eating smaller, less spicy meals.  Try to decrease pepper and acidic foods such as orange juice.
  • Elevate head of bed.  Putting small blocks under the top two legs of a bed creates an angle that may decrease reflux.
Step 2:  Medications

Most of these medications are available over the counter.  I have included brand names for reference, but the generic versions work just as well.  For generic medications, check the name of the active ingredient on the label.

  • Antacids.  These include medications like Tums, Rolaids, and Maalox.  They are fast-acting but are also fairly weak and do not last very long.  They are the first choice for mild, infrequent heartburn.
  • Histamine-2 blockers.  These are the next medications you should try if your heartburn is not relieved by antacids.  These medications are fast-acting but work best if taken before meals, and last up to 12 hours.  They include:
    • ranitidine (Zantac)
    • famotidine (Pepcid)
    • cimetidine (Tagamet)
  • Proton Pump Inhibitors.  Also known as PPI’s, these are the strongest medications available.  They almost completely block the production of stomach acid.  They do not work immediately, but they last up to 24 hours.  They may have side effects if taken long term, which you should discuss with your doctor.  They  include:
    • omeprazole (Prilosec, Zegerid)
    • lansoprazole (Prevacid)
    • esomeprazole (Nexium)
    • rabeprazole (Aciphex)

Step 3:  Surgical procedures

If your GERD persists for a long time or if it is unresponsive to medication, your doctor may recommend one of the following procedures.

  • Transoral incisionless fundoplication (Esophyx procedure):  a procedure done under anesthesia where a device is inserted through the mouth and into the stomach, which places stitches at the area between the stomach and esophagus to tighten it and prevent reflux. To learn more about this procedure, click here.
  • Laparoscopic fundoplication (Nissen procedure):  a surgical procedure done through small incisions, where the top of the stomach is wrapped around the lower esophagus to create a barrier to reflux.
GERD is a common and irritating problem for many Americans, but in most cases it can be successfully treated.  If you suffer from frequent GERD and would like a consultation with an Ochsner physician call 225-761-5200.  

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