All About Heartburn

Seunga (Jasmine) Han, PharmD Student

Before we get started, we just want to wish everyone a Merry Christmas!
Christmas often means hours of feasting. With the amount of sweets and rich foods we get to eat, we’re likely to come across an uninvited guest – heartburn.

Heartburn, also known as acid reflux, is that burning sensation in your stomach or chest pain that starts in your lower chest and travels up to the neck. In today’s article, we’ll discuss some common causes and solutions for heartburn symptoms so that you can enjoy your holiday season pain free!

Let’s Talk About Gastroesophageal Reflux Disease

Gastroesophageal Reflux Disease, also known as GERD, is a condition that occurs when your stomach acid flows back into the esophagus, the tube that connects your mouth to your stomach. This backflow of acidic stomach contents is what causes you to experience the discomfort and pain mentioned above.
GERD may be caused by various factors, and its symptoms can be worsened by several conditions including:

• • Asthma
  • Medications (opioids, nicotine, benzodiazepines, many blood pressure and heart medications)
  • Obesity
  • Smoking
  • Diet (fatty or spicy food, coffee, alcohol, potentially chocolate)
  • Age over 65
  • Pregnancy
  • Stress and anxiety

When to Seek Immediate Help

The important thing with GERD is making sure the symptoms you’re experiencing are actually due to acid reflux and aren’t a sign of something else. Discomfort in the chest or stomach could always potentially be something more serious. If any of the following apply to you, it’s important that you seek immediate help:

• Chest pain or discomfort that spreads to the upper neck or shoulder
• Symptoms get worse with physical activity and get better with rest
• Choking
• Difficulty or pain when swallowing
• Blood in vomit or stool
• Unintentional weight loss

How do I Treat GERD?

Good news! There are various treatment options for GERD, including prescription and non-prescription medications.

#1 Proton Pump Inhibitors (PPIs)
PPIs are often recommended for those with more severe symptoms of GERD and erosion of the esophagus. These include: esomeprazole (Nexium^®), dexlansoprazole (Dexilant^®), lansoprazole (Prevacid^®), omeprazole (Losec^®), pantoprazole magnesium (Tecta^®), pantoprazole sodium (Pantaloc^®), and rabeprazole (Pariet^®). With the exception of esomeprazole, all PPIs require prescription.

They work by blocking acid production in the stomach to provide more of a long-term benefit. They’re generally taken once daily, 30-60 minutes before meals for about eight weeks. While they’re very effective, growing evidence recommends against long term use of PPIs due to potential side effects, such as hip fracture and heart-related events. Additionally, long-term PPI use can lead to acid rebound if the medication is suddenly stopped. Therefore, it’s recommended that you talk to your healthcare provider before starting or discontinuing PPIs.

#2 Histamine H2 Receptor Antagonists (H2RAs)
H2RAs also work by reducing acid production in the stomach and are great options for those with milder symptoms (<3 times/week). They aren’t as effective as PPIs, but they offer quicker relief of symptoms and can be taken before meals to prevent symptoms. Additionally, they can be found over-the-counter or can be obtained by prescription for long-term use. Some examples of H2RAs include famotidine (Pepcid^®) and ranitidine (Zantac^®).

#3 Alginates/Antacids
Gaviscon^® is currently the only medication that belongs to the class of drugs called alginates. Alginates create a protective layer of gel in the stomach to block acid reflux.
Antacids, such as TUMS^® and Diovol^®, work by directly neutralizing acid in the stomach.

Both options typically provide immediate relief and are best taken immediately after a meal for prevention or relief of symptoms. Both Gaviscon^® and antacids are often well-tolerated and are available over-the-counter if you need a quick fix.

The Bottom Line

While some of these options are available over-the-counter, it’s always important to consult your healthcare provider, especially if you’re taking any other medications, are pregnant or have any other medical conditions.
Moreover, simple lifestyle changes like avoiding food that triggers symptoms, not lying down after a meal, achieving an ideal body weight, reducing alcohol/caffeine intake, and consuming smaller/more frequent meals can reduce or limit GERD symptoms without any need for medication.

As always, we hope you took away something valuable from this piece. If you have any questions or concerns regarding this article or others, feel free to reach out to us on Instagram, Facebook, or at ask@orbishealth.ca with your feedback. We’d love to hear from you.

RESOURCES

1. RxTx
2. DynaMed Plus