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Category Archives: Heartburn

Many people suffer from heartburn, and the slightly more serious form of the disease, Gastro Esophageal Reflux Disease (GERD).    There are a number of medications used to treat this problem.

It you suffer from the occasional heartburn attack an over the counter antacid can be very helpful.  Tums, Gaviscon, and Maalox, are a few examples.  As well you can try to avoid attacks by stopping eating two to three hours before bedtime. Reducing your alcohol intake, stopping smoking, elevating the head of your bed four to six inches, maintaining a healthy weight, and avoiding coffee, chocolate, and peppermint

If these measures are unsatisfactory you can try an H2-blocker such as Zantac.  An H2 blocker blocks acid secretion triggered by histamine.  These meds work without regard to meals, however patients can develop a tolerance to them.  For many people their doctor has started them on an additional medicine called a proton pump inhibitor (PPI).  Examples include Pariet, Nexium, Prevacid and Pantaloc. These medications work by shutting down the acid producing pumps in your stomach.  If you are on a PPI once a day, take it 30 to 60 minutes before a meal, preferably breakfast.  If you take it twice a day, the second dose should be taken 30 to 60 minutes before dinner.  This helps turn off the active acid producing pumps that are working at meal times.  If you are also taking an H2-blocker take that medication at bedtime.

Taking a PPI can affect the amount of calcium absorbed.  This could increase your risk of a fracture especially if you are over 50.  To help counter this make sure you are getting enough calcium and vitamin D through your diet or a supplement.  Calcium citrate is a better supplement to take for absorption if you are taking a PPI.  Long term use of a PPI can also lead to a B12 deficiency.  Taking a daily multivitamin can help prevent this.

Recently there has been a concern raised about an interaction with Plavix and PPIs.  If you are taking both medications ask your doctor about this issue.  Certain PPIs cause more of a problem than others.  PPIs have been shown to decrease the antiplatelet activity of Plavix, and therefore increase the risk of cardiovascular events such as heart attacks.

PPIs also seem to increase the risk of pneumonia, and clostridium difficile diarrhea, possibly because the gastric acid suppression may allow bacteria to overgrow.

PPIs are good medications but you should make sure you are on one for the right reason.  Many patients are put on them in hospital to prevent GI bleeding but they are not stopped on discharge.  PPIs should be used to prevent ulcers if a patient is taking a long term NSAID (Advil) or COX-2 inhibitor (Celebrex), and those patients at high risk for ulcers or GI Bleeding due to severe GERD and erosive esophagitis. Long term therapy is not needed for H.pylori or duodenal ulcers.  If you are able to stop your PPI it should be tapered to avoid acid rebound.

If you have chronic heartburn talk to your doctor about what the best treatment is for you.  Start with simple lifestyle changes, and over the counter medications.  If these steps fail consider discussing the appropriateness of a PPI.