$Unique_ID{BRK00181}
$Pretitle{}
$Title{How Do You Manage Heartburn Caused By Stomach Acid?}
$Subject{heartburn GER reflux esophagus irritation Digestive System Stomach
Acid Gastroesophageal carcinoma backflow gastric food foods Sedatives sedative
Antiacids antacid H2 receptor antagonist antagonists Carafate}
$Volume{I-10}
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Copyright (c) 1991-92,1993   Tribune Media Services, Inc.


How Do You Manage Heartburn Caused By Stomach Acid?


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QUESTION:  How do you manage heartburn caused by stomach acid?

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ANSWER:  Gastroesophageal reflux (GER), or heartburn, was once considered to
be common and relatively nonthreatening, but it is now recognized as having
serious effects on the lives of many patients and has been associated with
carcinoma and other risky conditions.  For this reason, diagnosis and
management are of supreme importance, and this is no longer a problem to take
lightly.  Careful diagnostic workup is a must to be sure that it is, indeed, a
condition caused by the backflow of acid into the esophagus.  For the purposes
of this answer, I am going to assume you are sure of your diagnosis.
     Basically, there are three therapeutic approaches for treating the
condition--lifestyle modification, drug therapy, and surgical intervention.
The initial approach should involve simple lifestyle changes alone, since they
pose no risk for the patient, and since long clinical observation has
determined they are beneficial practices for the general population on the
whole.
     To begin with, patients suffering from heartburn should eat small,
frequent meals and avoid the large evening meal which is so common in our
country.  GER disease has been associated with delayed gastric emptying and
smaller meals can make gastric emptying more efficient.
     Food selection is another important factor in managing chronic heartburn.
Certain foods such as animal fat and chocolate decrease the pressure in the
lower esophageal sphincter which can produce heartburn.  Therefore, patients
should steer clear from foods high in fat, and eat foods high in protein which
actually increase sphincter pressure.
     Patients should also be advised not to lie down immediately after eating
since there seems to be a correlation between heartburn and body position and
gravity.  Raising the head of the bed from six to eight inches is advisable as
well.
     Other lifestyle practices that effect heartburn involve certain
over-the-counter drugs and medications.  Sedatives and the deep sleep they
produce cause a decrease in the swallowing reflex and should therefore be
avoided.  Other medications, such as calcium channel blockers used by cardiac
patients, can cause heartburn as well.
     When symptoms persist after weeks of lifestyle modification, drug therapy
may be necessary.  Antiacids and H2 receptor antagonists are most frequently
prescribed, producing results within the first week.  Antacids have limited
powers and are not valuable for prolonged therapy.  However, they are
recommended as a first drug approach.  H2 receptor antagonists can offer
considerable relief, with the longer-acting agents proving more effective than
the shorter-acting ones.  In aggravated cases, these drugs should be taken for
a minimum of twelve weeks.  Carafate, another drug compound, mixed in water
and taken before meals and at bedtime, can be helpful as well.  Ideally,
therapy is most effective when antacids, H2 receptor blockers, and carafate
are taken together.
     If none of the above treatments work, surgery may be the last resort.
However, mild or intermittent symptoms should not warrant surgical
intervention.  Such treatment is required in only a small number of patients,
and only when all other therapy fails.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.