Heartburn medical therapy: Difference between revisions
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Bananas are a natural antacid so eat one for instant relief of heartburn. The inside of the banana skin is also good for soothing mosquito bites. | Bananas are a natural antacid so eat one for instant relief of heartburn. The inside of the banana skin is also good for soothing mosquito bites. | ||
==Overview== | ==Overview== | ||
Revision as of 18:17, 4 September 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]
Medical Therapy
Medications
Antacids, H2-receptor antagonists, alginates and proton pump inhibitors are used (in that order) to treat heartburn.
Antacids
Antacids work by neutralizing excess stomach acid. So although stomach acid will still splash up into the esophagus (acid reflux) the stomach acid will be neutralized and therefore will lead to lesser or no heartburn symptoms (the burning feeling). Antacids provide fast relief of symptoms, but relief typically lasts for just 30-60 minutes.
Sodium bicarbonate
A simple and relatively harmless way to treat a one-off heartburn is to drink a solution of a small amount of sodium bicarbonate mixed with water, which quickly neutralizes the acid that causes the pain. Excess sodium intake does, however, raise blood pressure and cause other undesirable health effects if resorted to with any frequency.
H2-receptor antagonists
Often called H2 Blockers, H2-receptor antagonists work by decreasing the amount of acid the body releases into the stomach. H2s are systemic, meaning they require absorption into the bloodstream in order to work. Therefore, H2s can often take 30 minutes or longer before they start working, and therefore are often taken to prevent heartburn rather than for fast relief of symptoms.
Alginates
Alginates work differently than antacids and H2 Blockers, by forming a protective barrier in the stomach that prevents stomach acid from refluxing back up into the esophagus. Alginic acid is naturally derived (from brown seaweed) and is non-systemic. Alginates provide faster relief than H2-receptor antagonists and PPIs and longer-lasting relief than antacids.
Proton-pump Inhibitors
Proton pump inhibitors, called PPIs, are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors are systemic and directly block acid production in the stomach cells. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them. Proton-pump inhibitors are not fast-acting, but provide long-lasting relief. PPIs are intended to be short-term medications only.
Restricting Diet
Restricting diet is very important, since 90-95% of patients of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn patients manage their diets as a way to treat their heartburn. Patients should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.
Bananas
Bananas are a natural antacid so eat one for instant relief of heartburn. The inside of the banana skin is also good for soothing mosquito bites.
Overview
The mainstay treatment of GERD is lifestyle modifications which include weight loss, elevating head of the bed and no eating before going sleep. The pharmacologic medical therapy is recommended among patients with persistent GERD despite following the lifestyle modifications. Antacids, histamine receptor antagonists, proton pump inhibitors, and prokinetics medications are used in treatment of GERD.
Medical Therapy
Lifestyle Modifications
- The following measures are recommended as the first line to treat GERD:[1][2][3][4]
- Weight loss
- Elevating head of the bed
- No eating two hours before going sleep
- Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
- Coffee
- Alcohol
- Excessive amounts of Vitamin C supplements
- Foods high in fats
- Smoking
- Eating shortly before bedtime
- Large meals
- Chocolate and peppermint.
- Acidic foods, such as oranges and tomatoes.
- Cruciferous vegetables such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
- Milk and milk-based products
Medical therapy
- The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.[5][6]
- The following medical therapies are strongly recommended by the American College of Gastroenterology:
- Antacids:
- Preferred regimen (1): Aluminum hydroxide 640 mg 5 to 6 times daily PO after meals and at bed time.
- Preferred regimen (2): Calcium carbonate One gram PO.
- Histamine-receptor antagonists (H2RA):
- Preferred regimen (1): Ranitidine 150 mg q12 daily PO
- Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
- Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
- Proton pump inhibitors:
- Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
- Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
- Prokinetic medications:
- Preferred regimen (1): Metoclopramide 10 mg q24 PO for 4 to 12 weeks
- Antacids:
References
- ↑ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
- ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
- ↑ Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). "Lifestyle Intervention in Gastroesophageal Reflux Disease". Clin Gastroenterol Hepatol. 14 (2): 175-82.e1-3. doi:10.1016/j.cgh.2015.04.176. PMC 4636482. PMID 25956834.
- ↑ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
- ↑ Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther. 25 (2): 143–53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239.
- ↑ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. Am J Ther 1995;2:546-552. PMID 11854825.