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Doctors' Answers to "Frequently Asked Questions" - Heartburn


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Severe Heartburn [posted 7/23/98]
Question: I am 39 years old and have never had a problem with heartburn before now, other than an occassional bout. Recently, the last two weeks especially, I have been experiencing heartburn everyday, morning and night. I have ulcers, but very seldom have any problems with them, although when I do it is very different from what I am experiencing now. I have been taking Pepcid AC recently, but am concerned that this may be something very serious.

Answer: Double/triple the Pepcid AC and if no better in two weeks or if getting worse-you'll need an x-ray or endoscope. Have you been treated for Helicobacter pylori? A common bacteria found in ulcer patients and treatment will decrease/eliminate the problem 80% of the time.

Heartburn / Antacids
Question: What are some active ingredients in antacids such as tums, malox, etc.?

Answer: Usually different aluminum and magnesium combinations. Some use calcium carbonate (like Tums) or a mixture of calcium carbonate and aluminum or magnesium. As a rule of thumb, an antacid starting with an A is basically aluminum products. An antacid starting with M is magnesium based products. The ingredients will be on the label.

Heartburn
Question: What is the best prescription to relieve the discomfort resulting from hiatal hernia and the pain of esophageal reflux?

Answer: For years we used H2 histamine blockers like Tagamet (cimetidine), etc. Many of these are now available over the counter. In the last 2-3 years, we have a new class of drugs which inhibits the hydrogen pump of the cells of the stomach. This results in decreased acid and generally is about twice as effective as H2 blockers. If this is ineffective, treatment with Propulsid to increase GI motility is added.

Heartburn - hot peppers
Question: I am 51 years old and have had a battle with heartburn for the past 25 years. About one year ago I went on a cabbage soup diet and one result was no more heartburn. Since that time I have almost become addicted to hot peppers. I put vast quantities of them on everything and eat, and everyone keeps telling me I will hurt the lining of my stomach. Will peppers do damage to the stomach or anything else?

Answer: This is no problem. Foods that increase acidity are nicotine and possible caffeine in some patients. Other foods will not cause ulcers or increased acidity.

Heartburn
Question: Should I use a prescription ulcer medication to treat my heartburn, or are there other safer options?

Answer: There are several types of prescription drugs available to treat ulcers. These include H2 Antagonists, drugs like Tagamet, Pepcid and Zantac, proton pump inhibitors, drugs like Prilosec and Prevacid, and coating agents like Carafate. The H2 antagonists have been available for about 20 years. Consequently, there is a long record of problems and advantages. These drugs are so well tolerated that they are now basically available without a prescription. Carafate is a unique drug in that it is not absorbed. Systemic side effects appear to be negligible. The newer agents like Prilosec and Prevacid have a less lengthy record. They appear to be more effective than H2 blockers in healing ulcers, but their long term side effect profile is not known. I would recommend H2 blockers without reservation.
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