Heartburn Treatment

In this article, we will be covering commonly prescribed heartburn medicine (including some shocking side effects) for heartburn treatment as well as over-the-counter medicines and holistic heartburn treatments.


Prescription Heartburn Medicine

The case of occasional heartburn does not necessitate medical intervention. However, when heartburn occurs two times a week (or more) with regularity, this is usually considered GERD. Over the long-term, GERD can result in esophageal ulcers and even cancer. As a result, medical treatment for GERD is recommended.

There are two primary classes of prescription medicine used to treat heartburn: H-2 blockers and proton-pump inhibitors. Both classes of medication reduce acid production.

H-2 blockers tend not to be as powerful and have shorter acting periods and are used before meals. Popular H2-blockers include Tagamet, Pepcid, Axid, and Zantac. These heartburn medications may have different names outside of the USA.

Proton-pump inhibitors on the other hand are often billed to provide “24 hour heartburn relief” and in general last much longer than H2-blockers. Popular proton-pump inhibitors include Prilosec (available over-the-counter in the USA), Prevacid, Nexium, Aciphex, and Protonix.

The problem with both of these types of medications is that their use in heartburn treatment is fairly new. Only now are studies of their long-term effects beginning to come available.

The first several reviews of the literature do not paint a good picture for proton-pump inhibitors. Multiple studies and reviews of the literature have linked proton-pump inhibitors to increased risk of bone fractures (1,2), impairment of Vitamin B12, iron, and magnesium absorption (1,2,3), multiple types of infections (1,2), cancer (1,2,4), and birth defects (1).

On the other hand, there have been significantly less long-term side effects reported with the use of H2-blockers. In fact, one study compared patients who used H2-blockers with those who used proton-pump inhibitors or both and found that the proton-pump inhibitor group had a slightly increased colorectal cancer rate whereas the H2-blocker group did not (4).

With that said, most doctors still recommend proton-pump inhibitors over non-treatment. After all, GERD can lead to esophageal ulcers and even cancer over time. However, the research does suggest that H2-blockers may be a safer alternative to proton-pump inhibitors for long-term usage. Unfortunately, many patients report that H2-blockers are not as effective when used regularly (5).

Over the next 10 years we will get a much clearer idea of the long term implications for the use of these heartburn medications.


Over-the-Counter Heartburn Medicine

Currently, the counter heartburn medicine is omeprazole (brand name: Prilosec) is one of the most popular heartburn medications. Omeprazole is very effective at achieving heartburn relief, but it is also a proton-pump inhibitor and long term usage may result in the side effects listed above. It should not be used long-term without permission from your your primary care physician.

Other common over-the-counter heartburn remedies are acid neutralizers which typically contain calcium carbonate (commonly called antacids). This compound reacts with stomach acid, neutralizing it. They can be quite effective for neutralizing the occasional problem but are not a viable solution for use on a regular basis. They are comparable to these heartburn remedies in terms of effectiveness and relative safety.

With that said, GERD should be managed by a physician and lifestyle changes.


Holistic Heartburn Treatment

The safest way to approach your heartburn treatment in the long-term is to take a full body approach. Being overweight, regular consumption of alcohol, overeating, and eating problem foods all can cause regular heartburn.

You will fair much better off in the long-run if you can eliminate heartburn by losing weight, eating a healthy diet (including avoiding specific foods which trigger heartburn for yourself), exercising regularly, elevating your bed post, and the cessation of drinking and smoking.

Most people will cease to experience heartburn (as well as live a longer, healthier life) by following these simple recommendations. In an ideal world, heartburn medication would be used when lifestyle changes are not enough to stop chronic heartburn.

References

1. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci. 2011 Apr;56(4):931-50.

2. Chapman DB, Rees CJ, Lippert D, Sataloff RT, Wright SC Jr. Adverse effects of long-term proton pump inhibitor use: a review for the otolaryngologist. J Voice. 2011 Mar;25(2):236-40.

3. Ito T, Jensen RT. Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Curr Gastroenterol Rep. 2010 Dec;12(6):448-57.

4. Chubak J, Boudreau DM, Rulyak SJ, Mandelson MT. Colorectal cancer risk in relation to use of acid suppressive medications. Pharmacoepidemiol Drug Saf. 2009 Jul;18(7):540-4.

5. Kushner PR. Role of the primary care provider in the diagnosis and management of heartburn. Curr Med Res Opin. 2010 Apr;26(4):759-65.