A. MARK FENDRICK, MD: I think that if you talk to anybody on the street and ask them if they've had any symptoms of a rising, burning feeling or acid in their stomach, that you'd be surprised, and I would guess it to be in the tens of millions of people.
ANNOUNCER: Heartburn is a common problem in the US. Its cause is simple. Acid in the stomach doesn't stay were its supposed to.
A. MARK FENDRICK, MD: Acid is made by the stomach. And most of the time, the acid remains in the stomach. Sometimes, a bit of the acid will back up, or reflux, into the esophagus, which is the food tube which connects the mouth to the stomach. So when this acid from the stomach gets into the esophagus, the symptom of heartburn is frequently experienced.
ANNOUNCER: When heartburn is accompanied by certain red flags, it ought to be evaluated by a doctor.
JOHN HORN, PharmD: Heartburn can be a sign of a more severe condition that might require a physician's evaluation when a number of symptoms or signs are present. For example, if a patient has painful or difficult swallowing, if they have GI blood loss, whether that's in the stool or perhaps vomiting blood. Sometimes patients develop coughs or upper respiratory symptoms associated with their heartburn. Severe chest pain ought to be evaluated by a physician. So there's a number of kind of warning signs or alarm signs.
ANNOUNCER: But when a person has none of these alarm symptoms, doctors say patients can feel comfortable treating their heartburn themselves.
Simple lifestyle changes are often a good place to start: avoiding acidic foods, cutting alcohol consumption, quitting smoking, losing weight, waiting a few hours after eating before lying down to bed. But when lifestyle changes are not enough, people with heartburn can usually get good relief with readily-available over-the-counter medicines, although a little trial and error may be in order.
JOHN HORN, PharmD: I think a lot of patients get good relief from over-the-counter medicines. They may find that they may have to try different medicines or combinations or different doses or combine them with some lifestyle changes, but, if a patient works at it, they can usually get pretty good relief from a simple episodic heartburn.
EVELYN HERMES DeSANTIS, PharmD: For treating simple heartburn, we have a number of different medications available. The over-the-counter products that have been on the market for some time include the antacids and the histamine blockers, the H2RAs, as they're known as. In addition to that, we also now have a proton pump inhibitor over-the-counter. So those are really the three main classes of drugs that have been used for the treatment of heartburn.
JOHN HORN, PharmD: Antacids really are the best treatment for an acute episode of heartburn. So if one has had a big dinner and at 10:00 at night they develop heartburn or two in the afternoon after lunch they get heartburn, the treatment for that episode of heartburn is an antacid.
A. MARK FENDRICK, MD: Antacids work by neutralizing the acid that already exists in the stomach. So these drugs work very quickly and will eliminate this excess acid.
JOHN HORN, PharmD: Their limitation is that they don't last very long, so that when you take an antacid you can treat the episode of heartburn that you're having right now, but it's not going to do much to prevent an episode happening later in the day or tomorrow.
ANNOUNCER: Rather than neutralize acid that already exists, another approach toward heartburn is to reduce acid production with an acid blocker, for longer-term relief.
JOHN HORN, PharmD: There's a cell in the stomach called a parietal cell, and that parietal cell makes acid. And there are a number of different things that stimulate that parietal cell, and one of them is histamine. And so there's this receptor called the histamine receptor that will stimulate the parietal cell to make acid. And H2 blockers simply block that receptor and prevent histamine from stimulating the parietal cell, thus reducing the amount of acid that's made.
A. MARK FENDRICK, MD: H2 blockers, particularly for intermittent and mild heartburn, are very effective and have been shown in studies to prevent these heartburn events and symptomatic events from occurring.
ANNOUNCER: But it takes an hour, or longer, for an H2 blocker to take full effect. What happens if a person wants to stop heartburn immediately, and also wants longer-term relief?
A. MARK FENDRICK, MD: For an individual experiencing a heartburn episode, I think the combination of an antacid that works quickly by neutralizing acid and an H2 blocker, which prevents the further production of acid, to be an ideal treatment choice.
ANNOUNCER: Another type of acid blocker is called a Proton pump inhibitor, or PPI, may be in order. H2 blockers cut down on acid production in the parietal cells that line the stomach. PPIs, working through another mechanism, come close to shutting acid production down altogether.
JOHN HORN, PharmD: PPIs are longer acting so that you don't have to be quite as careful about your timing with relationship to meals. And then secondly, a proton pump inhibitor might be effective in a patient in whom they had tried an H2 blocker but had not gotten complete relief. In other words, they were still having symptoms while taking their H2 blocker and needed something a little more potent to suppress enough acid to eliminate their symptoms.
ANNOUNCER: PPIs take longer than H2 blockers to start working, and they must be taken for a number of days before their maximum effectiveness is achieved.
EVELYN HERMES DeSANTIS, PharmD: In terms of the role of a proton pump inhibitor, you're really looking for a patient who has had multiple episodes of heartburn that are not being controlled by an H2 blocker to be turning to a proton pump inhibitor.
ANNOUNCER: Antacids, H2 blockers, proton pump inhibitors: There are many type of heartburn medications available.
What should be reassuring to the millions of people who suffer from occasional heartburn is the knowledge that many products offer good relief. And many are conveniently available, over the counter.
A. MARK FENDRICK, MD: Most people with heartburn can achieve very high-quality relief with agents that are available without the need of prescription.
ANNOUNCER: Heartburn is a common problem in the US. Its cause is simple. Acid in the stomach doesn't stay were its supposed to.
A. MARK FENDRICK, MD: Acid is made by the stomach. And most of the time, the acid remains in the stomach. Sometimes, a bit of the acid will back up, or reflux, into the esophagus, which is the food tube which connects the mouth to the stomach. So when this acid from the stomach gets into the esophagus, the symptom of heartburn is frequently experienced.
ANNOUNCER: When heartburn is accompanied by certain red flags, it ought to be evaluated by a doctor.
JOHN HORN, PharmD: Heartburn can be a sign of a more severe condition that might require a physician's evaluation when a number of symptoms or signs are present. For example, if a patient has painful or difficult swallowing, if they have GI blood loss, whether that's in the stool or perhaps vomiting blood. Sometimes patients develop coughs or upper respiratory symptoms associated with their heartburn. Severe chest pain ought to be evaluated by a physician. So there's a number of kind of warning signs or alarm signs.
ANNOUNCER: But when a person has none of these alarm symptoms, doctors say patients can feel comfortable treating their heartburn themselves.
Simple lifestyle changes are often a good place to start: avoiding acidic foods, cutting alcohol consumption, quitting smoking, losing weight, waiting a few hours after eating before lying down to bed. But when lifestyle changes are not enough, people with heartburn can usually get good relief with readily-available over-the-counter medicines, although a little trial and error may be in order.
JOHN HORN, PharmD: I think a lot of patients get good relief from over-the-counter medicines. They may find that they may have to try different medicines or combinations or different doses or combine them with some lifestyle changes, but, if a patient works at it, they can usually get pretty good relief from a simple episodic heartburn.
EVELYN HERMES DeSANTIS, PharmD: For treating simple heartburn, we have a number of different medications available. The over-the-counter products that have been on the market for some time include the antacids and the histamine blockers, the H2RAs, as they're known as. In addition to that, we also now have a proton pump inhibitor over-the-counter. So those are really the three main classes of drugs that have been used for the treatment of heartburn.
JOHN HORN, PharmD: Antacids really are the best treatment for an acute episode of heartburn. So if one has had a big dinner and at 10:00 at night they develop heartburn or two in the afternoon after lunch they get heartburn, the treatment for that episode of heartburn is an antacid.
A. MARK FENDRICK, MD: Antacids work by neutralizing the acid that already exists in the stomach. So these drugs work very quickly and will eliminate this excess acid.
JOHN HORN, PharmD: Their limitation is that they don't last very long, so that when you take an antacid you can treat the episode of heartburn that you're having right now, but it's not going to do much to prevent an episode happening later in the day or tomorrow.
ANNOUNCER: Rather than neutralize acid that already exists, another approach toward heartburn is to reduce acid production with an acid blocker, for longer-term relief.
JOHN HORN, PharmD: There's a cell in the stomach called a parietal cell, and that parietal cell makes acid. And there are a number of different things that stimulate that parietal cell, and one of them is histamine. And so there's this receptor called the histamine receptor that will stimulate the parietal cell to make acid. And H2 blockers simply block that receptor and prevent histamine from stimulating the parietal cell, thus reducing the amount of acid that's made.
A. MARK FENDRICK, MD: H2 blockers, particularly for intermittent and mild heartburn, are very effective and have been shown in studies to prevent these heartburn events and symptomatic events from occurring.
ANNOUNCER: But it takes an hour, or longer, for an H2 blocker to take full effect. What happens if a person wants to stop heartburn immediately, and also wants longer-term relief?
A. MARK FENDRICK, MD: For an individual experiencing a heartburn episode, I think the combination of an antacid that works quickly by neutralizing acid and an H2 blocker, which prevents the further production of acid, to be an ideal treatment choice.
ANNOUNCER: Another type of acid blocker is called a Proton pump inhibitor, or PPI, may be in order. H2 blockers cut down on acid production in the parietal cells that line the stomach. PPIs, working through another mechanism, come close to shutting acid production down altogether.
JOHN HORN, PharmD: PPIs are longer acting so that you don't have to be quite as careful about your timing with relationship to meals. And then secondly, a proton pump inhibitor might be effective in a patient in whom they had tried an H2 blocker but had not gotten complete relief. In other words, they were still having symptoms while taking their H2 blocker and needed something a little more potent to suppress enough acid to eliminate their symptoms.
ANNOUNCER: PPIs take longer than H2 blockers to start working, and they must be taken for a number of days before their maximum effectiveness is achieved.
EVELYN HERMES DeSANTIS, PharmD: In terms of the role of a proton pump inhibitor, you're really looking for a patient who has had multiple episodes of heartburn that are not being controlled by an H2 blocker to be turning to a proton pump inhibitor.
ANNOUNCER: Antacids, H2 blockers, proton pump inhibitors: There are many type of heartburn medications available.
What should be reassuring to the millions of people who suffer from occasional heartburn is the knowledge that many products offer good relief. And many are conveniently available, over the counter.
A. MARK FENDRICK, MD: Most people with heartburn can achieve very high-quality relief with agents that are available without the need of prescription.