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Why Do I Still Have Heartburn?

Posted Aug 24 2008 1:49pm
ANNOUNCER: Many people prone to frequent heartburn routinely take medications to supress acid production in the stomach. The drugs can be very effective, but sometimes they don't provide full protection. The result is called "acid breakthrough."

JOHN HORN, PharmD: Acid breakthrough occurs usually in a person who's taking some sort of acid suppression therapy, and in spite of that drug therapy they continue to have symptoms. So acid breakthrough is really symptom breakthrough, but since we believe the symptoms are caused by acid, we consider that to be acid breakthrough.

ANNOUNCER: There are different patterns of breakthrough, depending on the type of acid suppression being used. Sometimes one type of drug, called an H2 blocker, can be used to supplement another type, known as proton pump inhibiters, or PPIs.

This approach can be especially useful when the effects of a PPI begin to wear off.

JOHN HORN, PharmD: Episodes of heartburn that occur while a patient is on therapy sometimes differ depending on the drug. And I'll give you an example. Many times, patients that are on proton pump inhibitors will get good daytime symptom relief, but they might be awakened at night by heartburn. And it has been learned through studies that taking another dose of a PPI at bedtime really doesn't help that very much, and so that breakthrough, that nighttime breakthrough that occurs on PPIs, is really best treated by giving the patient a dose of an H2 blocker.

ANNOUNCER: Sometimes heartburn sufferers have another solution.

EVELYN HERMES DESANTIS, PharmD: If it's something that's occurring infrequently, and it's something that wakes them up, they can take an antacid at that point in time, treat the immediate symptom, the immediate episode, and then go on.

ANNOUNCER: Other times, an antacid plus an H2 blocker, available in one pill, does the job.

EVELYN HERMES DeSANTIS, PharmD: The combination product would be also effective for treating an acid breakthrough, because again, the antacid portion is taking care of the immediate problem, and the H2 component of it is really looking at a little bit more of a long-term, not for a full 24 hours, but getting you over that nighttime period. So that also would be an option.

ANNOUNCER: Doctors say self-treatment for acid breakthrough is common, even after people have seen a doctor.

JOHN HORN, PharmD: Some data seems to suggest that up to two-thirds of patients who are taking prescription acid blockers actually do take over-the-counter medications with them.

I think that does surprise doctors. I think doctors tend to think that these drugs are really wonderful and relieve all the patient's symptoms. And while they are really good drugs and they do relieve a lot of the symptoms, patients still have breakthrough symptoms on these drugs.

ANNOUNCER: Not all solutions to acid breakthrough involve using other drugs.

EVELYN HERMES DeSANTIS, PharmD: Non-medical solutions to acid breakthrough include not eating large, fatty meals, decreasing weight, decreasing alcohol consumption. Raising the head of the bed is probably one of the biggest things, especially for that nocturnal acid breakthrough.

ANNOUNCER: In fact, doctors and pharmacists say people experiencing breakthrough symptoms might do well to listen to their bodies, rather than run first to the medicine cabinet.

JOHN HORN, PharmD: Sometimes those symptoms are kind of like a little warning saying, "Gee, maybe you really ought to think more about your lifestyle, and maybe you ought not to be eating all this pasta and drinking all this red wine." It may just simply be reminding them that there are other things other than drugs that can influence the frequency and the severity of that heartburn.

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