Help for serious heartburn

Many chronic heartburn sufferers find relief from prescription strength treatments such as proton pump inhibitors (PPIs) – yet some may find these drugs are not always the ‘miracle’ they had hoped for.

In fact, according to a recent survey by the American Gastroenterological Association (AGA), nearly 40 per cent of people who take PPIs to control symptoms of gastroesophageal reflux disease (GERD) say they continue to experience breakthrough symptoms such as heartburn and acid breakthrough. For people over the age of 50, this number rose to 57 per cent.

What is acid breakthrough?

Acid breakthrough, also referred to as breakthrough heartburn refers to the continued occurrence of heartburn symptoms while taking daily prescription heartburn medication.

According to the AGA survey, the majority (65%) of breakthrough heartburn sufferers experience symptoms in the evening, with many reporting sleep disturbances as a result.

Other findings showed that:

– More than 40 per cent of respondents on a PPI who experience breakthrough symptoms report those symptoms occur two to four times per week, with symptoms occurring throughout the day and sometimes multiple times per day.

– Among those suffering from breakthrough symptoms, at least 50 per cent are not fully satisfied with the symptom relief they get from their once-daily PPI.

– While 98 per cent of respondents who experience breakthrough symptoms report taking their PPI as directed, more than 40 per cent have not spoken to their physician about these symptoms.

Stop-gap remedies

When PPIs don’t provide full protection, heartburn sufferers often look to over-the counter remedies for supplemental treatment. “The survey results show that people with GERD are not only using their prescribed PPI, but also are turning to over-the-counter remedies as a stop-gap when they have breakthrough symptoms,” John Inadomi, MD, associate professor of medicine, University of California, San Francisco said in a news release.

The AGA survey found that over half of people who experienced acid breakthrough used an over-the counter treatment to manage symptoms. In fact, taking an over-the-counter remedy to supplement a PPI has become routine for many with more than 70 per cent having used over-the-counter medications for at least one year.

Over-the-counter treatments

Over-the-counter treatments for breakthrough relief include Antacids, Alginates, and H2 blockers.

Antacids. Antacids often contain calcium carbonate and/or magnesium carbonate, and work by neutralizing acid in the stomach. Antacids can provide immediate relief, but this relief is often short-lived, as stomach acid is produced continuously. Tums, Rolaids and Maalox are examples of antacids.

Alginates. Alginates, specifically alginic acid and sodium alginate, provide fast relief of heartburn as well as long-lasting relief – for up to four hours. Alginates work differently from antacids as they don’t neutralize stomach acid, but form a protective barrier in the stomach that helps prevent acid from refluxing into the esophagus, where the acid may cause heartburn. Gaviscon is an example of an alginate.

H2-receptor blockers. H2-receptor blockers help reduce the amount of stomach acid that is produced and secreted into the stomach. Because they typically don’t work as quickly as antacids or alginates – often taking 30 – 60 minutes to kick-in – they are best taken as a preventative measure. Zantac and Pepcid AC are examples of H2 Blockers.

Note: If you are taking prescription heartburn medication it is recommended that you speak to your health care professional before adding an over-the-counter treatment.

Lifestyle changes can help

Raising the head of your bed is probably one of the most important things you can do to prevent nocturnal acid breakthrough. Other tips to help reduce reflux include:

– Limit fatty, spicy or fried foods

– Avoid high-acid foods, such as tomato products, citrus juices and caffeine

– Limit alcohol intake to moderate amounts

– Wear loose clothing

– Stop smoking

– Lose excess weight

– Don’t eat within three hours of bedtime.

The bottom line: If you experience breakthrough symptoms while taking a prescribed heartburn medication, you can get extra protection. Talk to your doctor about any changes you can make in your treatment and also your lifestyle choices.