We’re all familiar with the narrative. You wake up at night with heartburn and an upset stomach wondering when you will get back to sleep. During the day after you eat you experience bloating, gas, indigestion, or discomfort. Your doctor tells you to you to try heartburn medications to control the symptoms, but you get to the store and there and hundreds of options. What type is really best for you, and should you even be taking medication in the first place?
Heartburn medications are often used to control symptoms like heartburn and reflux. While these medications can be incredibly effective in providing short term relief for these symptoms, they’re not intended for long-term use and won’t treat the root issue if your symptoms are caused by a condition like GERD. In cases like this, surgery and lifestyle changes are typically necessary to treat the condition and stop symptoms on a long-term basis. That being said, medications do play an important role in patient wellness and are often one of the first treatment methods tried by patients who are experiencing frequent heartburn.
There are many different types of heartburn medications available, some over the counter and some prescription based. Below are the three most common forms of heartburn medications recommended by doctors: over the counter acid neutralizers, H2 blockers, and proton pump inhibitors.
Acid neutralizers are probably the most well-known of the common heartburn medications, and you’ll find them in most supermarkets and drug stores. These particular medications are usually over the counter and work by reducing stomach acid and increasing the pH level of the stomach, relieving heartburn and that “upset stomach” feeling. Most patients take these before a meal as a preventative measure, or directly after a meal to relieve heartburn. Medications that typically fall into this category are Tums, Rolaids, Maalox, Mylanta, and Alka Seltzer. These medications last for only a short period of time, and are designed for short-term use relief rather than as a permanent solution.
You do not need prescriptions for acid neutralizers. The medications are inexpensive and provide temporary relief before or after a meal. This type of medication is safe when used in moderation, but overall it is not useful for controlling more severe symptoms of heartburn and GERD.
Histamine 2 Receptors or H2 Blockers
H2 Blockers work by reducing the production of stomach acid. What a relief that is when too much acid causes heartburn, upset stomach and gas! H2 receptors are cells that produce stomach acid, and this medication blocks them, reducing the amount of acid produced in the stomach. H2 blockers take longer to work than acid neutralizers, but the effects typically last longer.
The benefits of H2 Blockers are that they are over the counter and less expensive than prescription drugs. They provide faster relief and are less dangerous than PPI’s, but aren’t as great for immediate heartburn relief as acid neutralizers like Tums. H2 Blockers are not helpful in serious cases of GERD when surgery may be needed, but they’re relatively safe for temporary use and have few side effects. Common H2 Blockers are medications like Pepcid, Zantac, Tagament, cimetidine, and ranitidine.
Proton Pump Inhibitors (PPI’s)
PPI’s are pretty much the heavy metal of heartburn medications. They pack the most powerful punch, and are often the last available option when it comes to heartburn medication. What are PPI’s? They are the most common drug prescribed by doctors for the relief of severe GERD symptoms, and you’ve probably heard of the more popular ones like Prevacid, Prilosec, Zegaird, Nexium, omeprazole, and lansoprazole.
These drugs reduce acid production in the stomach in a powerful way. They work by completely blocking the production of stomach acid, suppressing the system in the stomach known as the “proton pump” and stopping the production of acid completely. The effects can last for up to 3 days, making these incredibly appealing to patients who suffer daily symptoms from their GERD.
When you start on PPI’s they can take 3- 4 days to relieve symptoms. They’re not designed for immediate relief, and are often prescribed by the doctor for two weeks or longer. When it comes to heartburn medications, PPI’s provide the best results for more serious conditions. They can help prevent ulcerations and strictures from forming in the stomach. With that being said, they’re also the most dangerous.
PPI’s work by blocking the production of acid in your stomach, something which generally leads to the relief of reflux symptoms like heartburn. The problem is that stomach acid not only helps digest food, but also has a barrier function against various pathogens. When there’s less stomach acid, you’re left more vulnerable to nutritional deficiencies and infections. That’s not a huge issue if you’re taking the medication on an as-needed basis for a couple of weeks, but over the span of a few years that vulnerability drastically increases your risk of serious health problems. Health issues like increased risk of kidney disease, vulnerability to nutritional deficiencies and infections, and even increased risk of heart disease and dementia have been linked to the long-term use of PPI’s.
Another issue is that most patients have difficulties discontinuing their PPI’s once they’ve been on them for too long. There’s a kick-back effect when you stop taking the medications, and the amount of acid in your digestive system often surges, leaving patients with symptoms like excruciating stomach pain and increased heartburn. It’s a nasty business, but there are tricks for safely weaning yourself off PPI medications.
Regardless of what type of heartburn medication you’re thinking about using, whether it’s something as simple as the occasional Tums or something more heavy-duty like PPI’s, it’s important to remember that heartburn medications simply relieve symptoms, they do not cure the root cause. Often lifestyle changes in eating, losing weight, and surgery are needed to repair the damage to the esophagus and stomach. Only use medications according to instructions and always talk with your doctor before stopping, starting, or changing medications.
If you suffer from moderate to severe symptoms of GERD, make an appointment to learn about treatments for GERD that will address the root issue and bring you long-term symptom relief, like minimally invasive anti-reflux surgery.