Nothing seems to help my heartburn. I stopped drinking coffee, have used antacids for a long time, and have even tried the drugs advertised for heartburn that are now available without a prescription.
Heartburn is caused by the backflow (reflux) of stomach contents, primarily gastric acid, which irritate the lining of the esophagus. It is important to control reflux, not only to stop the heartburn, but to prevent other complications of the disorder.
These can include chronic inflammation, ulceration and even narrowing of the esophagus as a result of the chronic irritation from gastric contents. The irritation can alter the type of cells present in the lower esophagus, and this is thought to be a possible cause of a small number of esophageal cancers.
The regurgitation often associated with reflux can cause a sour taste in the mouth, excessive salivation, hoarseness, worsening asthma, cough and chronic bronchitis.
If you smoke cigarettes or drink alcohol, you should consider stopping -- both can worsen reflux. Also, see your doctor, since you have found that antacids, which can give some relief by neutralizing stomach acid, and nonprescription medications for heartburn have not helped.
This recommendation is based on the fact that several categories of drugs have proven effective in the treatment of reflux. Some reduce the production of gastric acid by the stomach. Various drugs in this group reduce gastric acid secretion by acting as antagonists to histamine H2 receptors: cimetidine (Tagamet), famotidine (Pecid), nizatidine (Axid) and ranitidine (Zantac).
TagametHB and PepcidAC are now available without a prescription, but in smaller strengths than can be obtained with a doctor's prescription. These over-the-counter strengths are sufficient to control reflux in many people.
Other drugs, such as omeprazole (Prilosec) and lansoprazole (Prevacid), lower gastric acid levels in a different way. Cisapride works by increasing the contractions of the lower esophagus and speeding the emptying of food from the stomach.
Your doctor could prescribe a larger dose of one of the histamine H2 antagonists, and that might be enough to control your reflux and heartburn. Your doctor would also have the option of prescribing a drug from one of the other categories mentioned above, or a combination of two drugs.
An article in a recent issue of the New England Journal of Medicine reported that omeprazole -- or a combination of omeprazole and cisapride (Propulsid) -- was more effective than any other drugs for the long-term treatment of reflux in people whose heartburn and other symptoms did not respond to, or recurred, after other forms of therapy.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.