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Heartburn is a burning sensation in the mid to upper chest.
It feels like a pressure or a bloating and
can come along with reflux.
It occurs sometimes at night or after a big meal, and
it's of concern when its going on more than twice or
three times a week, more than two weeks at a time.
Or if it doesn't go away when you are taking those regular
antacids over the counter or some of those proton
pump inhibitors which are now over the counter.
That's when it's time to call your doctor.
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So, if you're just having the run-of-the-mill heartburn that
first attack in the middle the night.
You eat something.
I suggest taking an over-the-counter Zantac,
Prilosec, or Ranitidine, any of those over-the-counter
medications should help you feel better.
Even a Tums or a Maalox can also be helpful.
If you're having symptoms more often, maybe once, twice,
three times a week, that may be time to take a daily medication,
like a Zantac or
a proton pump inhibitor like Omeprazole or Prilosec.
And then, if those symptoms aren't better within two weeks,
that's when it's time to call your doctor.
You may need a prescription to help you get better.
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There are side effects that have been described in the recent
media and in the literature about proton pump inhibitors and
H2 blockers, the most common medications for
antacid medications.
For reflux and heartburn, most of those risks are pretty small.
In general, the risks of not treating someone who has
esophagitis or inflammation of the esophagus, who has narrowing
of the esophagus, or somebody who's taking Motrin, Advil, and
is older or on blood thinners.
The risk of not treating
are pretty low compared to the benefits.
If you need the medications then you should take them for
your symptoms.
And longterm, the risk that have been described happen rarely but
they do happen sometimes.
So thinning of the bones or osteoporosis has been described.
Low calcium, magnesium, phosphorus is
recently described and has actually an FDA warning now.
There are some indications that being
on this proton pump inhibitors long term
can increase the risk of some infections.
There's a colitis that you can get.
Pneumonia or something called small bowel overgrowth.
These are very small risks, and in the grand scheme of things,
if you have a good reason to take the medications,
then you can take them safely, and
you don't have to worry about these risks.
But definitely talk to your doctor,
especially if you're taking Plavix.
You may need to change the timing or
the dosing of your medication a little bit, but
I think most of these medicines are very safe.
And we have a 30 year experience with them, and
they've been proven to be really effective and safe medications.
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When your medications aren't working well for you,
you have to take a step back and look at the whole picture.
Most people who don't have good response to these medications,
which are highly effective,
aren't taking them at the right time.
So you should really try to take them about 30 minutes
before a meal.
Sometimes people who are taking once a day medicine need that
twice a day medicine in order to help with their symptoms,
especially at night.
So, a second dose taken before dinner can really help.
If they're really still not working,
sometimes switching medications will help, but
most of the proton pump inhibitors are very effective
and they're pretty equivalent between the different classes.
When I see patients who aren't getting better I
also ask them a couple of questions.
Are you eating late at night?
Do you eat right before you lie down?
And are you drinking tons of sodas or coffee or
really kind of costic, acidic foods?
Those things can really set off symptoms and
no matter how much medicine you take,
I can't overcome a Big Mac and fries with medication, so
you really need to take the time to change your lifestyle.
And that really helps the medication do what it's
supposed to do.
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There are some lifestyle changes that most people can make to
help with their heartburn symptoms.
The first thing is to make sure that you haven't gained a little
bit of weight recently.
If you're up ten or
15 pounds from where you used to be, sometimes losing
that weight can really help get your symptoms under control.
Another thing that people do is drinking a lot of sodas,
coffees, and
other acidic foods and no matter how much medication you take,
you cannot overcome the acid that's in a cup of coffee.
So really cutting back on how much coffee or
soda you're having can have a big impact on your symptoms.
The last thing that I recommend is don't eat late at night.
And don't lie down right after eating.
Try to leave about two hours between the time that you finish
a meal and the time that you lie down.
That'll really help with your symptoms and
maybe cure the reflux that's been really bothering for you.
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Many patients are really worried when they get heartburn symptoms
that something might be going on with their heart.
When When you have heart burn, you have a burning
discomfort in the chest that usually happens after a meal.
When you have heart problems, they usually happen
when you are walking around, exerting yourself.
Climbing up a flight of stairs, and
the heart symptoms often come with shortness of breath.
A feeling like you have neck pain, jaw pain or arm pain,
or shoulder pain.
And they often continue to happen or happen in
an increasing frequency, the more you kind of move around.
Most people who are having heartburn however,
are just having heartburn and so they don't really need to worry.
But it's always a good idea when you first have symptoms,
to get checked out by your primary care doctor or
if you're having severe chest pain, to go to the ER, and
really have a full and complete evaluation.
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