Ellen Campbell Grizzle - Pharmacy Today AFTER CHRISTMAS and New Year festivities, there is increased demand for medication to relieve heartburn. Patients describe a burning pain that originates just below the breast bone, rises to the chest and radiates to the neck and throat. This is accompanied by a very unpleasant, strong taste of highly-acidic fluid rushing to the back of the throat and a sour taste in the mouth.
Lying down or bending forward aggravates the condition. Many patients associate heartburn with consuming a lot of spicy food, alcohol or as a consequence of anxiety or fear. Medication such as calcium channel blockers, beta blockers, progestin hormones, aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) including Ibuprofen have been implicated.
Heartburn is an expression of gastroesophageal reflux disease (GERD) or acid reflux. Normally, food travels down the oesophagus and then enters the stomach. A band of muscles at the end of the oesophagus, the lower oesophageal sphincter (LES), closes off the oesophagus to prevent back flow. If the LES does not close properly, partially digested contents of the stomach may re-enter the oesophagus. This regurgitation leads to heartburn and nausea.
The body protects itself from acid reflux. In the upright position, gravity and swallowing force refluxed contents downward and into the stomach. The chewing action stimulates saliva production. Saliva contains bicarbonate, a natural acid neutralising agent.
Nowadays, many persons self medicate with antacids. These remedies neutralise acid and provide brief relief. However, aluminium-based antacids may cause constipation while magnesium-based products lead to diarrhoea. Calcium-based antacids increase the stimulation of gastrin, a hormone responsible for acid secretion in the stomach. Many antacids are combination products and should be taken one hour after each meal, just before reflux is likely to take place.
Histamine antagonists that decrease acid production in the stomach are also popular. They provide more sustained relief than antacids and should be taken one-half hour before meals. The medication effect will peak just as the stomach begins to produce acid. A dose should be taken at bedtime to cover night time reflux.
Some foods such as chocolate, caffeinated drinks, peppermint, spearmint, alcohol, spicy and fatty foods, citrus juices and tomato juice are notorious for causing heartburn. Here are some lifestyle changes that can help. You should:-
Eat smaller meals, eat more slowly and relax
while you are eating.
Remain upright up to three hours after meals
Avoid bedtime snacks
If you are overweight, lose weight
Avoid tight belts
Avoid foods that will irritate your stomach
Quit smoking and alcoholic beverages
Avoid drugs that cause heartburn
Use a pillow wedge to raise your head six to eight inches off the bed at night
Exercise smartly, two hours after eating
Eat papaya and drink a lot of fluid
Palliative herbal remedies include catnip, chamomile, ginger and licorice may help.
Heartburn can be an indication of more serious conditions such as ulcers. Also, every chest pain is not heartburn. A severe pressing or squeezing sensation, pain lasting and not diminishing after 10 minutes, sometimes related to exercise or exertion could be an indication of a heart attack. This is a medical emergency. Remember, if you are pregnant, you are likely to experience episodes of heartburn. Discuss with your doctor what is best for you.
If you have transient heartburn, antacid and lifestyle adjustments will help. However, if you are experiencing one attack per week, it is time to see your doctor for a check up. Remember there are times when heartburn is a warning of more serious conditions. If you want to know more about relieving your heartburn and GERD, ask your pharmacist, you have the right to know.
Ellen Campbell Grizzle, President of the Caribbean Association of Pharmacists (CAP) and Director, Information & Research, National Council on Drug Abuse (NCDA), Kingston, Jamaica.
