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House Call: There are many options to treat heartburn

There are multiple treatments for heartburn, although Zantac was recently pulled from shelves. (Mark Lennihan / AP)
There are multiple treatments for heartburn, although Zantac was recently pulled from shelves. (Mark Lennihan / AP)
By Dr. Bob Riggs For The Spokesman-Review

As we approach the holidays and the many rich and delicious food choices surrounding us, you might want to prepare yourself for heartburn and what you can do about it. Most of the time, heartburn (caused by acid reflux) is uncomfortable and occasionally painful, but it is not a health emergency.

There are a variety of over-the-counter treatments available that are very good for stopping and soothing heartburn. Symptoms of heartburn include a burning pain in the chest, pain that gets worse when you lie down or bend over and a bitter or acidic taste in the mouth.

Severe chest pain or pressure (especially with other symptoms such as pain in the arm or jaw) can be a sign of a heart attack. If you are unsure whether your chest pain is heartburn or a heart attack, seek immediate medical attention.

Depending on the cause, heartburn can be easy to prevent. Years ago, I was working in a small urgent care, too busy to take a lunch break, and got in the habit of eating a can of beans for lunch every day. I started getting pretty significant heartburn every day. One day, I switched it up and started eating kidney beans instead of pinto beans, and the heartburn went away.

Pay attention to what you are eating as it could be anything and not the classic culprits like spicy foods and tomato sauce. Taking an antacid immediately after any of those activities also might be enough to prevent symptoms.

Not eating two to three hours before bedtime and raising the head of your bed a few inches with blocks under the bedposts can help prevent nighttime heartburn. If you have frequent heartburn, cutting back on caffeine, alcohol and nicotine might take care of the problem.

When I get heartburn, antacid tablets usually give me relief. Antacid tablets usually contain calcium carbonate, which neutralizes the acid in your stomach that is washing up into your esophagus and causing heartburn.

These days, antacids are available in more than just the original tablets. There are chewy bites, sugar-free tablets, smooth tablets that are less chalky, extra and ultra-strength tablets. There also are liquid over-the counter antacids in flavors including mint and cherry.

You might find that antacids like those described above don’t relieve your symptoms. Luckily, there are other over-the-counter medications you can try. There are proton pump inhibitors such as omeprazole and esomeprazole, as well as histamine-2 blockers such as ranitidine, cimetidine and famotidine.

I usually recommend the H2B’s, as they are safer, cheap and effective. There is a place for the PPI’s, but they are stronger than most people need, reduce the absorption of minerals like iron and calcium and can be habit forming.

They block acid to the degree that the stomach makes more acid pumps in response, and, in stopping them, people might make more acid than they did before taking them. These medications take more time to relieve heartburn but last longer than antacid tablets.

The acid-blocking heartburn medications are good for heartburn that lasts for a day or two. You should make an appointment to see your health care provider if your heartburn happens more than a few days a week, over-the-counter medications don’t help or you have difficulty swallowing, persistent nausea or vomiting or unintended weight loss.

Persistent acid reflux is called gastroesophageal reflux disease and may need to be evaluated as some patients with GERD get an inflamed esophagus that can lead to cancer. Some heartburn sufferers will need to take medications long term. If that turns out to be you, talk to your doctor about things you should watch out for in terms of long-term medication use risks.

Bob Riggs is a family medicine physician at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.

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