Knowing about Heartburn

Dr Harold Gunatillake Health writer

Heartburn is a descriptive term used commonly when one experiences a burning sensation behind the heart region. Sometimes, one finds it difficult to differentiate between heart burn due to leakage of stomach acid contents into the gullet (oesophagus), and discomfort arising from angina pain from coronary blood floor insufficiency. Most patients run through tests to exclude heart disease and the doctor will then tell you the problem is GERD ( gastro-oesophageal reflux diseases). Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.

Occasionally, GERD is also manifested as a chronic recurrent cough which can go undiagnosed for a long time. This symptom is due to the reflux of acid juice to the throat causing irritation and inflammation.

GERD or heart burn is made on a clinical diagnosis when your doctor will ask you detailed questions about the nature and pattern of your pain. Is it worse after you eat a heavy meal or eating certain foods, such as high fat foods, dairy products, or spicy food, or drug related, as after taking aspirin? In most situations heart burn comes on when you sleep on your back or turning to your right side in bed. You would get heart burn pain when you bend and tie your shoe laces.

If your symptoms are typical for gastroesophageal reflux (GERD, or simply, reflux), the first step is usually to try a medication such as omeprazole or lansoprazole. If symptoms improve, you switch to a less powerful medication. That might be an H2-receptor antagonist (H2 blocker) such as cimetidine (Tagamet), ranitidine (Zantac), or famotidine (Pepcid), or an antacid containing at least one of the four ingredients: Sodium, Calcium, Magnesium and Aluminium.

Antacids make you feel better by increasing the pH balance in your stomach. The pH system is a scale for measuring the acidity or alkalinity of a given environment (in this case, your stomach). The scale goes from 0 to 14. A pH of 7 is neutral. Below 7 is acid. Above 7 is alkaline. Normally, the acid level in your stomach is about 2 or 3. Trouble may start when your pH drops below those numbers. To make you feel better, an antacid need not bring the pH level all the way up to 7 (neutral), which would be a highly unnatural state for your stomach. In order to work, all the antacid has to do is get you to 3 or 4. It does this by neutralizing some of the excess acid.

Your doctor may suggest some tests to confirm the clinical diagnosis of GERD, or rule out other possible causes for your symptoms.

What is omeprazole?
Omeprazole (Prilosec) belongs to group of drugs called proton pump inhibitors. It decreases the amount of acid produced in the stomach.
Omeprazole is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis (damage to your oesophagus caused by stomach acid).

Omeprazole may also be given together with antibiotics to treat gastric ulcer caused by infection with helicobacter pylori (H. pylori). Omeprazole is not for immediate relief of heartburn symptoms. Omeprazole may also be used for purposes not listed in this medication guide.

You should not take this medication if you are allergic to omeprazole or to any other benzimidazole medication such as albendazole or mebendazole. Omeprazole is not for immediate relief of heartburn symptoms. (ref: healthinsite)

Ask a doctor or pharmacist if it is safe for you to take omeprazole if you have liver disease or heart disease, or low levels of magnesium in your blood. Some conditions are treated with a combination of omeprazole and antibiotics. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses of medication schedule without your doctor's advice.

Take omeprazole for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared.

Prilosec OTC (over-the-counter) should be taken for no longer than 14 days in a row. Allow at least 4 months to pass before you start another 14-day treatment. Heartburn is often confused with the first symptoms of a heart attack. Seek emergency medical attention if you have chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, and a general ill feeling.

Some people taking omeprazole may have an increased risk of bone fracture in the hip, wrist, or spine. This effect has occurred mostly in people taking omeprazole long term or at high doses, and in people who are age 50 and older. Omeprazole may not be the actual cause of increased fracture risk. Before you take this medication, tell your doctor if you have a bone disorder.

What is Lansoprazole?
Prescription lansoprazole is used to treat gastroesophageal reflux disease (GERD), Prescription lansoprazole is used to treat the symptoms of GERD, allow the oesophagus to heal, and prevent further damage to the oesophagus. Prescription lansoprazole is also used to treat ulcers (sores in the lining of the stomach or intestine), to prevent more ulcers from developing in people whose ulcers have already healed, and to decrease the risk that people who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers.

Prescription lansoprazole is also used to treat conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome. Prescription lansoprazole is also used in combination with other medications to treat and prevent stomach ulcers caused by a certain type of bacteria (H. pylori). Nonprescription (over-the-counter) lansoprazole is used to treat frequent heartburn (heartburn that occurs two or more days per week). Lansoprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.

How do you get heartburn?
Normally, a muscular valve called the lower oesophageal sphincter (LES) opens to allow food into the stomach (or to permit belching); then it closes again. Then the stomach releases strong acids to help break down the food. But if the lower oesophageal sphincter opens too often or does not close tight enough, stomach acid can reflux or seep back into the oesophagus, damaging it and causing the burning sensation we know as heartburn.

Not only can stomach acid in the oesophagus cause heartburn, but it can also cause ulcers, strictures (narrowing) of the oesophagus, and cancer of the oesophagus.

Lifestyle changes necessary
Over-eating especially the night meal may cause heartburn in bed. Have a light meal early and retire to bed late. Eat small meals more frequently like the Chinese to neutralise the gastric juice.

Eating certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus fruits, garlic, and tomatoes or tomato-based products may cause heartburn.

Drinking certain beverages, including citrus juices, alcohol, caffeinated drinks, and carbonated drinks may cause heartburn.

Getting slim is important. The valve mechanism at the junction of oesophagus and stomach (cardia0 may not function efficiently in obese subjects.
Smoking increases acid secretion, and it is better to give up totally.
Wearing tight cloths, tightening with a waist belt may exacerbate episodes.
Always rest your head on at least three pillows. Sitting up position relieves the condition.
Alcohol and certain medications like anti-inflammatories, and aspirin can bring about heartburn.
Avoid constipation and straining in the toilet.
Eating high fibre diet and fruits may help.

Most people can control their GERD taking the necessary precautions and change in lifestyles. A few may need surgery.

Surgery for GERD may become necessary:
When medical or drug treatment has failed to control symptoms
When the sphincter muscle is unable to work properly
When oesophageal cancer develops from chronic GERD
Stay slim and active. Avoid diets that brings it along.

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