When you have heartburn or reflux, the first thing people turn to are the acid neutralizers (Tums, Rolaids, Maalox, Mylanta, Alka-Seltzer). As people continue suffering they then move up the chain in terms of medication. Let’s look at the three classes of medication:
Examples: Tums, Rolaids, Maalox, Mylanta, Alka-Seltzer
Acid neutralizers represent oneof the most common types of drugs used to treat reflux disease. These over the counter medications are basic compounds (i.e alkaline or high pH), like calcium carbonate, that provide temporary relief from symptoms by neutralizing stomach. They are used during a reflux episode or before eating a meal that is likely to cause heartburn. They neutralize acid in the stomach immediately, andif used in sufficient dosage, increase the pHto a level where pain (heartburn) is reduced if reflux occurs.
Because your stomach is constantly monitoring and adjusting its pH level for optimal digestion, itresponds to the increase inpH caused by acid neutralizers by quickly ramping up acid secretion to bring the pH down to where it should be.As a result, acid neutralizers only relieve symptoms for a short period of time. The fact that these drugs have had a large market for over five decades suggests that they are effective in controlling reflux symptoms with intermittent use.
- Readily available over the counter
- Provides quick relief of mild symptoms
- Can relieve symptoms during a reflux episode
- Can prevent heartburn if taken before a meal that is known to produce heartburn
- Short duration of symptom relief
- Ineffective in long-term management of symptoms
- Ineffective in relieving moderate to severe symptoms
Few side effects have been associated with acid neutralizers. In fact, those that have calcium intheir formula actually act as a nutritional calcium supplement.
Histamine-2 Receptor Antagonists (H2 Blockers)
Examples: Pepcid, Zantac, Tagamet, cimetidine, ranitidine
H2 blockers are a category of drugs that work by deactivating the cellular receptors within the stomach responsible for signaling the production of acid. When the H-2 receptor is blocked, acid secretion by the cells in the stomach is decreased. If reflux occurs while this blockage isin place, the likelihood of heartburn is decreased. These drugs take longer to reduce gastric acid than acid neutralizers, but produce a more sustained acid reduction. H2 blockers are less effective than proton pump inhibitors (PPIs) in suppressing acid secretion on a long term basis, but they act more quickly to reduce acid than PPIs. They are sometimes used with PPIsto augment the efficacy of those drugs.
- Readily available over the counter
- Provide longer term relief from symptoms than acid neutralizers
- Act more quickly than PPIs in reducing acid secretion
- Less expensive than PPIs
- Fewer complications than PPIs
- Less effective than PPIs in the long term
- Ineffective in relieving severe symptoms because the total amount of acid reduction achieved is much lower than PPIs
Few side effects have been associated with H-2 receptor antagonists, with the exception ofcimetidine. Users of this variant of the medication have been known to experience hypotension, headache, fatigue, dizziness, confusion, constipation, diarrhea, and/or rash.
Proton Pump Inhibitors (PPIs)
Examples: Prilosec http://amzn.to/1MIrdCD, Prevacid : http://amzn.to/1MItFZQ, Zegarid, Nexium : http://amzn.to/1MAhuYH, omeprazole : http://amzn.to/1MAhacj, es-omeprazole, lansoprazole PPIs provide the most powerful method for decreasing acid production in the stomach. PPIs work by inhibiting the proton pump in the stomach’s acid-producing cells. When used correctly, PPIs can provide relief from acid reflux for 14-18hours each day. PPIs typically require 3-4 days tobegin working and are not very useful when taken to control symptoms as they occur. These drugs are generally prescribed for a period of two weeks or longer. Tobe effective, PPIs needtobe used continuously to keep acidity levels low so that the damage and symptoms are lessened when acid reflux inevitably occurs.
- Most powerful option for relief of acid reflux symptoms because they achieve the best control of acid secretion available
- Provide longer-term relief from symptoms than other medications
- Heal erosive esophagitis and prevent ulceration and stricture formation in the esophagus
- Long-term use of PPIs may carry an increased risk of bone fractures
- May increase severity of symptoms if treatment is discontinued because of a rebound acid secretion when the drug is withdrawn
- Ineffective for quickly treating symptoms as they occur
- Doesnot address the cause of reflux disease. LES damage is permanent andnot reversed by PPIs.
- Doesnot prevent Barrett’s esophagus or cancer
Direct side effects include headache, diarrhea and abdominal pain. Long-term side effects include increased risk of hip fracture, increased risk of Clostridium difficile (C. diff) infection, andinteractions with other medications.