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Frequent Heartburn
February 2000

Q. I have frequent heartburn, especially after big meals. Tums helps some, but not enough. What can I do?

A. Heartburn (gastro esophageal reflux) is very common. It is caused by reflux of acid from the stomach up into the esophagus (food pipe) via the gastroesophageal valve. Often, this is due to weakness/relaxation of the valve that normally should be tight/closed. Several substances can cause this weakness of the valve such as nicotine (tobacco), caffeine, alcohol, chocolate, and peppermint. Also, if there is increase pressure on the stomach, such as in obesity, or decrease pressure in part of the stomach that can slide up into the chest cavity (hiatal hernia), these conditions also can cause acid reflux.

Obviously, trying to eliminate, or at least decrease the above exacerbating substances can help reduce acid reflux as can weight loss. Also, avoiding large meals, and elevating the head of bed is often helpful. For mild cases, over the counter Tums or Mylanta may be all that is needed. However, for more moderate or severe cases, there are several acid blocking medications that reduce stomach acid production that usually are very effective. Zantac or Pepcid are commonly used. However, if these don't work, there are even stronger acid blockers such as Prilosec or Prevacid which almost always are effective. There also are drugs that increase the motility of the stomach that can help reflux such as Propulcid. However, there are very recent new warnings on Propulcid because several people have died from cardiac arrhythmia's (irregular heart rhythms) which may be due to worsening of an underlying heart condition and several drug interactions. I strongly advise that anyone on Propulcid speak with their doctor to discuss this issue and consider alternative treatment..

For more severe cases of reflux, it is probably a good idea to have an upper endoscopy (a procedure that uses a scope to look into the esophagus and stomach) to make sure there are no signs of any precancerous or cancerous changes of the mucous lining of the esophagus and stomach.

Lastly, there is a surgical procedure that in the hands of an experienced surgeon is very effective. It can now be done laparoscopically, and is called fundul plication. This is done by inserting a scope through the abdominal cavity and performing surgery to increase the pressure around the gastroesophageal valve. Patients are usually discharged within 24 hours and usually do not need medications any more.

For more info, you could call the National Digestive Disease Information Clearinghouse: (301) 654-3810

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