At least one big feast in a series of New Year's holidays is already over, which means clients with a burning sensation in the esophagus have already made their way to the nearest pharmacy. Overeating and heavy doses of alcohol almost inevitably lead to problems with the gastrointestinal tract, even for those who do not normally suffer from this. Pharmacy workers who celebrate the holiday are required to dispense “something for heartburn.” How to answer the strangest or trickiest questions from clients about antacids? We offer you the following answer options.
Recommend me something for heartburn that will last longer.
Modern antacid drugs that are not absorbed in the digestive tract, such as aluminum phosphoric acid or aluminum-magnesium drugs, are suitable for you. They bind hydrochloric acid quite quickly - usually within a few minutes after ingestion - and their effect lasts up to several hours. Maximum duration of action
characteristic of drugs containing aluminum hydroxide. They act for 2.5–3 hours [2].
Symptoms
Unpleasant excessive salivation, foul-smelling belches, loss of appetite, fatigue, irritability, sometimes accompanied by vomiting. If symptoms associated with gastric disease or lesions of the esophagus predominate, heartburn can be quite intense. There may be concomitant diseases - these are lung diseases complicated by a severe cough.
Persistent heartburn can cause unwanted complications. For example, damage to the mucous membrane of the esophagus by aggressive body fluid (hydrochloric acid, concentrated bile), which causes the formation of peptic ulcers of the esophagus, stomach, and duodenum. In addition, regular entry of stomach contents into the esophagus can cause constant bleeding, caries, inflammation of the gums and mucous membranes of the mouth.
Give me heartburn medicine. And it would be desirable to also help with bloating - are there any such remedies?
Yes, today there are combination drugs that simultaneously neutralize hydrochloric acid and stop the manifestations of flatulence due to the inclusion of simethicone in the antifoam composition. It reduces the surface tension of gas bubbles in the digestive tract, promoting their rupture. An example of such a drug is a combination of aluminum, magnesium hydroxide and simethicone in the form of a suspension. It simultaneously neutralizes hydrochloric acid, reduces gas formation in the intestines, and also envelops the mucous membrane of the digestive tract, protecting it from the damaging effects of aggressive substances [5].
Helicobacter pylor and night heartburn
Scientists have identified a connection between nocturnal hypersecretion of gastric juice and the presence of Helicobacter pylor (H. pylori) bacteria. Interestingly, antisecretory therapy without H. pylori treatment has been found to provide better control of gastric acid secretion. This may be due to nitrogen produced by H. pylori. This is one reason why the benefits and harms of eradicating this bacterium in patients with GERD are still so widely debated.
What is the difference between tablets and suspension from heartburn? Do they act differently?
The mechanism of action of a drug does not depend on the form (tablets, gel, suspension), but on its components. But the pharmacokinetic properties - the speed of onset of the effect, the duration of action - may differ between tablets and suspensions. It is believed that tablet forms maintain the acidity of gastric juice longer at a level of more than 4 ( acidity of gastric juice is considered normal in the range of 1.3–7.5 pH - editor's note.
) than suspensions. When chewable tablets for heartburn are taken correctly, acid-neutralizing components enter the digestive tract evenly, which has a positive effect on the result. At the same time, for heartburn, suspensions can begin to work faster than tablets [3]. In addition, they are optimally distributed over the surface of the mucous membrane, and in the lumen of the esophagus and stomach they form small drops with a large surface area, which enhances their medicinal properties [6].
And yet it cannot be said unequivocally that any form has an advantage. To draw such conclusions, you need to consider the properties of a particular drug.
Help with heartburn
According to WHO (World Health Organization) statistics, about 50% of the Russian population periodically experience heartburn, with 10-20% suffering from it several times a week. Heartburn usually occurs after eating, and can sometimes bother you between meals and at night.
Despite the fact that heartburn almost does not reduce the overall quality of life, it indicates serious problems in the body that can lead to serious consequences if left untreated. In addition, nighttime heartburn, which a person may not always feel, affects the quality of sleep and the feeling of fatigue during the day, not to mention the fact that the “hidden night threat” can damage the mucous membrane much faster than obvious heartburn.
In this article we will consider the following issues : the cause of heartburn ; standard therapy , positive and negative aspects of such treatment; non-drug treatment options
What is heartburn and how to treat it?
Causes of heartburn
Heartburn is a chemical burn of the esophagus , accompanied by a burning sensation, and sometimes even pain behind the sternum in the projection of the esophagus, sometimes simulating cardiac discomfort.
Most often, heartburn occurs when the lower esophageal sphincter does not close tightly, when the contents of the stomach are thrown into the esophagus. There are 3 types of reflux: acidic, alkaline and mixed. In some cases, the upper sphincter, which separates the esophagus from the pharynx, also enough , which further aggravates heartburn. The entry of gastric juice into the tissues of the esophagus leads to their damage, cell degeneration and, over time, can cause esophageal cancer ( adenocarcinoma ).
The leading causes of heartburn are:
- overweight, especially obesity of the central (apple or android) type - fat deposits on the abdomen. In recent decades, there has been a rapid increase in obesity, and its severe (morbid forms);
- smoking and drinking alcohol;
- taking certain medications that weaken the tone of the upper esophageal sphincter (cardiological, neurological, psychotherapeutic drugs, antispasmodics, etc.), which increases heartburn;
- Eating large volumes (portions) of food and then resting in a horizontal position after eating, as well as exercising shortly after eating, can also lead to the development of reflux.
Foods that trigger heartburn
An interesting fact is that it is not only acidic foods that are to blame for heartburn, as it might seem at first glance. Problems often arise when eating foods that require a long time to digest—fatty foods.
"The police are looking for them":
- semi-finished products;
- drinks that contain acids to improve taste and increase shelf life;
- products that are highly acidic or stimulate the release of hydrochloric acid (sour vegetables and fruits, spicy foods, chocolate, coffee, alcohol, carbonated drinks).
Heartburn medications
Television and Internet advertising imposes on us the idea that heartburn should be treated with folk remedies instead of starting to change your lifestyle and diet, understanding the peculiarities of the formation of the complaint.
The most effective drugs are considered to be drugs from the group of so-called proton pump inhibitors (PPIs), intended not only to eliminate this symptom, but also to treat the disease - gastroesophageal reflux disease (GERD). But, like any drug, these medications have side effects, which if self-medicated can lead to negative consequences. Please note that many medications, if taken incorrectly (incorrect dose selection, frequency and time of administration, etc.), in addition to the therapeutic effect, can also exhibit dangerous properties.
The most commonly used symptom-stopping agents, including for self-medication, are antacids . Just like the previous group, with constant use they can lead to side effects. One of them is the absorption of aluminum, especially with frequent or prolonged use, even though modern antacids (Almagel, Maalox, phosphalugel, Gastal) are considered non-absorbable. In some cases, H2-histamine receptor blockers are used in the treatment of heartburn, which, if used incorrectly, can also provoke serious undesirable consequences , and the “old generation” is even contraindicated for use.
You can avoid falling into the trap of self-medication with side effects by fighting heartburn not with medications, but by optimizing your diet and adjusting your lifestyle. This approach will reduce unpleasant symptoms and help restore damaged areas of the digestive tract , and sometimes even help you “get away” from medications.
Remember that if medicine for heartburn is prescribed to you by your doctor, you DO NOT voluntarily, without approval , cancel the medication and rely only on diet and lifestyle adjustments.
Only a specialist doctor can prescribe, adjust dosages, determine the duration of therapy
How to say goodbye to heartburn without medications
The most physiological, but difficult way to get rid of heartburn is:
- weight loss
- smoking cessation
- drinking alcohol only in small quantities
- avoiding unnatural carbonated drinks
- 3-4 meals a day instead of previously 5-6
- last meal at least 3 hours before bedtime
- raised head of the bed by about 15-20 cm
- exclusion or restriction of heartburn-provoking foods in the diet.
Here are the just published clinical recommendations of the RGA (Russian Gastroenterological Association) on GERD:
«Diet therapy and lifestyle changes
- All patients with GERD are recommended to make lifestyle changes (loss of excess body weight, cessation of smoking, avoidance of situations that increase intra-abdominal pressure) and diet therapy.
Lifestyle changes should be considered a prerequisite for effective antireflux treatment in patients with GERD. First of all, it is necessary to reduce body weight, if it is excessive, and stop smoking. Patients should avoid overeating; they should stop eating two hours before bedtime.
At the same time, you should not increase the number of meals: you must eat three or four meals a day and carefully avoid so-called “snacks.” Recommendations for frequent split meals are not justified.
It is important to avoid as much as possible situations that increase intra-abdominal pressure (wearing tight belts, corsets and bandages, lifting weights of more than 8-10 kg on both arms, work involving bending the body forward, physical exercises associated with overstraining the abdominal muscles). Elevating the head of the bed is necessary for patients who experience heartburn or regurgitation when lying down.
Dietary recommendations should be strictly individualized, taking into account a thorough analysis of the patient's medical history. It is advisable to avoid consuming tomatoes in any form, sour fruit juices, foods that increase gas formation, as well as fatty foods, chocolate, and coffee. It is necessary to limit the consumption of alcohol, very hot or cold food and carbonated drinks as much as possible.
Patients should be warned about the side effects of drugs that reduce the tone of the LES (nitrates, calcium antagonists of the nifedipine group, theophylline, progesterone, antidepressants), and can also cause inflammation themselves (non-steroidal anti-inflammatory drugs, doxycycline, quinidine).”
Nutrition tips
Avoid
Convenience foods, carbonated drinks, sour vegetables and fruits, alcohol, chocolate, coffee.
Try to diversify your diet
Whole grains, legumes, lean meats and seafood, and non-acidic vegetables and fruits are useful for preventing heartburn.
Whole plant foods contain a lot of fiber, which helps fight heartburn, improve digestion, reduce pressure on the lower digestive sphincter, and help normalize weight. It is useful to consume 400–500 grams of vegetables daily, half of which should preferably be eaten raw, and also 200–300 grams of fresh fruit into your diet daily .
Low-fat dairy products are considered “food antacids”, so if they are tolerated, you can and should also consume them.
Conclusion
Most of the above dietary tips can be followed on your own, but for long-term complaints and serious problems, as well as for weight loss, adjusting your diet and lifestyle without harm to your health, we recommend that you consult a specialist doctor.
Why does heartburn occur?
If you feel a burning sensation and discomfort in the upper abdomen, then something wrong is happening in the esophagus. And the following happens there. The normal environment in the stomach is acidic, and in the esophagus it is neutral. Acid from the stomach is thrown into the esophagus and begins to irritate the mucous membrane of its walls. But the esophagus is not designed to tolerate this. In addition to the fact that acid irritates the esophageal mucosa, it also has a damaging effect. When the receptors are irritated, a nerve impulse sends a signal to the brain, and you feel heartburn.
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When to go to the doctor
There are 3 degrees of severity of this symptom:
mild - appears 1-2 times a week;
medium - appears more than 2 times a week, but no more;
severe - appears almost every day.
If heartburn happens to you regularly, then you don’t need to self-medicate, much less endure it, in the hope that it will resolve on its own. Reflux disease itself causes many unpleasant moments, general well-being and quality of sleep deteriorate, there is a need to limit physical activity, and problems with nutrition. In addition to all this, reflux can cause serious complications, including esophageal ulcers. The fact is that, being regularly damaged, the wall of the esophagus becomes thinner. First, erosions appear on it, and then ulcers. Often people do not take this problem seriously and go to the doctor not with heartburn, but with severe pain, having an advanced stage of the disease. I wouldn’t like to scare you, but it is important to start timely treatment so as not to cause irreparable harm to your health.
Usually the following examinations are prescribed first:
- laboratory blood tests (general, biochemical, for the presence of antibodies to Helicobacter pylori);
- gastroscopy;
- urease breath test (detection of Helicobacter pylori infection);
- esophageal pH monitoring;
- esophagomanometry, etc.
