The symptoms of this disease occur more commonly in patients aged over 55, although symptoms can occur in young adults and particularly in pregnant women.
Symptoms of heartburn are caused when there is reflux of gastric contents, particularly acid, into the oesophagus, which irritate the sensitive mucosal surface (oesophagitis). Patients will often describe the symptoms of heartburn; typically a burning discomfort/pain felt in the stomach passing upwards behind the breastbone (retrosternally). The pain may be felt only in the lower retrosternal area or on occasion right up to the throat, causing an acid taste in the mouth. Heartburn is often brought on by bending or lying down. It is more likely to occur in those who are overweight and can be aggravated by a recent increase in weight. It is also more likely to occur after a large meal.
If symptoms have not responded to treatment after 1 week the patient should see a doctor.
Antacids can be effective in controlling the symptoms of heartburn and reflux.
In general, liquids are more effective antacids than are solids. Some patients find tablets more convenient and these should be well chewed before swallowing for the best effect. Antacids are best taken about 30 minute after a meal. AL MG is one of this drug category.
Because they raise the gastric pH, antacids can interfere with enteric coatings on tablets like Aspirin that are intended to release their contents further along the GI tract.
H2 antagonists (cimetidine, famotidine, ranitidine)
Cimetidine, famotidine and ranitidine in this drug category are effective in dyspepsia, hyperacidity and heartburn and could be used only for 2 weeks without prescription. The H2 antagonists have both a longer duration of action (up to 8–9h) and a longer onset of action than antacids. Where food is known to precipitate symptoms, the H2 antagonist should be taken an hour before food.
Cimetidine has a number of significant interactions with other drugs, including theophylline, warfarin and phenytoin.
Proton pump inhibitors
PPIs are generally accepted as being amongst the most effective medicines for the relief of heartburn and works by suppressing gastric acid secretion in the stomach. It may, however, take a day or so for them to start being fully effective. During this period a patient with ongoing symptoms may need to take a concomitant antacid. Patients taking PPIs should be advised not to take H2 antagonists at the same time. The tablets should be swallowed whole with plenty of liquid prior to a meal.
Omeprazole, Pantoprazole, Rabeprazole, esomeprazole and lansoprazole are in this drug category. Omeprazole is the only one that is OTC and should not be used more than 2 weeks without prescription.
General recommendations to help improve this disease:
- Weight reduction
- Eat small meals but frequently
- Not to eat high fat meals
- Taking evening meal several hours before going to bed
- Squatting rather than bending down
- Raising the head of the bed
- Avoid to use tight and constricting clothing, especially waistbands and belts
- Avoid to smoke and use alcohol, caffeine and chocolate
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