No Time for Heartburn

5 Reasons Why Your Heartburn Medicine Isn't Working


heartburn
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If you have horrible, persistent heartburn, relief can be as simple as popping a pill once or twice a day. Proton pump inhibitors, or PPIs, put the kibosh on the stomachs acid production, keeping gastric juice from backing up into the esophagus and causing pain. (PPIs include brand names such as Nexium, Prevacid, Prilosec, and Protonix.)

But they dont work for everyone. Even if youre one of those people who does well on PPIs you can still have “breakthrough” symptoms from time to time, when heartburn flares into an agonizing episode.

Studies suggest that up to 40% of people with heartburn who take a PPI once a day still experience heartburn or other breakthrough symptoms once in a while, says David A. Johnson, MD, a professor of medicine and the chief of gastroenterology at Eastern Virginia Medical School in Norfolk, Va., and past president of the American College of Gastroenterology.

Find out why heartburn meds can let you down—and what to do about it.

Why heartburn drugs can fail
Its possible that PPIs arent curing your heartburn because youve been misdiagnosed, says gastroenterologist Joel Richter, MD, the chair of the department of medicine at Temple University, in Philadelphia.

Many conditions cause symptoms that mimic those of gastroesophageal reflux disease (GERD), the medical term for persistent acid reflux that damages the esophagus. Muscle contractions, stretching, and non-acidic reflux in the esophagus can all lead to heartburn (the main symptom of GERD), as can unrelated conditions such as heart disease. “There is a big group of people who get put on these medications and dont get better, and most of the time its because they dont have an acid-related problem,” says Dr. Richter.

To find out if your symptoms are due to acid reflux, doctors may perform a test that combines pH monitoring, which measures stomach-acid levels in the esophagus, and impedance testing, which detects the movement of fluid and gas (acidic or otherwise) along the esophagus. This combination can help gastroenterologists distinguish acid- and non-acid reflux episodes. (For instance, if the impedance test registers a reflux but the pH level remains above a certain point, that indicates the reflux contains little or no acid.)

Experts say that if your symptoms are in fact related to acid reflux you should do well on PPIs.

But dont assume that taking medication means you can eat whatever you want, whenever you want. Numerous indiscretions—overloading on fatty or fried foods, say—can trigger breakthrough symptoms. So downing a huge meal, eating late at night, or hitting the sack shortly after a meal can be detrimental to your condition.

“You can eat your way out of these PPIs,” says Dr. Richter. They dont completely knock out acid, he explains. Although it sounds counterintuitive, thats a good thing. Stomach acid plays a key role in sanitizing the digestive tract and in killing off the bacteria that produce nitrosamines, a chemical compound that has been associated with an increased risk of gastric cancer. So a little stomach acid is good; too much, however, can be painful.

Many times symptoms arise because people arent taking their medication correctly or at a time that optimizes its effectiveness, Dr. Johnson explains. “Typically, the proton pump inhibitors are given 30 to 60 minutes before breakfast,” he says. However, some people do better taking two doses a day to stave off nighttime symptoms, he adds.

And missing a pill may readily ignite that familiar burning sensation in the chest and throat and sour taste in the mouth.


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Lead writer: Karen Pallarito
Last Updated: August 31, 2009

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