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Heartburn can be effectively managed with various medications, with PPIs being the most effective for frequent symptoms. It is important to use the appropriate medication based on the frequency and severity of symptoms and to seek medical advice if symptoms persist. Implementing a treatment algorithm can help ensure consistent and appropriate care for heartburn sufferers.
Heartburn is a common symptom often associated with gastroesophageal reflux disease (GERD). It can be triggered by various factors and may present in conditions other than GERD. Effective treatment requires careful diagnosis and appropriate medication. This article explores the different medications available for treating heartburn, their efficacy, and safety.
Understanding Heartburn and GERD
Heartburn is a burning sensation in the chest caused by acid reflux, where stomach acid flows back into the esophagus. GERD is a chronic condition where acid reflux occurs frequently, leading to symptoms like heartburn. However, not all heartburn is due to GERD, and other conditions can mimic its symptoms1.
Types of Medications for Heartburn
Proton Pump Inhibitors (PPIs)
PPIs are the most effective medications for treating heartburn, especially in GERD patients. They work by reducing the production of stomach acid. Common PPIs include omeprazole, lansoprazole, and esomeprazole.
- Efficacy: PPIs provide significant relief from heartburn. Studies show that a 14-day regimen of lansoprazole 15 mg once daily is effective for frequent heartburn, with rapid and sustained relief throughout a 24-hour period3. Esomeprazole 20 mg once daily also shows high treatment satisfaction and maintains its effect for at least one week after treatment ends5.
- Safety: PPIs are generally safe for short-term use. However, long-term use may be associated with potential side effects, and it is important to consult a healthcare provider if symptoms persist1.
Histamine-2 Receptor Antagonists (H2RAs)
H2RAs, such as famotidine, reduce stomach acid production by blocking histamine receptors in the stomach lining.
- Efficacy: H2RAs are effective for short-term relief of heartburn. A study demonstrated that low doses of famotidine (5, 10, or 20 mg) provided rapid and frequent relief of spontaneous heartburn episodes10. However, they are less effective than PPIs for frequent heartburn9.
- Safety: H2RAs are well-tolerated, but tolerance can develop with repeated use, reducing their effectiveness over time9.
Antacids
Antacids neutralize stomach acid and provide quick relief from heartburn symptoms.
- Efficacy: Antacids are suitable for occasional heartburn but are not recommended for frequent heartburn due to their short duration of action9. They can be used as rescue medication in combination with other treatments3.
- Safety: Antacids are generally safe for short-term use, but overuse can lead to side effects such as constipation or diarrhea9.
Other Medications
- Prokinetics: These medications help strengthen the lower esophageal sphincter and improve gastric emptying. They are less commonly used and are generally considered when other treatments are ineffective6.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Interestingly, a study found that diclofenac, an NSAID, reduced acid-induced heartburn symptoms by inhibiting prostaglandin production in the esophagus7. However, NSAIDs are not typically recommended for heartburn treatment due to their potential to cause gastrointestinal irritation.
Treatment Algorithm
For effective management of heartburn, especially in an over-the-counter setting, a treatment algorithm can be helpful:
- Occasional Heartburn: Use antacids or H2RAs as needed.
- Frequent Heartburn: Use PPIs for a 2-4 week course. If symptoms persist or recur rapidly, consult a healthcare provider4.
- Persistent Symptoms: If heartburn does not resolve with initial treatment, further evaluation by a healthcare provider is necessary to rule out other conditions and adjust treatment accordingly1.