Heartburn medical therapy: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(22 intermediate revisions by 5 users not shown)
Line 1: Line 1:
==Treatment==
__NOTOC__
{{CMG}}
{{Heartburn}}
=== Prevention ===
{{CMG}}; {{AE}} {{AEL}} {{Jose}}
If heartburn occurs when lying down, elevating the head of the bed, or elevating the upper body with pillows or sleeping sitting up frequently provides relief.  Avoid pillows that raise the head only, as this does little for heartburn and places continuous strain on the neck. To minimize attacks, a sufferer may find benefit in avoidance of certain foods that relax the opening between the stomach and esophagus, such as chocolate, peppermint, and chamomile tea shortly before bedtime.
==Overview==
The treatment of heartburn in the setting of GERD is lifestyle modifications which include [[weight loss]], elevating head of the bed and no eating before going sleep. The pharmacologic medical therapy is recommended among patients with persistent GERD despite following the lifestyle modifications. [[Antacids]], [[H2 antagonist|histamine receptor antagonists]], [[proton pump inhibitors]], and [[Prokinetic|prokinetics medications]] are used in treatment of GERD.


=== Medications ===
==Medical Therapy==
[[Antacid]]s, [[H2-receptor antagonist]]s, alginates and [[proton pump inhibitor]]s are used (in that order) to treat heartburn.
===Gastroesophageal reflux disease===
====Lifestyle Modifications====
* The following measures are recommended as the first line to treat GERD:<ref name="pmid17573791">{{cite journal |author=Piesman M, Hwang I, Maydonovitch C, Wong RK |title=Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2128–34 |year=2007 |pmid=17573791 |doi=10.1111/j.1572-0241.2007.01348.x}}</ref><ref name="pmid16682569">{{cite journal |author=Kaltenbach T, Crockett S, Gerson LB |title=Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach |journal=Arch. Intern. Med. |volume=166 |issue=9 |pages=965–71 |year=2006 |pmid=16682569 |doi=10.1001/archinte.166.9.965}}</ref><ref name="pmid259568342">{{cite journal| author=Ness-Jensen E, Hveem K, El-Serag H, Lagergren J| title=Lifestyle Intervention in Gastroesophageal Reflux Disease. | journal=Clin Gastroenterol Hepatol | year= 2016 | volume= 14 | issue= 2 | pages= 175-82.e1-3 | pmid=25956834 | doi=10.1016/j.cgh.2015.04.176 | pmc=4636482 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25956834  }}</ref><ref>Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. ''Am J Gastroenterol'' 1999;94:2069-73. PMID 10445529.</ref>
** [[Weight loss]]
** Elevating head of the bed
** No eating two hours before going sleep 
* Avoidance of the following foods and lifestyles is recommended in treatment of GERD:
**[[Coffee]]
**[[Alcohol]]
**Excessive amounts of [[Vitamin C]] supplements
**Foods high in fats
**[[tobacco smoking|Smoking]]
**Eating shortly before bedtime
**Large meals
**[[Chocolate]] and [[peppermint]].
**[[Acid]]ic foods, such as oranges and tomatoes.
**[[Cruciferous vegetables]] such as: Onions, cabbage, cauliflower, broccoli, spinach, brussel sprouts
**[[Milk]] and milk-based products


==== Antacids ====
==== Medical therapy ====
Antacids work by neutralizing excess stomach acid. So although stomach acid will still splash up into the esophagus (acid reflux) the stomach acid will be neutralized and therefore will lead to lesser or no heartburn symptoms (the burning feeling). Antacids provide fast relief of symptoms, but relief typically last for just 30-60 minutes.
* The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.<ref name="pmid17229239">{{cite journal |author=Tran T, Lowry A, El-Serag H |title=Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs |journal=Aliment Pharmacol Ther |volume=25 |issue=2 |pages=143-53 |year=2007 |id=PMID 17229239 | doi=10.1111/j.1365-2036.2006.03135.x}}</ref><ref>Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. ''Am J Ther'' 1995;2:546-552. PMID 11854825.</ref>
* The following medical therapies are strongly recommended by the American College of Gastroenterology:
** '''[[Antacids]]''' Antacids work by neutralizing excess stomach acid. Antacids provide fast relief of symptoms, but relief typically lasts for just 30-60 minutes. There may be rebound pain after its effect is over:
*** Preferred regimen (1): [[Aluminum hydroxide]] 640 mg 5 to 6 times daily PO after meals and at bed time.
*** Preferred regimen (2): [[Calcium carbonate]] One gram PO.
** '''Histamine-receptor antagonists (H2RA)''' H2-receptor antagonists work by inhibiting the H2 receptor on [[parietal cells]] which signals the production of gastric acid by them:
*** Preferred regimen (1): [[Ranitidine]] 150 mg q12 daily PO
*** Preferred regimen (2): [[Cimetidine]] 400 mg q6h or 800 mg q12 PO for 12 weeks
*** Preferred regimen (3): [[Famotidine]] 20 mg q12 PO for 6 weeks 
** '''[[Proton pump inhibitors]]''' Proton pump inhibitors inhibit the proton (H+) pump localized at the apical part of the parietal cell and is responsible for acid secretion. These are the most potent gastric acid release inhibitors:
*** Preferred regimen (1): [[Omeprazole]] 20 mg q24 PO for up to 4 weeks
*** Preferred regimen (2): [[Esomeprazole]] 20 mg or 40 mg q24 IV
** '''[[Prokinetic|Prokinetic medications]]''' these medications work by stimulating proper contraction of the stomach and esophagus to make the gastric emptying happen faster, which decreases the likelihood of reflux of gastric content into the esophagus:
*** Preferred regimen (1): [[Metoclopramide]] 10 mg q24 PO for 4 to 12 weeks


==== Sodium bicarbonate ====
===Medical therapy for other causes of heartburn or chest pain with similar clinical features===
A simple and relatively harmless way to treat a one-off heartburn is to drink a solution of a small amount of [[Sodium bicarbonate]] mixed with water, which quickly neutralizes the acid that causes the pain. Excess [[sodium]] intake does, however, raise blood pressure and cause other undesirable health effects if resorted to with any frequency.
* For [[chest pain]] in the setting of a proven [[acute coronary syndrome]], the use of [[nitrates]] may improve it.
* In case of [[scleroderma]] the treatment for [[heartburn]] is the same as for [[GERD]].
* For other causes such as [[eosinophillic esophagitis]] - treatment include specific dietary changes and [[proton pump inhibitor]]s, with [[corticosteroids]] being used in a few cases.


==== H2-receptor antagonists ====
==References==
Often called H2 Blockers, H2-receptor antagonists work by decreasing the amount of acid the body releases into the stomach. H2s are systemic, meaning they require absorption into the bloodstream in order to work. Therefore, H2s can often take 30 minutes or longer before they start working, and therefore are often taken to prevent heartburn rather than for fast relief of symptoms.
{{Reflist|2}}
 
==== Alginates ====
Alginates work differently than antacids and H2 Blockers, by forming a protective barrier in the stomach that prevents stomach acid from refluxing back up into the esophagus. Alginic acid is naturally derived (from brown seaweed) and is non-systemic. Alginates provide faster relief than H2-receptor antagonists and PPIs and longer-lasting relief than antacids.
 
==== Proton-pump Inhibitors ====
[[Proton pump inhibitor]]s, called PPIs, are a class of medications which can be effective for people who do not respond to antacid or acid blockers. Proton-pump inhibitors are systemic and directly block acid production in the stomach cells. In order to prevent heartburn the medication disfigures and disables the proteins (proton pumps) that control the pH of the stomach, allowing the body to digest them. Proton-pump inhibitors are not fast-acting, but provide long-lasting relief. PPIs are intended to be short-term medications only.


=== Restricting Diet ===
[[Category:General practice]]
Restricting diet is very important, since 90-95% of patients of heartburn or esophageal disorder can link their symptoms to specific foods. Therefore, it is important that heartburn patients manage their diets as a way to treat their heartburn. Patients should choose the kinds of foods and drinks which have little risk of causing acid reflux, while some kinds of foods or drinks should be avoided as they are major heartburn triggers.
[[Category:Gastroenterology]]
 
[[Category:Digestive disease symptoms]]
=== Bananas ===
Are a natural antacid so eat one for instant relief of heartburn. The inside of the banana skin is also good  for soothing mosquito bites.
 
 
==References==
{{reflist|2}}
{{WH}}
{{WS}}
[[Category:Needs content]]
[[Category:Disease]]
[[Category:Bacterial diseases]]
[[Category:Pulmonology]]
[[Category:Infectious disease]]

Latest revision as of 20:08, 6 September 2020

Heartburn Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Heartburn from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT-Scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Heartburn medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Heartburn medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA onHeartburn medical therapy

CDC on Heartburn medical therapy

Heartburn medical therapy in the news

Blogs on Heartburn medical therapy

Directions to Hospitals Treating Heartburn

Risk calculators and risk factors for Heartburn medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2] José Eduardo Riceto Loyola Junior, M.D.[3]

Overview

The treatment of heartburn in the setting of GERD is lifestyle modifications which include weight loss, elevating head of the bed and no eating before going sleep. The pharmacologic medical therapy is recommended among patients with persistent GERD despite following the lifestyle modifications. Antacids, histamine receptor antagonists, proton pump inhibitors, and prokinetics medications are used in treatment of GERD.

Medical Therapy

Gastroesophageal reflux disease

Lifestyle Modifications

  • The following measures are recommended as the first line to treat GERD:[1][2][3][4]
    • Weight loss
    • Elevating head of the bed
    • No eating two hours before going sleep
  • Avoidance of the following foods and lifestyles is recommended in treatment of GERD:

Medical therapy

  • The medical therapy is indicated for the patients who have persistent GERD regardless the lifystyle and food modifications.[5][6]
  • The following medical therapies are strongly recommended by the American College of Gastroenterology:
    • Antacids Antacids work by neutralizing excess stomach acid. Antacids provide fast relief of symptoms, but relief typically lasts for just 30-60 minutes. There may be rebound pain after its effect is over:
    • Histamine-receptor antagonists (H2RA) H2-receptor antagonists work by inhibiting the H2 receptor on parietal cells which signals the production of gastric acid by them:
      • Preferred regimen (1): Ranitidine 150 mg q12 daily PO
      • Preferred regimen (2): Cimetidine 400 mg q6h or 800 mg q12 PO for 12 weeks
      • Preferred regimen (3): Famotidine 20 mg q12 PO for 6 weeks
    • Proton pump inhibitors Proton pump inhibitors inhibit the proton (H+) pump localized at the apical part of the parietal cell and is responsible for acid secretion. These are the most potent gastric acid release inhibitors:
      • Preferred regimen (1): Omeprazole 20 mg q24 PO for up to 4 weeks
      • Preferred regimen (2): Esomeprazole 20 mg or 40 mg q24 IV
    • Prokinetic medications these medications work by stimulating proper contraction of the stomach and esophagus to make the gastric emptying happen faster, which decreases the likelihood of reflux of gastric content into the esophagus:

Medical therapy for other causes of heartburn or chest pain with similar clinical features

References

  1. ↑ Piesman M, Hwang I, Maydonovitch C, Wong RK (2007). "Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?". Am. J. Gastroenterol. 102 (10): 2128–34. doi:10.1111/j.1572-0241.2007.01348.x. PMID 17573791.
  2. ↑ Kaltenbach T, Crockett S, Gerson LB (2006). "Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach". Arch. Intern. Med. 166 (9): 965–71. doi:10.1001/archinte.166.9.965. PMID 16682569.
  3. ↑ Ness-Jensen E, Hveem K, El-Serag H, Lagergren J (2016). "Lifestyle Intervention in Gastroesophageal Reflux Disease". Clin Gastroenterol Hepatol. 14 (2): 175-82.e1-3. doi:10.1016/j.cgh.2015.04.176. PMC 4636482. PMID 25956834.
  4. ↑ Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO. Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 1999;94:2069-73. PMID 10445529.
  5. ↑ Tran T, Lowry A, El-Serag H (2007). "Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease drugs". Aliment Pharmacol Ther. 25 (2): 143–53. doi:10.1111/j.1365-2036.2006.03135.x. PMID 17229239.
  6. ↑ Decktor DL, Robinson M, Maton PN, Lanza FL, Gottlieb S. Effects of Aluminum/Magnesium Hydroxide and Calcium Carbonate on Esophageal and Gastric pH in Subjects with Heartburn. Am J Ther 1995;2:546-552. PMID 11854825.
Retrieved from "https://www.wikidoc.org/index.php?title=Heartburn_medical_therapy&oldid=1660089"