December 15, 2003 -- Anyone who’s watched TV lately can’t miss the many commercials for heartburn medication. It’s a growing market because more Americans are suffering from heartburn-related conditions. Still, pills may not be the answer for everyone, and they’re not the best place to start.

UNDERSTANDING HEARTBURN

Twenty-five percent to 30 percent of Americans suffer from frequent heartburn. Heartburn is caused by stomach acid that backs up into the esophagus--the tube that carries food from the mouth to the stomach.

A muscle between the stomach and the esophagus -- the lower esophageal sphincter (LES) -- plays a major role. When working properly, the LES opens to allow food into the stomach. In some people the LES becomes weak or doesn't always close properly, allowing stomach acid to flow back up. This can lead to varying degrees of heartburn and, in some cases, gastroesophageal reflux disease (GERD).

Why are there more cases of GERD than ever before? “We eat too fast, we eat too much, and we eat the wrong things,” says Dr. David Peura, associate chief of UVa’s Division of Gastroenterology and part of U.Va.’s Digestive Health Center of Excellence. “We eat high-fat foods that delay stomach emptying. We inhale our food rather than eat it, and we often eat large meals at night. All of these things can provoke reflux.”

CANCER AND OTHER RISKS?

Frequent reflux of stomach acid can damage the lining of the esophagus, which isn’t protected against the acid as the stomach is. It also may lead to hoarseness, chronic cough, asthma, tooth decay and esophagitis--an inflammation of the esophagus. The chest pain that accompanies heartburn can feel similar to the most common sign of a heart attack.

While GERD can cause serious damage, doctors are beginning to realize that the threat of it leading to cancer is not as great as they had thought. “We recognize that while that is a possibility, it’s far more the exception than the rule,” says Peura.

ACID BACKUP

Several factors may weaken the LES or increase the amount of acid in the stomach. These include:

• Obesity
• Pregnancy
• Smoking
• Lying down or bending over after eating.

To prevent heartburn, done eat “red light” foods (see photo), manage your weight and don’t eat anything for three hours before bed time.

OVER-THE-COUNTER RELIEF

People with mild or occasional episodes of heartburn can usually treat it with over-the-counter antacids such as Tums or Mylanta. These medications quickly neutralize stomach acids but work only for short periods of time.

For more severe heartburn, H2 blockers such as Tagamet, Pepcid, Axid and Zantac, which don’t need prescriptions, reduce the amount of acid the stomach produces and provide relief for up to 12 hours. Larger doses may require a prescription.

If you are using either type of acid reducers regularly for more than two weeks, you should see a doctor because you may need different treatment.

OVER-THE-COUNTER PRILOSEC