Large numbers of Americans use over-the-counter antacids and other agents that are available without a prescription to treat minor GI discomforts and infrequent heartburn. In 1995, the U.S. Food and Drug Administration (FDA) approved the non- prescription availability of important acid blockers, also called H2 blockers, for treatment of infrequent heartburn with dosage levels below the prescription strength formulations. It is anticipated that the FDA will approve the non-prescription availability of another distinct class of drugs, known as proton pump inhibitors (PPIs), for the treatment of infrequent heartburn, also at dosage levels below the prescription strength formulations. While these reduced strength formulations have been approved for relief of symptoms/discomfort from occasional heartburn, they are not recognized by FDA as promoting actual healing of esophagitis, whereas FDA does recognize the healing benefits of some prescription strength medications, e.g. proton pump inhibitors, when taken regularly at prescription dosages.
Over-the-counter medications have a significant role in providing relief from heartburn and other occasional GI discomforts. More frequent episodes of heartburn or acid indigestion may be a symptom of a more serious condition that could worsen if not treated. If you are using an over-the-counter product more than twice a week, you should consult a physician who can confirm a specific diagnosis and develop a treatment plan with you, including the use of stronger medicines that are only available with a prescription.
Why are heartburn and GERD not trivial conditions?
When symptoms of heartburn are not controlled with modifications in lifestyle, and over-the-counter medicines are needed two or more times a week, or symptoms remain unresolved on the medication you are taking, you should see your doctor. You may have GERD.
When GERD is not treated, serious complications can occur, such as severe chest pain that can mimic a heart attack, esophageal stricture (a narrowing or obstruction of the esophagus), bleeding,
or a pre-malignant change in the lining of the
esophagus called Barrett’s esophagus. A 1999 study reported in the New England Journal of Medicine showed that patients with chronic, untreated heartburn of many years duration were at substantially greater risk of developing esophageal cancer, which is one of the fastest growing, and among the more lethal forms of cancer in this country.
Symptoms suggesting that serious damage may have already occurred include:
Dysphagia: difficulty swallowing or a feeling that food is trapped behind the breast bone.
Bleeding: vomiting blood, or having tarry, black bowel movements.
Choking: sensation of acid refluxed into the windpipe causing shortness of breath, coughing, or hoarseness of the voice.
What are the treatment goals for GERD?
GERD is a problem that is symptomatic by day but in which much damage is done by night. Treatment should be designed to: 1) eliminate symptoms; 2) heal esophagitis; and 3) prevent the relapse of esophagitis or development of complications in patients with esophagitis. In many patients, GERD is
a chronic, relapsing disease. Long-term maintenance is the key to therapy; therefore, continuous long-term therapy, possibly life-long therapy, to control symptoms and prevent complications is appropriate. Maintenance therapy will vary in individuals ranging from mere lifestyle modifications to prescription medication as treatment.