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Posts Tagged ‘Acid-Peptic Disorders’

Acid-Peptic Disorders and How to Treat Them with Over-The-Counter Medications. By Our July Student Pharmacist, Shawn Rutledge, Who is Having a Spicy Burrito for Lunch, Because He is Prepared for the Consequences!

What is Heartburn?

Heartburn is a painful, burning sensation in the esophagus located just behind the sternum or ribcage. This burning is caused by the backwards flow of gastric acid from the stomach into the esophagus. If this sensation occurs two or more days per week and and lasts for three months or more, it is classified as gastroesophageal reflux disease (GERD).

How is Heartburn Different Than Acid Indigestion?
Acid indigestion is discomfort in the upper portion of the stomach caused by the excess production of hydrochloric acid in the stomach. Acid indigestion is usually characterized by nausea, abdominal bloating, or belching. Frequent acid indigestion can weaken the duodenum (the first section of the small intestine) and be a factor in the development of peptic ulcer disease (PUD), a slightly more serious medical condition.

Comparison of Symptoms Between Heartburn and Acid Indigestion:                    

Location of Symptoms:

  • Heartburn: Sub-sternal. May radiate to chest, back, and neck.
  • Acid Indigestion: Slightly below the rib-cage.


  • Heartburn: Burning sensation that moves up the esophagus. Excess saliva production. Regurgitation of acid.
  • Acid Indigestion: Nausea, belching, bloating, and vomiting.

Effects of Diet:

  • Heartburn: Symptoms worsen with food.
  • Acid Indigestion: Food may improve or worsen the symptoms.

Time of Day:

  • Heartburn: After meals. At bedtime. When exercising.
  • Acid Indigestion: Night-time awakenings.

What over-the-counter medicines are available?


Antacids are medicines that help neutralize the gastric acid in the stomach and therefore increase the pH of the stomach. Antacids do not prevent acid from being produced, but just help to deal with the problem once it occurs. There are many different formulations available and they range from rapid onset with a short duration of action, such as milk of magnesia or Alka-Seltzer, to slow onset but long acting, like Tums. These antacids are best used to treat mild, infrequent heartburn.

Histamine 2 Receptor Antagonists

Histamine is a chemical that can be found many places in your body and has a wide variety of functions. One of these functions is to increase the amount of gastric acid you produce, usually in response to eating. Certain foods such as chocolate, caffeine containing foods, and spicy foods are thought to cause acid indigestion by releasing more gastric acid. For this reason, a medication that stops histamine from telling your stomach to produce more acid can be very beneficial in the treatment and prevention of acid indigestion and heartburn.

Two medications in this class are Zantac and Pepcid. They are very helpful in the relief of symptoms. These medications do not work as quickly as the antacids discussed before. They can be taken thirty minutes or an hour prior to eating to prevent the over production of stomach acid. This comes in handy when you know you are going to eat a food that usually causes you to have acid-indigestion (i.e. a trigger food–spicy Mexican food).

To get the best of both worlds, there is a product called Pecid Complete. Pepcid Complete is a combination medicine of both an antacid and histamine receptor blocker. This combination is beneficial to take when you have acid indigestion or heartburn related to eating, because it can work quickly to neutralize the acid and it also works longer to help reduce any further production of stomach acid.

Proton Pump Inhibitors

The last class of drugs we will discuss are the Proton Pump Inhibitors. Unlike the histamine receptor blockers that block the signaling chemical (histamine) from activating these pumps, the proton pump inhibitors work to directly inhibit the pump itself from secreting acid. For this reason, these drugs are considered the most effective agents for stopping frequent heartburn. These medicines are not fast acting and actually may take at least one to four days to start working. They are, therefore, used for prevention and not to treat a current bout of heartburn.

There are many available medicines in this class, such as Prevacid, Prilosec, and the newest over-the-counter, Nexium. These medicines should only be taken for 14 days when they are used over-the-counter as self-treatment. If you have more persistent heartburn that continues for three months, you should see your healthcare provider.

If you experience the following symptoms you should not self treat and should consult your healthcare provider:

  • Symptoms that last for more than two weeks while taking an over-the-counter product.
  • Heartburn that occurs more than two days a week and lasts for more than 3 months.
  • Difficult or painful swallowing.
  • Any signs of GI bleeding.

There are also various lifestyle changes that are recommended and can be tried to lower the incidence of heartburn or acid-indigestion. These include:

  • Avoiding trigger foods such as caffeine, chocolate, fatty or spicy foods, carbonated or acidic beverages, and alcohol.
  • Weight loss.
  • Smoking cessation.
  • Not lying down directly after eating.

If you have questions about heartburn, acid indigestion, or the medications used to treat these conditions, your local pharmacist would be glad to talk to you.

Source: Acid-Peptic Disorders lecture given by Bella Mehta Pharm D, The Ohio State University College of Pharmacy, course 7630, September 10th, 2013.

photo credit: http://www.t-drops.com/2011/04/spicy-foods-acid-reflux/