50 | June• 2019
THE BURNING QUESTION
Take medicationPeople with infrequent heartburn
may find relief from over-the-coun-
ter antacids or alginates, a heartburn
remedy derived from seaweed. But
those with GORD often need prescrip-
tion-strength relief. Some people feel
better after an eight-week course of
medication. Others need to continue
for years to keep symptoms at bay.
The two most commonly prescribed
classes of drugs for
GORD are known as
H2 blockers and pro-
ton pump inhibitors
(PPIs). Both reduce the
amount of acid your
stomach produces.
“The evidence over-
whelmingly shows that
proton pump inhibi-
tors are much better
than H2 receptor an-
tagonists at healing gastroesophage-
al reflux,” says Professor Lovat. The
oesophagus will heal in 50 per cent
of people who take H2 blockers for an
eight-week course. But it will heal in
80 per cent of people who take PPIs
for the same amount of time.
Because PPIs are more effective,
doctors prescribe them more of-
ten, even long-term. Occasionally,
research is released that tries to link
long-term PPI use to an increased
risk of heart attack, dementia, kid-
ney damage or stomach cancer, but
experts say that the evidence for risk
remains weak.
“The side effect of long-term treat-
ment with PPI has been debated
for many years,” says Professor Asle
Medhus o f the University of Oslo.
“These dr ugs have now been availa-
ble for about 30 years, and millions of
patients have used this drug for pro-
longed periods. Many of the previous
concerns about side effects have thus
turned out to be needless.”
“The problem with those stud-
ies is that they are all
based on large-scale
data collection,” says
Professor Amritpal
Hungin from Durham
University in the UK.
“They’re not cause-
and-effect studies.”Avoid triggers
Some people get heart-
burn when they eat
chocolate or when they drink alcohol
or coffee. If you’ve identified a pattern,
steer clear of things that cause reflux.
In patients with milder disease,
avoiding tr iggers is often an effective
strategy, b ut as Professor Hebbard
points out, this does not control
symptoms sufficiently in all patients,
so extra measures will be needed.
“In patients with severe reflux – with
ulceration and scarring, or Barrett oe-
sophagus – lifestyle measures alone
don’t control the underlying disease,
which can lead to complications
and [the need for] acid suppression
[medications], usually a PPI.”