at least 25% of heartburn sufferers are not helped by
H2 blockers.
Proton-pump inhibitors also inhibit acid produc-
tion by the stomach, but are much more effective than
H2 blockers for some people. They are also more
effective in aiding the healing process. Esophagitis is
healed in about 90% of the patients undergoing pro-
ton-pump inhibitor treatment.
The long-term effects of inhibiting stomach acid
production are unknown. Without the antiseptic
effects of a consistently very acidic stomach environ-
ment, users of H2 blockers or proton-pump inhibitors
may become more susceptible to bacterial and viral
infection. Absorption of some drugs is also lowered by
this less-acidic environment.
Prokinetic agents (also known as motility drugs)
act on the LES, stimulating it to close more tightly,
thereby keeping stomach contents out of the esopha-
gus. It is not known how effectively these drugs pro-
mote healing. Some of the early motility drugs had
serious neurological side effects, but a newer drug,
cisapride, seems to act only on digestive system nerve
connections.
Surgery
Fundoplication, a surgical procedure to increase
pressure on the LES by stretching and wrapping the
upper part of the stomach around the sphincter, is a
treatment of last resort. About 10% of heartburn
sufferers undergo this procedure. It is not always effec-
tive and its effectiveness may decrease over time, espe-
cially several years after surgery. Dr. Robert Marks
and his colleagues at the University of Alabama
reported in 1997 on the long-term outcome of this
procedure. They found that 64% of the patients in
their study who had fundoplication between 1992
and 1995 still suffered from heartburn and reported
an impaired quality of life after the surgery.
However, laparoscopy (an examination of the
interior of the abdomen by means of the laparoscope)
now provides hope for better outcomes. Fundoplica-
tion performed with a laparoscope is less invasive.
Five small incisions are required instead of one large
incision. Patients recover faster, and it is likely that
studies will show they suffer from fewer surgical
complications.
Nutrition/Dietetic concerns
Prevention, as outlined below, is a primary feature
for heartburn management in alternative medicine
and traditional medicine. Dietary adjustments can
eliminate many causes of heartburn.
Herbal remedies include bananas, aloe vera gel,
chamomile (Matricaria recutita), ginger (Zingiber offi-
cinale), and citrus juices, but there is little agreement
here. For example, ginger, which seems to help some
people, is claimed by other practitioners tocauseheart-
burn and is thought to relax the LES. There are also
many recommendations toavoidcitrus juices, which are
themselves acidic. Licorice (Glycyrrhiza uralensis)can
help relieve the symptoms of heartburn by reestablish-
ing balance in the acid output of the stomach.
Several homeopathic remedies are useful in treat-
ing heartburn symptoms. Among those most often
recommended areNux vomica, Carbo vegetabilis, and
Arsenicum album. Acupressure and acupuncture may
also be helpful in treating heartburn.
Sodium bicarbonate (baking soda) is an inexpen-
sive alternative to use as an antacid. It reduces esoph-
ageal acidity immediately, but its effect is not long-
lasting and should not be used by people on sodium-
restricted diets.Prognosis
The prognosis for people who get heartburn only
occasionally or people without esophageal damage is
excellent. The prognosis for people with esophageal
damage who become involved in a treatment program
that promotes healing is also excellent. The prognosis
for anyone with esophageal cancer is very poor. There
is a strong likelihood of a painful illness and a less than
5% chance of surviving more than five years.Prevention
Given the lack of completely satisfactory treat-
ments for heartburn or its consequences and the lack
of a cure for esophageal cancer, prevention is of the
utmost importance. Proponents of traditional and
alternative medicine agree that people disposed to
heartburn should:
avoid eating large meals
avoid alcohol, caffeine, fatty foods, fried foods, hot
or spicy foods, chocolate, peppermint, and nicotine
avoid drugs known to contribute to heartburn, such
as nitrates (heart medications such as Isonate and
Nitrocap), calcium channel blockers (e.g., Cardizem
and Procardia), and anticholinergic drugs (e.g., Pro-
banthine and Bentyl), and check with their doctors
about any drugs they are taking
avoid clothing that fits tightly around the abdomen
control body weight
wait about three hours after eating before going to
bed or lying downHeartburn