Pharmaceutical guidelines of patients with pathology of digestive organs. SYMPTOMATIC TREATMENT OF HEARTBURN

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Pharmaceutical guidelines of patients with
pathology of digestive organs. SYMPTOMATIC
TREATMENT OF HEARTBURN
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HEARTBURN

• typically begins with a burning sensation that
  starts in the upper abdomen and moves up into the
  chest, often making its way to the back of the
  throat, and sometimes up into the jaw, arms and
  back. It usually feels worse when lying down or
  bending forward.
• One in 10 Americans experiences heartburn
  symptoms at least once a week.

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Heartburn triggers

• Healthy people
• fat-laden or acidic foods,
• medications (aspirin),
• obesity,
• drinking alcohol,
• smoking,
• eating chocolate ,
• pregnancy,
• emotional turmoil,
• tension
• lying down

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Heartburn causes

• Gastroesophageal Reflux (GERD) - stomach fluids
  containing acid and digestive enzymes back up
  past the valvelike sphincter that separates the
  stomach from the esophagus, causing pain.
• Gastrointestinal diseases
• Chronic gastritis (B), stomach ulcer disease,
  chronic cholecyctitis
• diabetes,
• hiatal hernias,
• autoimmune disorders

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Heartburn An Inside LookFood travels through
the esophagus to the stomach. A valve-like ring
of muscle called the lower esophageal sphincter
opens to let the food in. Then it's supposed to
close again to prevent stomach acids from sliding
up into the esophagus.
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Heartburn Faulty ValveIn some people, the
sphincter between the stomach and esophagus
doesn't work as well as it should. This allows
acid to seep into the esophagus (called acid
reflux), where it can cause pain and irritation.
Not everyone with acid reflux suffers from
heartburn, and some people with "heartburn"
symptoms don't actually have acid reflux but may
have some other condition causing this pain.
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Acid Reflux Symptoms

• The hallmark of acid reflux is heartburn -- a
  painful burning sensation in the middle of the
  chest. Heartburn typically strikes after meals
  and can last several hours. The discomfort may be
  worse after bending over or lying down. Other
  symptoms of severe acid reflux include a
  sour-tasting fluid in the back of the throat,
  difficulty swallowing, or feeling that food is
  stuck in the chest or throat. A chronic cough or
  asthma attacks can also be caused by acid reflux.
  A description of heartburn symptoms is usually
  all thats needed to diagnose acid reflux.

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Heartburn Whos at Risk?

• Anyone can develop heartburn, but certain
  lifestyle factors affect how well the sphincter
  works, as well as the amount of acid produced by
  the stomach. People who are overweight, eat large
  meals, wear tight-fitting clothes, or smoke tend
  to be more vulnerable.

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Is it GERD?

• Heartburn usually doesn't pose a serious threat
  to health. However, complications can occur with
  severe, frequent, and persistent acid reflux. If
  someone have severe heartburn or heartburn two or
  more times a week, he may have a condition called
  GERD (gastroesophageal reflux disease). Without
  treatment, chronic GERD can cause inflammation,
  ulcers, and scarring. GERD can also lead to
  changes in the cells lining the esophagus. Known
  as Barrett's esophagus (shown here), compensation
  by growing more cells like the ones in the
  intestinal lining, these changes raise the risk
  of esophageal cancer.

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Nighttime Heartburn

• Waking with a sore throat, cough, or a bitter
  taste in mouth - It could be nighttime acid
  reflux, and it could be dangerous. In addition to
  disturbing sleep, nighttime reflux increases the
  risk of esophageal damage. That's because lying
  down leaves stomach acid in the esophagus longer.
  And as we sleep we swallow less acid-neutralizing
  saliva than when awake.

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Heartburn. Life-threatening symptoms

• Accompanied by chest pain that feels like a heart
  attack, persistent dry cough, vocal modification,
  hoarseness, a sensation of globus pharyngis (a
  lump at the back of the throat) and otalgia (ear
  pain)
• Abdominal pain or difficulty swallowing,
• weight loss,
• fever or signs of bleeding, including vomiting
  and black stools, which could indicate bleeding
  from the esophagus into the stomach
• Heartburn 3 days and more
• Heartburn connected with certain medicines

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Managing Heartburn at HomeHeartburn treatment
may include medications, home remedies, or diet
changes.

• Patient may be able to manage mild heartburn with
  a few changes to daily routine. Start by eating
  smaller meals. Finish dinner at least three to
  four hours before bedtime and avoid late-night
  snacks.

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Foods

• Some foods are known to contribute to heartburn
  by bringing additional acid into the stomach or
  by relaxing the lower esophageal sphincter.
  Should avoid tomatoes, onions, garlic, chocolate,
  peppermint, fatty foods, and citrus fruits,
  including oranges and grapefruit.

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Beverages

• Certain beverages can also bring on heartburn.
  These include coffee, tea, sodas, alcohol, tomato
  juice, and orange juice.

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Heartburn During Pregnancy

• More than half of all pregnant women report
  symptoms of severe heartburn, especially during
  their second and third trimesters.
• Changing hormone levels and increased abdominal
  pressures during pregnancy increase the risk of
  acid reflux and heartburn.
• Mild symptoms should be treated with lifestyle
  changes, including eating several small meals a
  day instead of three large ones, avoiding fried
  and spicy foods, and not lying down after eating.
  
• If diet and lifestyle don't alleviate symptoms,
  pregnant women should consult their doctor before
  taking any medications.

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Stop Smoking to Stop Heartburn Smoking weakens
the valve at the end of the esophagus, which can
lead to acid reflux and heartburn. And it
increases the risk of various gastrointestinal
cancers. Smokers also have higher risks of
developing peptic ulcers and Crohn's disease than
nonsmokers
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Alcohol interferes with acid secretion, stomach
muscles, and nutrient absorption. Too many drinks
can contribute to heartburn, diarrhea, liver
problems, esophageal and gastric cancer
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Heartburn Remedies Antacids

• For occasional heartburn, should take something
  that works immediately, like a liquid antacid. An
  antacid neutralizes stomach acid. This provides
  temporary relief from heartburn, and is emptied
  from the stomach quickly. It's important to
  follow the directions carefully, because the
  overuse of antacids can cause serious side
  effects. And with more prolonged heartburn
  symptom, antacids may not help.

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Antacids

• nonabsorbed
• 1st generation (Al)
• Phosphalugel
• Compensan
• 2nd generation - (Al, Mg)
• Almagel, Maalox
• 3rd generation - (Al, Mg alginate)
• Gaviscon, Topalcan

• absorbed in
• Sodium bicarbonate
• Calcii carbonate

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Heartburn Remedies Antacids

• They are also occasionally prescribed to help
  relieve the pain of ulcers. Some antacids also
  contain simethicone, an ingredient that helps
  eliminate excess gas.
• Some antacids contain magnesium or sodium
  bicarbonate, ingredients that may have a laxative
  effect.
• Side effects include constipation, diarrhea,
  white or pale bowel movements, and stomach
  cramps. Serious side effects can occur with an
  overdose or overuse of antacids.

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ANTACIDS. GUIDELINES

• it is impossible to combine antacids with de-nol
  and sucralfate (pharmacodynamic incompatibility)
• all antacids are accepted only perorally - in
  case of occurring of heartburn or in 1 hour
  after-meal
• at the prolonged reception of antacids there is
  propensity to the infections of gastrointestinal
  way as a result of decline of protective role of
  hydrochloric acid

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ANTACIDS. GUIDELINES (contd)

• To the patients with hypertensive disease,
  cardiac and kidney insufficiency, liver cirrhosis
  antacids, containing sodium bicarbonate, are
  contra-indicated. As a result of chemical
  reaction with muriatic acid they form chlorous
  sodium which is well absorbed in and causes the
  delay of water in an organism
• Absorbed antacids in large doses can cause system
  metabolic reactions - alkalosis

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Heartburn Remedies H2 Blockers

• Also available over-the-counter, H2 blockers work
  differently than antacids. Rather than zapping
  acids after they appear, these medications lower
  the production of stomach acid. This can help
  prevent heartburn from acid reflux if taken about
  30 minutes before meals. More powerful doses are
  available in prescription form.

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H2 Blockers

• 1st generation (cimetidine)
• 2nd generation (ranitidine)
• 3rd generation (famotidine)

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H2 blockers

• They can be taken at bedtime to suppress
  nighttime production of acid. Available both
  over-the-counter and as prescriptions, H2
  blockers help about half of heartburn sufferers.
  Brands include Axid, Pepcid AC, Tagamet HB, and
  Zantac 75

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H2 blockers

• Possible serious side effects include confusion,
  chest tightness, bleeding, sore throat, fever,
  irregular heartbeat, weakness, and unusual
  fatigue. Other, less serious side effects include
  headache, dizziness, and diarrhea. These are
  usually temporary and will likely go away on
  their own.
• When combined with lifestyle changes, these
  over-the-counter remedies relieve symptoms in
  about 25 of heartburn sufferers. People who have
  more severe heartburn symptoms that aren't
  relieved with these medications or who have been
  using these drugs for more than two weeks should
  contact their physician.

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Acid Blockers Proton Pump Inhibitors

• Proton pump inhibitors, available
  over-the-counter and by prescription, are a class
  of drugs that block the production of stomach
  acid. They are more effective at decreasing acid
  production than H2 blockers. Brands include
  Aciphex, Nexium, Prevacid, Prilosec, Protonix,
  and Zegerid.

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Promotility agents

• The drug Reglan speeds up the digestion process
  and decreases the amount of stomach acid that
  splashes back into the esophagus.

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Which Heartburn Medication to Take?

• The heartburn treatment that's best for the
  patient depends on many things. How often does
  heartburn happen? How bad is it? Does the patient
  want fast relief or prevention?
• Antacids offer fast relief for mild heartburn. H2
  blockers can stop the burn before it starts, but
  only if you know when to take them. Proton pump
  inhibitors can tackle really stubborn heartburn.