PPIs not the best choice for occasional heartburn

Ask Dr. Keith Roach M.D

PPIs not the best choice for occasional heartburn

DEAR DR. ROACH: For the past 50 years I have been bothered by occasional indigestion or heartburn after eating a greasy or spicy meal. This might occur several times per month, but not more than once a week.

I have always gotten instant relief through either calcium carbonate tablets (Turns) or a teaspoon of sodium bicarbonate (baking soda) in water.

Several years ago, I discussed this with my doctor, and he prescribed omeprazole with instructions to take one 20-mg capsule daily. After reading of the negative side effects of omeprazole, I began taking it only before I ate a heavy meal that might bring on the symptoms. My doctor agreed that it was not necessary to take it daily. I noted that omeprazole was effective only when taken before the meal and provided no relief when taken after the discomfort had started.

The Turns or baking soda seemed to be such a quick and easy fix. Is there a reason to use omeprazole instead of the antacids? — S.D.K.

ANSWER: Proton pump inhibitors like omeprazole are powerful medications that have made an enormous impact on improving the symptoms of people with severe heartburn.

However, not everyone needs such powerful medication.

PPIs also are slow to relieve symptoms. It takes several days of once-daily dosing of omeprazole to suppress acid secretion. Because of this, dosing omeprazole on an as-needed basis is not going to be effective for most people. For occasional symptoms of heartburn, it is far better to use an antacid, like Turns, or an H2 blocker (which blocks the histamine receptor in the stomach), like famotidine (Pepcid), which has a fast onset of action.

I don’t want to forget to mention dietary control. It seems like you know what meals are likely to cause symptoms, and at the risk of sounding trite, you should avoid overdoing it.

Eat smaller meals, avoid latenight eating and stay away from food triggers, such as alcohol and caffeine — these all are ways of controlling symptoms without medication. All medicines have the potential for side effects, so minimizing them is wise. The list of potential complications from long-term use of PPIs is long.

Some people need to take omeprazole regularly, whether it’s because nothing else is effective or they have a condition like Barrett’s esophagus. Fortunately, most people do not.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.Cornell, edu or send mail to 628 Virginia Dr., Orlando, FL 32803.