What to do about heartburn

What can you do for heartburn?

A causal therapy of the Reflux (Heartburn) except for anatomical changes (Hiatal hernia) mostly Not possible. The conservative, drug therapy of heartburn usually has to be continued for years, since only the symptoms and not the cause of the disease itself is treated.

Behavior and nutrition

Conservative heartburn therapy is symptom-related long-term therapy that also includes dietary and behavioral measures.

In many cases, dietary measures and the observance of certain behavioral measures are completely sufficient for a successful therapy. This includes all factors that prevent increased gastric acid excretion, such as avoiding sweets, high-fat foods, alcohol and cigarettes. Weight reduction (reduction of obesity) is also desirable. It is also recommended to eat several small, protein-rich meals throughout the day, in contrast to the classic and extensive morning, lunch and evening meals.

In order to keep the pressure on the lower esophageal sphincter low, no large amounts of food should be consumed before going to bed. This is especially important before going to bed, because the lying position per se increases the pressure on the lower esophageal sphincter. A sleeping position with a slightly (20-30%) raised head and upper body also contributes to this. The stomach position as a sleeping position should be avoided.

For more information that can help you make changes to your diet, see: Diet for heartburn

Medication

In the case of mild reflux disease (heartburn), so-called acid-neutralizing drugs (antacids) are used (e.g. Talcid ®, Riopan ®, Maaloxan ®). These are chewable tablets or gel bags (suspensions) that are taken when symptoms occur. A preventive use of this type of medication does not make sense because neither acid production nor reflux are prevented.

In mild cases one Reflux esophagitis there are drugs that promote gastric and intestinal movement (Prokinetics) are used (e.g. domperidone (Motilium®)). These cause food to pass faster through the stomach and into the intestines.

If there is already inflammation of the mucous membranes, so-called H2-receptor blockers are used (e.g. ranitidine (Sostril®), cimetidine (Tagamed®)). H2-receptor blockers are drugs that block the H2-receptors of the acid-producing stomach cells (parietal cells) and thereby reduce the production of stomach acid.

Proton pump inhibitors such as Omep® are prescribed for severe forms of heartburn. Their effectiveness does not decrease significantly even after prolonged administration. This is a decisive advantage compared to the H2-receptor blockers. In addition, these drugs are mostly well tolerated in long-term therapy.

Read more about this under: Heartburn medication

Proton pump inhibitor (PPI)

Proton pump inhibitors are the gold standard for the drug therapy of gastroesophageal reflux disease. The proton pump blockers inhibit certain enzymes in the stomach cells and thus prevent the secretion of gastric acid. Since the blockage of these enzymes is irreversible, the necessary enzymes must first be produced in order to resume gastric acid production. This usually takes 2-3 days (Please also read: Effect of proton pump inhibitors)

Possible side effects mostly affect the digestive tract and are mostly harmless. These are expressed, for example, by gas, diarrhea, stomach pain, nausea or a feeling of fullness. Ingestion can also cause dizziness and headaches. A deficiency in the electrolyte magnesium is discussed as a possible side effect of long-term administration over several months.

Read more on this topic: Side effects of proton pump inhibitors and proton pump inhibitors in comparison

Proton pump inhibitors are also used in the treatment of gastric ulcers, ulcers in the small intestine, and inflammation of the gastric mucosa. In addition, the acid blockers are prescribed to protect the stomach with long-term use of certain pain relievers.

Home remedies for heartburn

There are numerous home remedies available to help relieve heartburn. Avoiding gastric acid-stimulating stimulants such as coffee, alcohol and cigarettes is beneficial. Aside from these preventive methods, drinking lukewarm, still water or low-acid tea (e.g. chamomile or fennel) can alleviate the symptoms. Slowly chewed almonds, rice cakes or oatmeal help to soak up stomach acid and thus support digestion. Eating alkaline foods can also help, and the ingestion of healing earth can naturally bring about lasting improvement.

Heartburn prevention is considered the best home remedy. It is recommended to only take small portions with meals, to eat a diet rich in protein, to cook low-fat and not to eat too late before going to bed. The reduction of obesity and the avoidance of tight clothing can also reduce the pressure on the stomach and thus possible symptoms caused by heartburn. Since the symptoms often occur during sleep, because the stomach and esophagus are at the same level when lying down and stomach acid can flow back particularly easily, positioning with an elevated upper body can only have a positive effect on the symptoms at night.

homeopathy

Homeopathy also offers an alternative approach to treating heartburn. We always try to see and treat people as a whole with their individual living conditions, accompanying illnesses and moods. This is also the reason why there is no general recommendation for taking globules for heartburn. Depending on the individual circumstances of the patient, the preparations Nux Vomica 6X, Robinia pseudoacacia, Arsenicum album and sodium phosphoricum in the form of globules are used particularly often.

Read more on this topic: Homeopathy for heartburn

Schuessler salts

There is the alternative approach, the occurrence of heartburn with the help of the biochemical teaching according to Dr. Treat Schuessler. This is based on the idea that diseases arise from disorders in the mineral balance. For heartburn with acid regurgitation, the intake of Schüssler salt No. 9, also known as sodium phosphoricum D6, and for excess stomach acid, Schüssler salt No. 23 (sodium bicarbonicum D6) is recommended. Although the effect of Schüssler salts has not yet been scientifically proven, the use of Schüssler salts can alleviate the symptoms.

Read more on this topic: Schuessler salts

Operative therapy

A surgical approach is indicated for very severe and therapy-resistant courses of reflux esophagitis. Complications of reflux disease can also make a surgical procedure necessary.
A diaphragmatic hernia can be treated in different ways. The aim is to move the hernia back into the abdominal cavity.
Most operations can be performed using a laparoscopy.

• Hiatal plasty: First, the part of the stomach that has moved into the chest is moved back into the abdomen. Then the pathologically widened diaphragmatic gap (hiatus esophageus) is narrowed. In this way, the lower esophageal sphincter is reconstructed again.
• Fundopexy: In this surgical procedure, the part of the stomach that has protruded into the chest is first shifted back and then sewn from below to the diaphragm. This prevents the stomach from slipping back into the chest. The surgical procedure of fundopexy is often combined with the surgical procedure of hiatal plastic.
• Fundoplication: In fundoplication, the upper part of the stomach is placed around the lower part of the esophagus and sewn in place. This creates a kind of new esophageal sphincter which prevents reflux (backflow of stomach acid).

Hoarseness therapy

Since the reflux of gastric acid is the cause of the symptoms, this is also what the therapeutic approach is based on. With the help of so-called proton pump inhibitors, gastric acid production is suppressed. The stomach acid can then continue to flow back into the esophagus and possibly back to the cabbage, but it loses its aggressive and irritating character, which leads to inflammation there and causes hoarseness. An improvement in the hoarseness can also be brought about by protecting the voice. Since smoking is an important risk factor for inflammation of the vocal cords, it is also recommended to stop smoking. In rare cases, cortisone is also used for vocal cord inflammation.

Heartburn during pregnancy

About half of all pregnant women develop symptoms of reflux disease during pregnancy due to the increased pressure in the abdominal cavity. Heartburn, which is perceived as extremely uncomfortable and annoying, is harmless for mother and child. If the symptoms are unclear or too severe, a doctor should still be consulted immediately. There are numerous home remedies that can provide relief from the discomfort. Medicines should always be prescribed by a doctor for pregnant women and should not be taken on their own responsibility, as this can endanger the health of mother and child.

The reason for heartburn in pregnant women is, on the one hand, the increased intra-abdominal pressure, which can lead to gastric juice rising into the esophagus and irritating the mucous membranes there. Another reason for the symptoms is the hormonal change. The hormone progesterone produced by the placenta causes the sphincter muscle between the esophagus and stomach to close more poorly. This promotes the backflow of stomach acid during the digestive process. This reflux then manifests itself as increased acidic belching, burning behind the sternum, feeling of fullness and pressure on the stomach. Symptoms can get worse when lying down.

Read more on this topic: Heartburn in pregnancy