How Heartburn (Acid Reflux) Medication Works?

Medication to relieve heartburn is some of the most commonly prescribed and purchased drugs. Some are available over-the-counter (OTC) while others can only be obtained with a prescription from a medical doctor. Heartburn is just a symptom. These drugs target the root cause of heartburn, which is acid reflux. While heartburn medication can vary in the way they work, they offer relief within minutes and even be used to prevent heartburn for several hours. Through one way or the other, these drugs counteracting the effects of acidic stomach contents in the esophagus. Heartburn medication are not anti-inflammatory drugs or painkillers (analgesics) that just numbs the sensation.

Why does heartburn occur?

Heartburn is one of the most common upper gastrointestinal symptom that people suffer with. For some people it is nothing more than mild discomfort felt in the chest area that occurs every now and then. But for others it can be distressing. It can affect a person’s appetite, hamper their ability to continue with their daily activities and is now known to be one of the common causes of sleep-related problems. It is also one of the symptoms that a large number of people opt to treat and manage on their own without medical supervision, at least for a period of time.

Normally the acidic stomach contents cannot flow backwards up into the esophagus. It is prevented by the lower esophageal sphincter (LES) which lies at the junction between the stomach and esophagus. Sometimes the LES is not able to maintain its tonicity and stays open for longer than it should. This allows the acidic stomach contents to spill into the esophagus. The esophagus is unable to contend with the acid, unlike the stomach which has developed to handle it. The acid irritates the esophageal lining. This is known as acid reflux or more correctly as gastroesophageal reflux disease (GERD). Heartburn is one of the main symptoms.

Drugs To Relieve Heartburn

Understanding how heartburn medication works is important in order to use it properly. It is not just about finding relief from the burning chest pain after using the drug. Based on the mechanism of action of the drug in question, symptomatic relief may only be felt minutes or even hours later. For this reason, a combination of heartburn medication is sometimes used – for immediate symptomatic relief and longer lasting action against the root cause of the problem which is acid reflux. Although most heartburn medication is safe, using it incorrectly can lead to adverse effects particularly if this incorrect behavior is repeated on a daily basis.

These drugs work by:

  • Neutralizing stomach acid.
  • Forming a barrier between the acid and esophagus.
  • Reduce or even block acid production.
  • Speed up emptying of the stomach contents.
  • Tighten the lower esophageal sphincter.

Neutralize Stomach Acid

Most common heartburn are antacids. These drugs work by increasing the pH of stomach acid. In other words it makes stomach acid more alkaline than it currently is. Strong acids like stomach acid are not easily tolerated by most living tissue. The stomach has mechanisms that allows it to produce and usually withstand the corrosive effects of stomach acid. But the esophagus does not. By neutralizing the stomach acid, antacids are able to reduce the corrosive property of stomach acid thereby easing the irritation to the esophagus.

Antacids are usually alkalis. These drugs contain calcium, bicarbonate, aluminum, magnesium and sodium. Although most people think that antacids are safe, this is not always the case. In excess, it can cause a host of gastrointestinal symptoms like vomiting, abnormal bowel movements and abdominal pan. Since the ingredients of antacids can be absorbed into the bloodstream, it can also lead to a range of other effects. It can disrupt the blood electrolyte levels and lead to serious complications such as milk-alkali syndrome.

Forms An Acid Barrier

Many of the common heartburn medication that is thought to be antacids but actually do not neutralize gastric acid. Instead these substances form a barrier between the stomach acid and the wall of the esophagus. It is known as raft-forming agents and most are aliginate-based which contain sodium or potassium bicarbonate. When these substances make contact with stomach acid, it forms carbon dixoxide which rises to the surface of the stomach acid. A foam is formed on the surface which acts as the barrier.

Alginate-based raft-forming agents are not absorbed into the blood stream. Therefore it does not have any systemic effects although many are combined with antacids which can have various effects. These raft formulations are therefore safe and very effective as it stays within the stomach for long periods of time therefore offering prolonged relief from acid reflux. However, it does not address the cause of the problem which is acid spilling into the esophagus.

Lowers Acid Production

Acid-suppressing drugs have become more popular in recent years. It offers longer lasting relief than antacids by targeting acid production rather than just neutralizing it. The parietal cells in the stomach wall produce stomach acid by combing hydrogen and chloride ions to yield hydrochloric acid. The acid suppressing drugs, namely proton pump inhibitors and H2-receptor blockers, work by disrupting acid production and its subsequent secretion into the stomach cavity.

H2-receptor blockers reduce stomach acid production but does not stop it entirely. Proton pump inhibitors blocks the acid production. These drugs are useful for acid reflux and to relieve or prevent heartburn. It is also useful for the treatment of peptic ulcer disease. Both drugs are available in over-the-counter (OTC) and prescription forms, the latter usually being a stronger formulation. These drugs are largely safe to use but overuse can lead to digestive problems as the action of stomach acid is impaired.

Speed Up Stomach Emptying

Another type of drug that is less frequently used for acid reflux is prokinetic agents. These drugs work in two ways. It strengthens the contraction of the lower esophageal sphincter (LES) thereby ensuring that stomach acid is blocked from flowing backwards in to the esophagus. It also speeds up emptying of the stomach contents into the duodenum (first part of the small intestine). In this way it minimizes the spillage of the acidic stomach contents into the esophagus.

Prokinetic drugs are not commonly prescribed for gastroesophageal reflux disease (GERD) largely due to the side effects associated with its use. It is reserved for severe acid reflux where other medication has not yielded satisfactory results. Some of the side effects that may occur when using prokinetic drugs include fatigue, psychological disturbances such as anxiety and depression, as well as neurological conditions. Given the nature of these side effects, prokinetic drugs are not often favored for the treatment of acid reflux.

Non-Drug Remedies

Apart from these drugs there are a number of home remedies that people use to ease acid reflux. Milk is one of the most popular since it is an edible alkali that is easily accessible in the home. However, it does not offer relief for as long as commercial antacids. Another popular remedy is baking soda since it contains sodium bicarbonate. Even though baking soda is a widely used food item, overuse can cause complications and it should not be used as a means to replace OTC or prescription drugs for acid reflux.

Instead simple measures can help to relieve acid reflux and heartburn. This includes:

These measures should be incorporated in daily management of acid reflux even if heartburn medication is being used. Failure for these drugs, diet and lifestyle changes to yield results may mean that surgery is necessary.

References:

www.ncbi.nlm.nih.gov/pubmed/10848650