Medicines

Antacids
For people who only suffer from the occasional episode of heartburn, over-the-counter antacids can bring relief. Antacids provide relief from the symptoms of heartburn by neutralising the stomach acid. If symptoms of heartburn are still present after you have used antacids for two weeks, you should consult your doctor. There is a wide range of antacids available. The main ingredients of antacids are:

• Aluminium hydroxide
  
  
• Magnesium
  
  
• Calcium carbonate
  
  
• Sodium bicarbonate
  
  
• Potassium
  
  
• Bismuth salts

Antacids sold over-the-counter may contain one or a combination of these products. For example, aluminium and magnesium salts are often combined to reduce the incidence of diarrhoea or constipation.

Antacids are best taken when the symptoms of heartburn first occur, preferably about one hour after a meal.

Antacids may interfere with the absorption of other medicines from the digestive system into the blood. A gap of at least two hours should be left between using an antacid and taking other medicines. If you have any concerns, please talk to your doctor or pharmacist.

Alginates
Some antacids contain sodium alginate.

• Sodium alginate forms a ‘raft’ which floats to the top of the stomach, forming a barrier between the acid and the oesophagus, thus preventing acid refluxing into the oesophagus.
  
  
• Antacids which contain alginates are particularly useful for heartburn caused by pressure on the stomach, eg during pregnancy.
  
  
• These medicines can be bought over-the-counter.

If antacids do not improve your symptoms, your doctor may prescribe one of the following medicines:

Proton pump inhibitors
Proton pump inhibitors are a group of medicines which include omeprazole, esomeprazole and pantoprazole.

• These medicines are very effective in the treatment of heartburn.
  
  
• These medicines block the action of the stomach’s proton pump, which pumps hydrogen ions into the stomach, making the stomach acidic. Proton pump inhibitors therefore reduce the acidity of the stomach.
  
  
• They also reduce the leakage of acid into the oesophagus which reduces the incidence of heartburn.
  
  
• They need usually only be taken once a day.
  
  
• Proton pump inhibitors are available from your doctor on prescription, and in some countries, can be bought over-the-counter.

Histamine2-receptor antagonists
Histamine2-receptor antagonists are a group of medicines which include cimetidine, ranitidine and nizatidine.

• These medicines work by stopping (blocking) the action of histamine (a chemical released by the stomach). The presence of histamine in the stomach, results in the release of hydrogen ions into the stomach, making the stomach acidic.
  
  
• Many histamine2-receptor antagonists can be bought over-the-counter at low doses but a doctor’s prescription is needed for higher doses.

Prokinetic drugs
Prokinetic drugs are a group of medicines which includes metoclopramide, domperidone and bethanechol. They act by strengthening the LES so there is less acid reflux, and by reducing the time that food stays in the stomach.