WHEN IS IT TIME TO REVIEW MY MEDICINE FOR HEARTBURN?
About one in five of us have heartburn from gastro-oesophageal reflux at one time or another. A short course of a medicine such as a proton pump inhibitor (PPI) can be very effective for relieving these symptoms. If you have been taking a proton pump inhibitor for longer than eight weeks for heartburn, ask your GP whether you still need it. They might suggest that you take a lower dose or take a dose only if you have symptoms.
This brochure highlights the symptoms of gastro-oesophageal reflux, what you need to know about taking a proton pump inhibitor medicine, and the dietary and lifestyle changes that might help you to best manage any ongoing symptoms.
What is reflux and why does it cause heartburn?
We all need acid to help us digest our food. In people with gastro-oesophageal reflux, acid from the stomach leaks up into the oesophagus (the tube that carries food from your mouth to your stomach) and causes discomfort (see diagram). This feeling of discomfort is called heartburn and is the most common symptom of reflux.
In gastro-oesophageal reflux disease (GORD) these symptoms occur more than twice a week and affect your day-to-day life. If this occurs, talk to your GP.
If you are having difficulty or pain when swallowing, talk with your GP so that they can check that your symptoms are caused by reflux.
What do I need to know about taking a proton pump inhibitor?
Proton pump inhibitors are medicines that reduce the amount of acid produced in the stomach. They are used to treat gastro-oesophageal reflux disease but can also be used to treat other conditions. These include stomach ulcers, prevention of ulcers that might be caused by certain medicines, Barrett’s oesophagus or severe inflammation of the oesophagus.
There are five proton pump inhibitor medicines, which are listed below with examples of some brand names. If you are not sure whether any of your medicines is a proton pump inhibitor, ask your GP or pharmacist.
Examples of brand names for this medicine
Nexium, Esomeprazole Apotex, Esomeprazole RBX, Noxicid Caps
Zoton, APO-Lansoprazole ODT, Zopral ODT, Lanzopran
Losec, Acimax Tablets, APO-Omeprazole, Ozmep
Somac, Salpraz, APO-Pantoprazole, Sozol
Pariet, APO-Rabeprazole, Rabeprazole Sandoz, Zabep
What do I need to know when taking a proton pump inhibitor for gastro-oesophageal reflux:
Most people don’t need to take a proton pump inhibitor medicine long-term.
If you have symptoms mostly during the day, take the proton pump inhibitor in the morning. If you have symptoms mostly at night, take it before going to bed.
Like all medicines, proton pump inhibitors have side effects. Talk to your GP or pharmacist if you are concerned about any side effects. Some side effects might be more likely when these medicines are used over a long time.
At your next appointment, ask your GP if your proton pump inhibitor is still needed.
- For heartburn, proton pump inhibitors are initially prescribed for four to eight weeks.
- If your symptoms are well controlled after this time, talk to your GP about gradually reducing the dose or taking a tablet only on the days you have symptoms. Most people find that they can stop taking their proton pump inhibitor without symptoms returning.
- If your heartburn returns after you stop the medicine, talk to your GP about it. These symptoms might last only for a short time.
Some people with gastro-oesophageal reflux have recurring symptoms that require the use of a medicine (such as an antacid, acid blocker, or proton pump inhibitor) from time to time.
- These medicines can be prescribed by your GP or bought from a pharmacy.
- Talk to your GP or pharmacist if you take a medicine for heartburn more than twice a week for more than two weeks or if your symptoms worsen.
Some other medicines can make heartburn worse including those bought from a pharmacy, supermarket or health food store. Ask your GP to review your medicines to see if any of them could be making your symptoms worse. They might suggest you have a Home Medicines Review. In this free service, a specially trained pharmacist comes to your home and reviews your medicines. Together with your GP and pharmacist, you can work out how to best manage your medicines and which ones might need a change.
Always talk to your GP before stopping, starting or changing any of your medicines. Some medicines such as a proton pump inhibitor need to be stopped gradually, guided by your GP.
When should I ask my GP if I still need to take a proton pump inhibitor?
If you have been taking the medicine for more than eight weeks
When your symptoms have improved
With each prescription
If your proton pump inhibitor was first started in hospital
What else can I do to help reduce heartburn?
The symptoms of heartburn might vary depending on the type of foods you eat, levels of stress in your life, whether you smoke, and if you are overweight. Take note of the things that seem to make your heartburn worse and see if changing any of these helps to reduce the symptoms.
Try these practical tips to see if they help you:
Avoid foods or drinks that might make your symptoms worse. Fatty foods, fried or spicy foods, coffee, alcohol and chocolate might make your heartburn worse.
Avoid having your largest meal of the day in the evening.
Eat small meals, rather than three large meals a day.
Try to avoid lying down or going to bed straight after eating.
Try to make meal times less stressful by eating slowly, taking time to chew food properly and generally making it a relaxing time.
Aim to walk every day; this helps with digestion and weight loss.
Wear loose fitting clothes that are not tight around your stomach.
If you have symptoms at night, ask your GP about special aids and appliances that can raise the head of your bed e.g. an adjustable bed rest (see diagram below). DVA Gold and White Card holders may be eligible to receive these.
Reduce your weight if you are overweight. Research shows this is one of the best ways to avoid or reduce reflux. Even losing a few kilograms can help. Talk to your GP about services that can help to support you. DVA Gold and White Card holders may be eligible for services provided by a dietician, exercise physiologist or physiotherapist and require a referral from their GP.
Stop smoking. Smoke can irritate your digestive system and make symptoms worse. Talk to your doctor and pharmacist about the options for quitting. For support to quit and a personalised quitting plan contact the national smoking Quitline on 13 7848 or at: www.quitnow.gov.au
What about gut health?
There is a lot that is not yet known about gut health. Some of the things that we do know that help us to have a healthy gut and weight include:
- having a wide variety of fresh fruit and vegetables
- plenty of fibre in our diets
- getting outside for some exercise each day.