ANNOUNCER: An estimated 60 million Americans experience heartburn. That means many trips to the drugstore and supermarket for over-the-counter medicines.
STUART SPECHLER, MD: I think most people do self-medicate. It's very hard to know exactly how many people are self-medicating, but certainly the surveys on this issue do suggest that most people with heartburn are self-medicating.
ANNOUNCER: With scores of heartburn products available, how is a person to know which ones will bring him or her the best relief?
One test is very simple.
HASHEM B. EL-SERAG, MD, MPH: If your symptoms are provoked by meals, by eating, and you take the pill with the meal or just before the meal and then the symptoms that predictably happen don't happen anymore, or they happen to a very reduced severity, then you know that they're working.
ANNOUNCER: "Working" when it comes to heartburn relief has several measures. One is "onset" and the quickest relievers are usually antacids.
STEVEN PEIKIN, MD: The benefit of an antacid is that it works immediately. You don't have to wait for it to be absorbed by the body. It works quickly.
ANNOUNCER: Another measure of relief is "how long." Drugs called H2 blockers and Proton Pump Inhibitors generally provide longer relief by curbing the production of acid.
STUART SPECHLER, MD: Since they're interfering with the stomach's ability to make acid in the first place, you can get much more prolonged relief from those agents, and it's one simple pill. You take a pill and you get hours of relief rather than having to take the antacid very frequently.
STEVEN PEIKIN, MD: They last longer than antacids, but they don't work as quickly. It takes about 20 to 40 minutes, maybe even up to an hour for them to work because they have to be absorbed by the small intestine, get into the blood stream, in order to work.
ANNOUNCER: People experience heartburn when acid from the stomach backs up into the esophagus, where it doesn't belong. Doctors call that condition Gastro esophageal Reflux Disease or GERD.
Millions of Americans find over-the-counter remedies provide effective relief.
But when researchers try to demonstrate effectiveness scientifically, they run into a problem.
HASHEM B. EL-SERAG, MD, MPH: Heartburn is a subjective symptom. There is no blood test that would determine if your heartburn is going better or worse. There is no endoscopic test that will determine if our treatment is doing better or not. And there is no X-ray that will detect these things.
ANNOUNCER: Instead, when researchers conduct clinical trials to determine the effectiveness of heartburn medication, they focus on what can easily be reported by the patient.
HASHEM B. EL-SERAG, MD, MPH: The outcome measures are geared towards: how can we measure and quantify and qualify the symptom of heartburn itself? This is problematic, but this has progressed a long way throughout the past 20 years from just asking them, "Do you feel well or not," to questionnaires that have certain grades to it. So those are the so-called validated questionnaires that measure the symptoms of heartburn.
ANNOUNCER: Armed with these tools, researchers in the 1990s started conducting well-designed, scientific studies of over-the-counter heartburn medications.
In an effort to develop treatment recommendations, the American Gastroenterological Association recently convened a panel of experts, to review those studies.
One of those studies, which is un-published, divided 16-hundred heartburn sufferers into four groups.
One group tried antacids. One tried H2 blockers. A third group tried a tablet that combined an H2 blocker with an antacid. The fourth group was given an inactive substance, a placebo.
HASHEM B. EL-SERAG, MD, MPH: The key results were that the tablet that contains the combination of an antacid with an H-2 blocker has combined the advantages of an antacid with the advantages of an H-2 blocker, and therefore almost predictably it performed better than an antacid alone, and better than an H-2 blocker alone, and definitely better than placebos.
ANNOUNCER: Based on this research and other studies, the panel of experts convened by the American Gastroenterological Association concluded that over-the-counter medications can be safe and effective for treating episodic heartburn for periods not exceeding four weeks.
HASHEM B. EL-SERAG, MD, MPH: Our consensus regarding the use of OTC in the treatment of heartburn were that OTC are effective or have been shown to be effective in the prevention of heartburn and acid regurgitation symptoms. They have also been effective in reducing the severity of heartburn symptoms. And they have been effective in relieving meal-induced heartburn symptoms.
ANNOUNCER: Most doctors agree, as long as there are no warning signs of a more serious condition.
STEVEN PEIKIN, MD: I think it is fine to self-medicate and take some of the products that are widely available in the supermarkets and the drugstores, for most people that's fine. I think though that if you find that these medications aren't totally alleviating your symptoms or that you have to take them every day, all the time. If you have any symptoms of trouble swallowing or burning when the food goes down, then these are situations where you really should see a doctor.
ANNOUNCER: But for most sufferers of heartburn, that's not necessary. Instead, research and clinical experience show an over-the-counter product may be all that's needed for safe and effective relief.
©2007 Healthology, Inc.