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AGA , Hashem B. El-Serag MD, MPH, Steven R. Peikin M.D., Stuart Spechler MD
Choosing heartburn medicines is easier if you know how they work against acid. In this program, experts explain the difference among common treatments.
ANNOUNCER: There are scores of available heartburn medicines, including many that can be purchased without a prescription. Understanding how they work can help sufferers determine which ones may bring them the best relief.
ANNOUNCER: Antacids provide the most direct assault on acid that backs up -- or refluxes -- causing the burning sensation known as heartburn.
HASHEM EL-SERAG, MD: An antacid typically works very quickly. It works within the first 30 minutes... It just works exactly like putting out a fire. So you take it, it neutralizes the acid, therefore it works within minutes.
STEVE PEIKIN, MD: The benefit of an antacid is that it works immediately. You don't have to wait for it the drug to be absorbed by the body. It works quickly. The bad news is that it doesn't last that long.
ANNOUNCER: But often the quick response, even if short-lived, is all that's necessary for heartburn relief. Especially if symptoms seem to come and go with meals. If an antacid doesn't bring long-enough relief, another approach is to curb the production of the acid.
HASHEM EL-SERAG, MD: The stomach is the source of acid production. In the stomach, there are specialized cells called the parietal cells that produce the gastric acid. The acid in these cells is produced in response to certain stimuli, certain things that tell the cell, "Please produce acid."
STEVE PEIKIN, MD: It turns out that there's actually three different ways to make acid. Histamine is a chemical in the body, stimulates acid secretion very potently. There's two other ways of stimulating acid -- one is gastrin, hormone in the body that stimulates acid secretion, and there is a chemical from nerves called acetylcholine and that also stimulates acid secretion. So there is three different ways.
ANNOUNCER: Block the right receptor on the parietal cells and you reduce that acid production.
STUART SPECHLER, MD: The histamine H2 receptor blockers work by blocking the receptors that are actually telling the stomach "make acid." It actually blocks the histamine receptor, and therefore it interferes with its ability to make acid.
ANNOUNCER: But it takes time for an H2 blocker to bring relief.
HASHEM EL-SERAG, MD: First it has to get absorbed into the stomach. It goes into the blood circulation and then from the blood it gets back to the stomach cells, gets absorbed into those cells and then blocks the histamine receptors or the H-2 receptors, and then the action starts. That typically takes 30 minutes to 1 hour to start working. Once it starts working, its effect lasts for a few hours; anywhere from three to six hours.
ANNOUNCER: But often delayed action will not be a problem if you can anticipate trouble.
STUART SPECHLER, MD: I think one of the best ways to use the H2 blockers, if you're going to a situation where you know you're going to get heartburn unless you do something about it, that's a really good way to use the H2 blockers. So if you know that you're going to eat a pizza tonight and you know that it always gives you heartburn, take that H2 blocker half an hour or an hour before you go to the restaurant, and you may well get relief that way.
ANNOUNCER: There's also a combination technique in treating simple heartburn.
STUART SPECHLER, MD: The combination, using antacids along with H2 blockers, is something that had been done for many years.
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