Medications for heartburn

Most people with a hiatal hernia don’t experience any signs or symptoms and won’t need treatment. If you experience signs and symptoms, such as recurrent heartburn and acid reflux, you may require treatment, which can include medications or surgery.

If you experience heartburn and acid reflux, your doctor may recommend medications, such as:

• Antacids that neutralize stomach acid. Over-the-counter antacids, such as Gelusil, Maalox, Mylanta, Rolaids and Tums, may provide quick relief.
• Medications to reduce acid production. Called H-2-receptor blockers, these medications include cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR) and ranitidine (Zantac 75). Stronger versions of these medications are available in prescription form.
• Medications that block acid production and heal the esophagus. Proton pump inhibitors block acid production and allow time for damaged esophageal tissue to heal.Over-the-counter proton pump inhibitors include lansoprazole (Prevacid 24HR) and omeprazole (Prilosec OTC). Stronger versions of these medications are available in prescription form.

There are no medications to treat a hernia directly.  Symptoms from hiatal hernias are caused by a structural defect that is not corrected by medications.  The prescription and over the counter remedies are used to decrease the acid content in the gastric fluid and to decrease the severity of symptoms.

Medications

Your physician may recommend over-the-counter antacids or medications that stop acid production. You can buy many of these medications without a prescription; however, see your physician before starting or adding a medication.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects

Magnesium salt can lead to diarrhea, and alumi­num salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, can be a supplemental source of calcium. They can cause constipation.

Foaming agents, such as Gaviscon, work by cover­ing your stomach contents with foam to reduce symptoms.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.

Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex) and esomeprazole (Nexium), which are available by prescription. Many of these are now available in over-the-counter strength that doesn’t require a prescription. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD by providing a less acidic environment that promotes healing but they do not stop the reflux from occurring.

Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics can have side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety and problems with physical movement in some patients

Because drugs for GERD work in different ways, combina­tions of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your physician is the best source of information about how to use medications for GERD.

It is important to note that medications do not “cure” reflux like antibiotics “cure” infections. Medical management of GERD is designed to con­trol the symptoms and lessen the damage caused by stomach fluid splashing into the esophagus and airway. Medications and lifestyle adjustments do not repair the mechanical defects that allow reflux to occur. Most patients experience a rapid return of their previous symptoms when medications are discontinued.