What causes Heartburn?
Most people will experience heartburn when the lining of the esophagus comes in contact with gastric acidity.

How common is heartburn?
You are not alone. More than 15 million Americans experience heartburn daily and are considered severe refluxes.

Why doesn’t everybody suffer from heartburn?
To experience heartburn you need to have two conditions:

1. an incompetent lower esophageal sphincter (a one-way muscular valve located between the stomach and the esophagus - this valve relaxes at the time of swallowing),
2. excess gastric acidity.

What is the treatment for heartburn?
Lifestyle and dietary modifications are the first step. Over the counter antacid and H₂ blockers are the second step. If you continue to have symptoms or need to take frequent antacid see your doctor for evaluation and prescription strength medications.

What are Proton Pump Inhibitors?
See the section on prescription medications.

What is GERD?
All diseases related to Gastro-Esophageal Reflux (GER) are called GERD - GastroEsophageal Reflux Disease. One of the manifestations of GER is heartburn. However, the refluxed materials can damage the esophageal mucosa and cause ulcers or stricture, it can travel up higher and produce sore throat, laryngitis, hoarseness, chronic cough, or it can travel down the wind pipe specially when sleep at night and cause asthma, chronic lung disease and pneumonia.

When should I be alarmed about my heartburn and GERD?
First of all, if you get heartburn frequently or you think you may be suffering from other manifestations of GERD, you should see a Doctor and a Gastroenterologist if possible. Second, if you have difficulty swallowing, weight loss, easy fatigability due to low iron anemia, or if you wake up coughing and chocking in the middle of the night, you should see a Doctor immediately.

Can GERD lead to Cancer?
Yes. Cancer of the esophagus secondary to GERD is very rare but its incidence is on the rise. Amongst the risk factors for adenocarcinoma of the esophagus are long-standing severe heartburn, Barrett’s esophagus and obesity.

Can this cancer be prevented?
Yes. If you are suffering from heartburn you should take it seriously, particularly if you are a white male in you 40s or older. If you have any of the alarmed symptoms you should see a Gastroenterologist immediately. If you are known to have Barrett’s esophagus you should have regular surveillance for possible early cancer detection.

Is surgery an option in GERD?
Yes. If you have failed medical treatment or opt not to continue with medical treatment and watching your diet then you should consider surgery. The best surgery is what is called a laparoscopic Nissen’s fundoplication. It is successful in the hand of surgeons experienced with this surgery.

Does every patient suffering from GERD and heartburn require PPIs?
No. Majority of heartburn sufferers will benefit from life style modifications, Antacid use when necessary, and if longer relief is required use of over the counter H₂ blockers like Zantac 75, Pepcid complete or Tagamet HB.

Are all the PPIs the same in term of their effectiveness in heartburn relief?
No. In my experience of treating hundreds of patients with moderate to severe heartburn, most patients will do equally as well on 20 mg of Prilosec, vs 30 mg Prevacid, vs 40 mg of Nexium. Protonix 40 mg appears to be the least effective of all PPIs. Nexium is slightly more effective than Prilosec, however, not many patients will require stronger medications.

Does esophageal injury due to reflux heals on its own without treatment?
I have never seen grade 3 and grade 4 chronic erosive esophagitis heal without the use of PPIs or surgery to prevent acid reflux.

Which over-the-counter H₂ blocker do you recommend?
Cimetidine or Tagamet HB is the least expensive and Axid AR is the least effective of this group of medications.

Which PPI is the best?
In term of expense and effectiveness, in my experience Protonix (pantoprazole) is the least effective and least expensive of PPIs. The other PPIs are almost equally effective in their most recommended clinical dose (Lanzoprazole 30 mg, Omeprazole 20 mg, Esomeprazole 40 mg) with Esomeprazole having edge over the competitors partly due to higher dose and partly due to its metabolic pathway. For more information please see the following study (A Clinical Survey Comparing ---).