There has been a long and often painful journey for me and my family with a health condition that was sometimes passed off as being the result of bad habits or bad behavior. As far back as I can remember, my father was battling to find a way to treat what many doctors brushed off as simply heartburn, which they, either directly or implicitly, said was probably caused by his own behavior. Yes, he smoked, and yes, he probably enjoyed red meat and fried foods too much. But these weren’t the direct causes of the chronic acid reflux he suffered from (what is now more commonly called gastroesophageal reflux disease – GERD). It was later discovered that there are far more complex reasons why some people can live their whole lives eating all the “wrong” foods and drinking “too much” alcohol and still never feel even a hint of a bad reaction. Others, like my father, couldn’t escape the corrosive effects of stomach acids no matter what they ate or drank, or indeed no matter what the doctors did to treat them.
In the end, progress in medicine came to the rescue for my family with the discovery of the condition known as Zollinger-Ellison Syndrome (ZES), which was in fact, the root cause of all of his problems. I also benefited from this development since there’s a high degree of inheritability in ZES, so I (and my children) have been pre-warned and have adjusted our lifestyles (and kept our medicine cabinets appropriately stocked) so that the chances of us developing full-blown ZES are reduced to manageable levels.
While ZES is a fairly rare condition, it shares most of its symptoms with gastroesophageal reflux disease (GERD). GERD is actually a common condition affecting a growing proportion of the general population. Statistics show that up to 28 percent of the adult population of the US has sought help from their doctors for their symptoms, mainly of heartburn/reflux. In some of these cases, what they were experiencing was slightly different from true GERD, so it’s helpful to outline what distinguishes heartburn, acid reflux, and GERD.
What is Heartburn?
Heartburn is characterized by a burning sensation in the chest, typically behind the breastbone at the bottom of the esophagus, the tube that connects the throat to the stomach. The esophagus’s normal function is to channel food down after chewing into the stomach, and it has a muscle sphincter at the gastroesophageal junction to prevent a flow back of stomach contents. When there is a backward flow, the highly acidic contents may irritate the lining of the esophagus, creating a burning sensation.
Heartburn may be experienced after eating a large meal, especially one with fatty or spicy foods, or when lying down too soon after eating. While it can be uncomfortable, it can often be relieved with over-the-counter antacid medications and doesn’t necessarily indicate a chronic problem. It may not require medical intervention unless it occurs frequently.
What is the Difference Between Heartburn and Acid Reflux?
Acid reflux (sometimes known simply as reflux) refers to the process of stomach acid flowing up through the gastroesophageal junction into the esophagus, which is what causes heartburn. While heartburn is a symptom, acid reflux is the actual physiological cause. Acid reflux can result from a variety of triggers, including:
- Spicy foods, alcohol, coffee, and high-fat meals.
- Smoking, obesity, and lying down too soon after eating.
- Anatomical issues such as hiatal hernias can cause acid reflux by squeezing the gastroesophageal junction, which can prevent the muscles that normally close the esophagus from contracting correctly.
While acid reflux is often experienced in mild, occasional instances, it can become chronic, in which case it may progress to GERD.
What Is GERD?
Gastroesophageal reflux disease (GERD) is a chronic, more severe symptom of acid reflux. GERD occurs when acid reflux happens frequently or persistently over time, causing continuous irritation to the esophagus. GERD is often diagnosed when reflux symptoms are felt more than twice a week, or they interfere significantly with daily life. This chronic irritation can lead to more serious complications, such as:
- Esophagitis, which is inflammation of the esophagus due to repeated exposure to stomach acid.
- Barrett’s esophagus, a condition where the esophagus’s lining changes increase the risk of esophageal cancer.
- Narrowing of the esophagus due to scar tissue (strictures) from continuous acid exposure making swallowing difficult.
GERD is typically diagnosed through a combination of symptom analysis and medical tests, which can include endoscopy, pH monitoring, and esophageal manometry. Treatments may include lifestyle changes, medications, and, in severe cases, surgical interventions.
What is Zollinger-Ellison Syndrome?
Zollinger-Ellison syndrome (ZES) is a rare (two per million) condition in which tumors called gastrinomas grow inside the pancreas or in the upper part of the small intestine. The tumors produce large amounts of the hormone gastrin, which in turn causes the stomach to make way too much acid. This leads to the main symptoms, which are persistent stomach pain, diarrhea, acid reflux and heartburn, constant burping, and nausea and vomiting. If it progresses untreated, it can lead to bleeding from the digestive tract, losing weight, and loss of appetite. Treatments can include PPI antacids such as Nexium, but if it persists, it may require surgery to remove the gastrinomas.
What are the Shared Features of Heartburn, Reflux, ZES and GERD?
While heartburn, acid reflux, ZES and GERD each refer to different aspects of acid-related digestive issues, they are interlinked in several ways:
- Heartburn is the main symptom of acid reflux and GERD. Some of the other common symptoms include a sour taste in the mouth, regurgitation of food or acid, and difficulty swallowing.
- High-fat foods, caffeine, alcohol, and lifestyle factors like obesity and smoking can trigger both reflux and GERD, and make the symptoms of ZES worsen.
- There are shared treatments, such as over-the-counter antacids and prescribed acid reducers, including H2 blockers and proton pump inhibitors (PPIs). Diet and lifestyle changes are also widely recommended for anyone dealing with all of the conditions.
- Stomach acid is the common factor in all of the conditions. The common term for this is gastric hyperacidity. In each case, the backflow of stomach acid into the esophagus leads to discomfort, whether it manifests as occasional heartburn, acid reflux episodes, or more severe GERD.
What are the key differences between Heartburn, Acid Reflux, ZES, and GERD?
Despite their similarities, there are distinct differences between heartburn, acid reflux, ZES and GERD:
Severity and Frequency:
- Heartburn is a symptom of acid reflux. It often occurs without warning and is linked to a particular meal or situation. It can be treated as an isolated symptom.
- Acid reflux is broader, as it describes the backflow of acid that only sometimes causes heartburn. It may occur frequently, but it isn’t necessarily chronic.
- GERD is a chronic condition characterized by frequent occurrences of acid reflux, often with more severe symptoms. It can also have long-term consequences, so it requires ongoing management and, sometimes, medical intervention.
- Zollinger-Ellison is not directly related to any weakness in the flow control at the gastroesophageal junction. Instead, it is the result of excess acid secretion, which raises the levels of corrosive liquids in the stomach. When the acids eat through the lining of the stomach and small intestines, they cause symptoms similar to heartburn and can produce perforative ulcers, which can be life-threatening.
Diagnosis:
- Self-diagnosing heartburn as a minor irritant and ignoring the possible underlying causes without professional advice can lead to a missed diagnosis of conditions like GERD and ZES. Anyone who experiences frequent heartburn should consult a healthcare professional. Acid reflux needs to be monitored if the symptoms are persistent, but it can slip under the radar because laypeople consider it to be a common occurrence.
- GERD and ZES require a formal diagnosis, usually involving tests to assess the esophagus and measure acid levels. This helps differentiate them from other conditions with similar symptoms, such as peptic ulcers or esophageal motility disorders.
Long-term Health Risks:
- Heartburn and acid reflux are generally not harmful in the long term as long as they are appropriately managed and occur only rarely.
- However, both ZES and GERD can lead to significant complications. Prolonged acid exposure increases the risk of esophageal inflammation, scarring, and can cause potentially cancerous changes in the esophageal lining.
What are the treatment and management options for hyperacidity?
There is wide overlap in the ways to manage heartburn, acid reflux, ZES, and GERD. All three require a combination of lifestyle adjustments, dietary changes, and medications. Here’s a breakdown of common approaches:
Lifestyle and Dietary Changes:
- Avoid triggers such as highly spiced, fatty, and acidic foods, as well as caffeine and alcohol. Keep a food diary to help identify your own specific triggers.
- Maintain a healthy weight, since excess weight places pressure on the abdomen, increasing the likelihood of reflux.
- Sit upright or walk around after eating, waiting at least two to three hours after consuming a large meal before reclining.
- Let gravity help, by elevating the head of the bed. It has been observed that raising the head of the bed may help reduce the onset of nighttime reflux for patients with GERD.
Medications:
- Antacids: Over-the-counter medications such as Tums, Alka-Seltzer, Pepto-Bismol and Rolaids can effectively neutralize stomach acid and provide fast-acting relief for heartburn. They are pure palliative treatments and do not get to the heart of the problem, or prevent recurrence.
- Histamine 2 receptor agonists (H2 blockers) such as Pepcid reduce acid production and can relieve current gastric symptoms. They can also be taken prophylactically 30 to 60 minutes before consuming known food or beverage triggers. They offer longer-lasting relief than antacids.
- Esomeprazole is a Proton Pump Inhibitor (PPI). Drugs such as Nexium and Prevacid are often prescribed for more severe symptoms and work by significantly reducing stomach acid production. They are commonly used in GERD and ZES treatments to prevent complications.
Surgical Interventions:
- For individuals with severe GERD who don’t respond to medication, surgical options like fundoplication may be considered. This procedure prevents acid reflux by strengthening the barrier between the stomach and esophagus.
FAQs
Is Nexium good for acid reflux?
Yes, Esomeprazole (brand name Nexium) is commonly prescribed for acid reflux and gastroesophageal reflux disease (GERD). It is a proton pump inhibitor (PPI) that decreases the amount of acid the stomach produces. PPIs can relieve symptoms of acid reflux, such as heartburn and chest pain. By reducing acid production, Nexium helps prevent erosive esophagitis and can support healing in the esophagus.
How long does it take for Nexium to work for acid reflux?
Nexium does not provide immediate relief of heartburn. It may take up to one to four days to feel the full effects, as delayed-release capsules like Nexium are designed to reduce stomach acid levels gradually. Some people may notice a decrease in symptoms within a few hours, but consistent relief typically builds over the first few days.
What are the downsides of Nexium?
While Nexium is effective for acid reflux, it does have potential downsides. Long-term use may lead to a risk of fundic gland polyps in the stomach, gastric ulcers, skin rash, joint pain, and even nutrient deficiencies, such as low magnesium and vitamin B12 levels. Some people may also experience side effects like stomach pain or bloating, particularly with prolonged use.
Is it okay to take Nexium every day?
Yes, Nexium is often prescribed as a daily delayed-release medication for chronic GERD or other acid-related issues. However, it is important to take Nexium under a doctor’s supervision, as daily, long-term use should be monitored for side effects like fundic gland polyps or gastric ulcers.
Why can’t you take Nexium for more than 14 days?
The recommendation of restricting use to not more than 14 days comes from lower-dose Nexium versions. Those are only available in some countries for over-the-counter use, and are is intended for temporary relief. Longer use is associated with side effects, such as nutrient deficiencies, and may mask more serious health conditions like Helicobacter pylori infection or Zollinger-Ellison syndrome. For long-term use, it’s best to consult a healthcare provider.
What happens if you stay on Nexium too long?
Extended use of Nexium can lead to issues such as fundic gland polyps, reduced calcium absorption (increasing fracture risk), and potential gastric ulcers or erosive esophagitis. Long-term users may also experience withdrawal symptoms due to rebound acid production if they try to stop suddenly.
Why is it so hard to stop taking Nexium?
After prolonged use, stopping Nexium can trigger rebound acid hypersecretion. That is the condition where the stomach produces more acid than before, leading to a return of acid reflux symptoms. People who have been reducing stomach acid production with Nexium often need to taper off treatment under medical guidance to avoid this.
Does Nexium counter the side effects of other medications while reducing stomach acid?
Yes, several common drugs either provoke excess acid production or worsen the symptoms of conditions like GERD and ZES. One of these is the widely used range of nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, which is a first-line treatment for arthritis.
Is it better to take Nexium at night or in the morning?
For most people, Nexium is more effective when taken in the morning before the first meal. This prepares the stomach by reducing acid production throughout the day. However, for those with night-time acid reflux, a healthcare provider may recommend taking it before the evening meal.
Can I take Tums and Nexium at the same time?
Tums and Nexium can be taken together but should not be taken simultaneously. Most of the popular OTC antacids can quickly relieve heartburn symptoms, whereas Nexium works to reduce acid levels over a longer term. It is best to wait at least an hour after taking Nexium before using other OTC antacids.
How long should you not eat after taking Nexium?
Waiting at least 30 to 60 minutes before eating is recommended to allow Nexium’s delayed-release capsule to activate fully. This helps the delayed-release capsule reach the stomach, where it can begin effectively reducing stomach acid.
Can you drink coffee after taking Nexium?
Coffee can stimulate stomach acid production, which might counteract Nexium’s effects. Generally, it is advised to avoid drinking alcohol or coffee immediately after taking Nexium. This can irritate the stomach and lessen the medication’s benefits for acid reflux.
Does Nexium provide immediate relief by reducing stomach acid?
No, Nexium does not offer immediate relief of heartburn or acid reflux. Because it is a delayed-release PPI, it gradually lowers acid levels. Consider using an OTC antacid like Tums or Pepto-Bismol for immediate relief while Nexium builds its delayed release effect over a few days.
