Case: Heartburn

Question:

FG is a 39-year-old woman who is looking for something for her heartburn. She recently started a diet and has been eating healthier. FG gave up regular soda and replaced it with diet soda. She likes it so much that she is drinking 8 to 10 cups of diet soda daily. In addition, FG has been eating salads with spicy jalapeño dressing. These dietary changes often cause a burning sensation. FG’s physician recommended she take an OTC product to alleviate her heartburn, but she does not know which product to select. What recommendations do you have?

Answer: 

Because FG has changed her dietary habits significantly, she should seek counseling on lifestyle modifications.

Many foods can trigger heartburn, especially spicy foods. FG should try to avoid alcohol, caffeinated drinks, citrus fruits, coffee, peppermint, and tomatoes. She should also replace her diet soda with regular water or at least noncaffeinated beverages to see whether her symptoms decrease or resolve. In addition, FG can try eating smaller meals or eating more frequently. OTC medications that might help include antacids, such as calcium carbonate; a histamine 3 receptor antagonist, such as cimetidine, famotidine, or ranitidine; and a proton pump inhibitor (PPI), such as esomeprazole, lansoprazole, or omeprazole. She can start with a histamine 2 receptor agonist (H2RA) as needed when she has symptoms. FG can escalate to a PPI if symptoms do not resolve with H2RAs. If her symptoms persist or worsen, she should be reevaluated by a physician.