Over 60 million Americans suffer from heartburn. It is possibly the single most income-creating medical problem for the pharmaceutical companies. Heartburn is a burning pain starting behind the breastbone and spreading upwards. The stomach acid, backing up the wrong way from the stomach, enters the esophagus and inflames and irritates the esophagus. The lower esophagus sphincter, either through weakness or getting relaxed due to alcohol or drugs, allows this leak.

There are three different approaches to manage this problem. The antacids provide a simple temporary cure. These medications, mainly made of calcium carbonate, aluminum and magnesium, neutralize the acid in the stomach. They act very fast, but are effective only for short periods (1 to 2 hours). Antacids like Pepto-Bismol coat the esophagus so that the acid does not come in contact and cause heartburn. Medications like Gaviscon form a barrier of foam between stomach and esophagus.

The H2 blockers are the second type of medications used to cure heartburn. Drugs like Cimetidine, Ranitidine, Nizatidine and Famstidine provide relief from the heartburn by suppressing acid production in the stomach. They take about 1 hour to take effect and last up to 12 hours.

Proton Pump Inhibitors (PPI) are the third class of medication for heartburn. PPIs like Omeprazole and Lansoprozole turn off acid production by a different method from H2 blockers. PPI interferes with the proton pump in the mucus lining of the stomach at the last stage of acid production. It is effective within one hour and the effect lasts up to 24 hours. There is also a combination medicine: antacid for fast relief and H2 blocker for longer relief.

We do not know, by any systematic study, how effective herbal remedies are or how they work. But many physicians accept and recommend them as supporting medication. Ginger root, aloe vera juice, basil leaves, bitters and aromatics all have their proponents.

Self-treating heartburn with OTC drugs is quite reasonable, up to a point. But if the problem persists for longer periods than recommended by the drug manufacturer or if the patient finds no relief with the medication, it is time to consult a physician. The heartburn could be a symptom of a more serious underlying problem.