Dear Dr. Roach: For the past 50 years, I have been bothered by occasional indigestion or heartburn after eating a greasy or spicy meal. This might occur several times per month, but not more than once a week. I have always gotten instant relief through either calcium carbonate tablets (Tums) or a teaspoon of sodium bicarbonate (baking soda) in water.
Several years ago, I discussed this with my doctor, and he prescribed omeprazole with instructions to take one 20-mg capsule daily. After reading of the negative side effects of omeprazole, I began taking it only before I ate a heavy meal that might bring on the symptoms. My doctor agreed that it was not necessary to take it daily. I noted that omeprazole was effective only when taken before the meal and provided no relief when taken after the discomfort had started.
The Tums or baking soda seemed to be such a quick and easy fix. Is there a reason to use omeprazole instead of the antacids?
Proton pump inhibitors such as omeprazole are powerful medications that have made an enormous impact on improving the symptoms of people with severe heartburn. However, not everyone needs such powerful medication.
PPIs also are slow to relieve symptoms. It takes several days of once-daily dosing of omeprazole to suppress acid secretion. Because of this, dosing omeprazole on an as-needed basis is not going to be effective for most people. For occasional symptoms of heartburn, it is far better to use an antacid, such as Tums, or an H2 blocker (which blocks the histamine receptor in the stomach), such as famotidine (Pepcid), which has a fast onset of action.
I don’t want to forget to mention dietary control. It seems like you know what meals are likely to cause symptoms, and at the risk of sounding trite, you should avoid overdoing it.
Eat smaller meals, avoid late-night eating and stay away from food triggers, such as alcohol and caffeine — these all are ways of controlling symptoms without medication. All medicines have the potential for side-effects, so minimizing them is wise. The list of potential complications from long-term use of PPIs is long.
Some people need to take omeprazole regularly, whether it’s because nothing else is effective or they have a condition like Barrett’s esophagus. Fortunately, most people do not.
Dr. Roach Writes: Many readers asked about the safety of petroleum jelly (such as Vaseline) for use with dry nostrils to prevent cracking. I reviewed the literature on this, and there is a rare complication of chronic use of nasal petroleum jelly called lipoid pneumonia. In most people who use petroleum jelly in the nose, the petroleum jelly will be wiped away or swallowed, but a few people have developed lipoid pneumonia by breathing in the petroleum jelly, usually over a period of years.
To reduce the risk of this complication, people should use petroleum jelly sparingly and occasionally, and not use it right before lying down at bedtime. People who need treatment every day should consider a water-based lubricant such as Ayr nasal gel or K-Y.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.