by Dr. C.H. Weaver M.D. 11/2019
Many people with cancer experience acid reflux or "heartburn", a burning pain in the chest. Other symptoms such as a persistent sore throat, a consistently hoarse voice, a regular cough, or choking when lying down at night all suggest "reflux" or what doctors call gastroesophageal reflux disease (GERD)
What is heartburn?
Heartburn is an irritation of the esophagus which causes burning discomfort in the chest just behind the breastbone. Heartburn can occur in association with eating certain foods or taking certain drugs, including chemotherapy drugs.
The burning sensation results when harsh stomach juices come in contact with and irritate the delicate lining of the esophagus, which is the tube-like structure that connects the mouth to the stomach.
What causes heartburn?
Heartburn is caused when harsh stomach juices come in contact with and irritate the delicate lining of the esophagus, which is the tube that connects the mouth to the stomach. Stomach juices help break down food in the stomach and contain a strong acid, called hydrochloric acid. While the stomach is naturally protected from the harmful qualities of acid, the esophagus is not.
Stomach juices come into contact with the esophagus when the muscle that separates the stomach from the esophagus, called the lower esophageal sphincter, does not work properly. When working normally, this muscle works like a natural valve, letting food into the stomach but keeping stomach juices out of the esophagus. When not functioning properly, this muscle relaxes and allows stomach juices to flow upward into the esophagus. Your doctor may call this backward movement of stomach juices gastroesophageal reflux. The hydrochloric acid damages the lining of the esophagus causing heartburn and its associated symptoms.
What are the symptoms of heartburn?
Heartburn may feel like:
- A burning chest pain that begins at the breastbone that moves up toward the throat
- Food or liquid is coming back into the mouth or throat
- An acid or bitter taste at the back of the throat
- A worsening pain/burning behind the breastbone when lying down or bending over
How can heartburn be prevented?
In general, there are a number of lifestyle changes that you can make to prevent or lower your risk of experiencing heartburn. These may include:
- Stop smoking
- Limit or eliminate alcohol
- Limit your caffeine intake (coffee, soda, tea)
- Lose some weight if you are overweight
- Avoid fatty foods (deep fried foods)
- Do not eat 2-3 hours before going to bed
- Avoid foods that cause you to have heartburn
How is heartburn treated?
Avoiding things that cause heartburn can help, but if lifestyle changes are not enough to prevent heartburn, your doctor may prescribe medication. Effective over-the-counter and prescription medications are available.
Over the counter antacids: Antacids work by neutralizing the acid in your stomach. They may contain the following compounds alone or in combination: calcium carbonate, aluminum hydroxide, magnesium hydroxide and magaldrate. Examples are Maalox®, Mylanta®, Rolaids®, or Tums®.
Proton-pump inhibitor: These medications inhibit the final step in the production of gastric acid. Examples include omeprazole (Prilosec®), lansopraxole (Prevacid®), esomeprazole (Nexium®), pantoprozole (Protonix®) or rabeprazole (Aciphex®). If it is determined that an ulcer is the underlying cause of your heartburn, these medications may be prescribed for short-term treatment of the ulcer. However, an ulcer is caused by the H. pylori bacteria and must be treated with a combination of medication and antibiotics for long-term results.
H2 blockers: These medications decrease stomach acid by blocking histamine from binding to the H2 receptors on cells in the stomach lining. Histamine, a natural substance produced by the body, stimulates cells in the stomach lining to release acid into the stomach. H2 blockers decrease gastric acid secretions. A few examples of these drugs that may be prescribed include cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®) and ranitidine (Zantac®). Pepcid® and Zantac® are now available over the counter.
Voluntary Recall of Zantac by Sanofi/FDA
Sanofi, the maker of Zantac initiated a voluntary recall of all Zantac OTC (over-the-counter) products in the United States. This includes Zantac 150®, Zantac 150® Cool Mint, and Zantac 75®. Zantac tablets are an oral, over-the-counter product to prevent and relieve heartburn associated with acid ingestion and sour stomach. This announcement can be found on the FDA website.
On September 13, 2019, the U.S Food and Drug Administration issued a public statement alerting that some ranitidine medicines, including Zantac OTC, could contain NDMA at low levels and asked manufacturers to conduct testing.
Evaluations are ongoing on both drug substance (active ingredient) and finished drug product. Due to inconsistencies in preliminary test results of the active ingredient used in the U.S. products, Sanofi has made the decision to conduct the voluntary recall as the investigation continues.
Active ingredients used in Sanofi’s ranitidine products outside of the U.S. and Canada are sourced from different suppliers. Sanofi has also issued a voluntary recall in Canada. The company is committed to transparency and will continue to communicate results with health authorities from the ongoing testing, and work with them to make informed decisions based on available data and evidence.
Risk Statement: NDMA is classified as a probable human carcinogen (a substance that could cause cancer) based on results from laboratory tests. NDMA is a known environmental contaminant and found in water and foods, including meats, dairy products, and vegetables.
Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by fax.
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