Night Pains: Is Heartburn Kee... Video Transcript

Participants

James W. Freston MD, PhD, David R. Marks MD, M. Michael Wolfe MD, Eric R. Lemmer MD, PhD

Summary

Heartburn can be a nuisance at any time of day, but for many people the greatest frustration happens at night. Not only can heartburn get in the way of a good night's sleep, but going to bed can actually make heartburn worse, even if you're on medication. Join our panel as they talk about nighttime heartburn, and what you can do to fight it.

Webcast Transcript

DAVID R. MARKS, MD:  Hi, and welcome to our webcast.  I'm Dr. David Marks.

Heartburn can be a nuisance at any time of the day.  But for many people, the greatest frustration happens at night.  Not only can heartburn get in the way of a good night's sleep, but going to bed can actually make your heartburn worse, even if you're on medication.

Now, joining me to talk about nighttime heartburn and what you can do about are two experts.  First is Dr. Jim Freston from the University of Connecticut, welcome.

JAMES FRESTON, MD, PhD:  Okay.

DAVID R. MARKS, MD:  And next to him is Dr. Michael Wolfe, and he is from Boston University School of Medicine.  Welcome.

MICHAEL WOLFE, MD:  Thank you.

DAVID R. MARKS, MD:  How big a problem is this?

MICHAEL WOLFE, MD:  It's actually more of a problem than previously recognized.  We used to think of heartburn as occurring only after meals.  And, actually, in many situations, was more bothersome at night than during the daytime.

DAVID R. MARKS, MD:  What is it that happens, that cause the pain?

JAMES FRESTON, MD, PhD:  Well, acid coming up into the esophagus -- where acid doesn't belong -- is what causes the pain.  When one is lying down at night, one doesn't have gravity to pull the acid back down in the stomach, like if you were upright.

The other thing is, when one is asleep, there is less swallowing.  Swallowing clears the esophagus of acid, and also saliva helps neutralize the acid.

MICHAEL WOLFE, MD:  A natural antacid.  Saliva has --

DAVID R. MARKS, MD:  Saliva.

MICHAEL WOLFE, MD:  -- has bicarbonate inside it.

DAVID R. MARKS, MD:  And it's free.

MICHAEL WOLFE, MD:  It's free.

DAVID R. MARKS, MD:  Now, we all think that medication -- medication does work very well for heartburn.  And we probably think that it helps us all the time.  But, in some cases, at night, it -- you get some breakthrough.  How -- is that a common situation.

MICHAEL WOLFE, MD:  Well, the classic example are the proton pump inhibitors.  They're wonderful medication, and most people actually do get by by taking one pill a day in the morning.  But there's significant number of people who actually will breakthrough at night.  So-called "nocturnal acid breakthrough."  And it'll occur right in the middle of the night, when someone is sound asleep.  Not a good way to start the next day.

DAVID R. MARKS, MD:  But if these medications are turning off the acid production, how is there acid that's actually there to get through?

JAMES FRESTON, MD, PhD:  Well, in the case of the proton pump inhibitors that Michael just mentioned, they're taken in the morning.  And their effect gradually does wear off.  But then, as their effect is wearing off, remember now the patient is recumbent.  Or the person is recumbent.  And those factors I had mentioned earlier, that drive heartburn, kick in.  They're not operating necessarily during the day.

DAVID R. MARKS, MD:  So what should a person do?

MICHAEL WOLFE, MD:  Well, there's several different maneuvers one can take to avoid --

DAVID R.