DEAR MAYO CLINIC:

I've taken antacids almost daily for 20 years for my acid reflux. Are there going to be long-term effects for me?

ANSWER:

Taking antacids for as long as you have can cause long-term side effects.

Treatment for acid reflux has advanced considerably over the last 20 years. I recommend you talk with your doctor about what could be causing your chronic acid reflux and discuss alternative treatment options.

Acid reflux is the backward flow of stomach acid into the tube that connects the throat and stomach (esophagus). During an episode of acid reflux, you may taste food or sour liquid at the back of your mouth or feel a burning sensation in your chest (heartburn).

Occasional heartburn is common, and typically it's not a cause for concern. Most people manage the discomfort of heartburn on their own with lifestyle changes and over-the-counter medications, such as antacids.

Antacids have three major classes: magnesium hydroxide, calcium carbonate and aluminum hydroxide.

To find out which type of antacid you're taking, check the active ingredient listed on the packaging. It's a good idea to double-check that over time, too, as the formulations of many brand name antacids change occasionally.

These medications relieve acid reflux by neutralizing stomach acid.

Generally, it's recommended that you use antacids only as needed and for short periods -- usually no more than two weeks -- because long-term use of antacids can cause health problems.

For example, magnesium hydroxide can cause diarrhea. Using calcium carbonate over time can result in constipation and, eventually, may result in kidney damage, as well as milk-alkali syndrome -- a serious condition characterized by excessively high levels of calcium and a shift in the body's acid-base balance to alkaline. Long-term use of aluminum products has been associated with weak bones.

Acid reflux that lasts could be a symptom of something more serious.

If you haven't already done so, talk to your doctor about investigating the cause of your chronic reflux. I would recommend that you have endoscopy -- a procedure that involves inserting a lighted, flexible tube (endoscope) with a camera on its tip through your mouth and into your esophagus and stomach, so your doctor can examine the esophageal lining.

It's particularly important for someone in your situation to have an upper endoscopy exam because you've had reflux for more than five years.

That puts you at higher risk for developing Barrett's esophagus -- a condition characterized by a change in the color and composition of the cells lining your lower esophagus. In some cases, Barrett's esophagus can be a precursor to esophageal cancer.

If endoscopy does uncover a problem, treatment for that condition may relieve your reflux symptoms.

If your doctor examines your esophagus and determines that no underlying medical condition is causing the chronic acid reflux, you should explore other options that can treat reflux more effectively than over-the-counter antacids.

For example, proton pump inhibitors (dexlansoprazole, esomeprazole, lansoprazole, omeprazole, omeprazole / sodium bicarbonate, pantoprazole, and rabeprazole) are often used for chronic acid reflux. These medications block acid production and allow time for damaged esophageal tissue to heal. Switching to a proton pump inhibitor should eliminate the need for daily antacids.

Because of possible side effects, taking over-the-counter antacids long term isn't a good solution for chronic acid reflux.

Make an appointment to see your doctor to have your condition evaluated and develop a more effective treatment plan.

-- Yvonne Romero, M.D., Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn.

Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care.

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