Acid Reflux Symptoms - Heartburn Symptoms - Gastroesophageal Reflux Disease - GERD

Acid Reflux, Heartburn Information by: National Digestive Diseases (NDDIC). Use your browser's "back" button to navigate the acid reflux menu.

• What are the symptoms of Acid Reflux (GERD)?
• Acid Reflux in children
• What are the causes?
• How is Acid Reflux treated?
• What if symptoms persist?
• The long-term complications of Acid Reflux
• Points to Remember
• Hope Through Research
• For More Information

Gastroesophageal reflux disease, or GERD, occurs when the lower esophageal sphincter (LES) does not close properly and stomach contents leak back, or reflux, into the esophagus. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach. The esophagus carries food from the mouth to the stomach.

When refluxed stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called heartburn. The fluid may even be tasted in the back of the mouth, and this is called acid indigestion. Occasional heartburn is common but does not necessarily mean one has GERD. Heartburn that occurs more than twice a week may be considered GERD, and it can eventually lead to more serious health problems.

Anyone, including infants, children, and pregnant women, can have GERD.

What are the symptoms of acid reflux?

The main symptoms are persistent heartburn and acid regurgitation. Some people have GERD without heartburn. Instead, they experience pain in the chest, hoarseness in the morning, or trouble swallowing. You may feel like you have food stuck in your throat or like you are choking or your throat is tight. GERD can also cause a dry cough and bad breath.

Acid reflux in Children

Studies* show that GERD is common and may be overlooked in infants and children. It can cause repeated vomiting, coughing, and other respiratory problems. Children's immature digestive systems are usually to blame, and most infants grow out of GERD by the time they are 1 year old. Still, you should talk to your child's doctor if the problem occurs regularly and causes discomfort. Your doctor may recommend simple strategies for avoiding reflux, like burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, the doctor may recommend avoiding

• sodas that contain caffeine
• chocolate and peppermint
• spicy foods like pizza
• acidic foods like oranges and tomatoes
• fried and fatty foods

Avoiding food 2 to 3 hours before bed may also help. The doctor may recommend that the child sleep with head raised. If these changes do not work, the doctor may prescribe medicine for your child. In rare cases, a child may need surgery.

*Jung AD. Gastroesophageal reflux in infants and children. American Family Physician. 2001;64(11):1853-1860.

What causes acid reflux symptoms (GERD)?

No one knows why people get acid reflux. A hiatal hernia may contribute. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, the muscle wall that separates the stomach from the chest. The diaphragm helps the LES keep acid from coming up into the esophagus. When a hiatal hernia is present, it is easier for the acid to come up. In this way, a hiatal hernia can cause reflux. A hiatal hernia can happen in people of any age; many otherwise healthy people over 50 have a small one.

Other factors that may contribute to GERD include

• alcohol use
• overweight
• pregnancy
• smoking

Also, certain foods can be associated with reflux events, including

• citrus fruits
• chocolate
• drinks with caffeine
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, chili, and pizza

How are acid reflux symptoms treated?

If you have had heartburn or any of the other symptoms for a while, you should see your doctor. You may want to visit an internist, a doctor who specializes in internal medicine, or a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on how severe your GERD is, treatment may involve one or more of the following lifestyle changes and medications or surgery.

Lifestyle Changes

• If you smoke, stop.
• Do not drink alcohol.
• Lose weight if needed.
• Eat small meals.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by putting blocks of wood under the bedposts--just using extra pillows will not help.

Medications

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach.

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Pepto-Bismol, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts--magnesium, calcium, and aluminum--with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, have side effects. Magnesium salt can lead to diarrhea, and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.

Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.

Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.

H₂ blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), impede acid production. They are available in prescription strength and over the counter. These drugs provide short-term relief, but over-the-counter H₂ blockers should not be used for more than a few weeks at a time. They are effective for about half of those who have GERD symptoms. Many people benefit from taking H₂ blockers at bedtime in combination with a proton pump inhibitor.

Proton pump inhibitors include omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are all available by prescription. Proton pump inhibitors are more effective than H₂ blockers and can relieve symptoms in almost everyone who has GERD.

Another group of drugs, prokinetics, helps strengthen the sphincter and makes the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H₂ blockers. The antacids work first to neutralize the acid in the stomach, while the H₂ blockers act on acid production. By the time the antacid stops working, the H₂ blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for GERD.

What if acid reflux symptoms persist?

If your heartburn does not improve with lifestyle changes or drugs, you may need additional tests.

• A barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and severe inflammation of the esophagus. With this test, you drink a solution and then x rays are taken. Mild irritation will not appear on this test, although narrowing of the esophagus--called stricture--ulcers, hiatal hernia, and other problems will.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor's office. The doctor will spray your throat to numb it and slide down a thin, flexible plastic tube called an endoscope. A tiny camera in the endoscope allows the doctor to see the surface of the esophagus and to search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD. The doctor may use tiny tweezers (forceps) in the endoscope to remove a small piece of tissue for biopsy. A biopsy viewed under a microscope can reveal damage caused by acid reflux and rule out other problems if no infecting organisms or abnormal growths are found.
• In an ambulatory pH monitoring examination, the doctor puts a tiny tube into the esophagus that will stay there for 24 hours. While you go about your normal activities, it measures when and how much acid comes up into your esophagus. This test is useful in people with GERD symptoms but no esophageal damage. The procedure is also helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.

Acid reflux surgery

Surgery is an option when medicine and lifestyle changes do not work. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.

Fundoplication, usually a specific variation called Nissen fundoplication, is the standard surgical treatment for GERD. The upper part of the stomach is wrapped around the LES to strengthen the sphincter and prevent acid reflux and to repair a hiatal herni

This fundoplication procedure may be done using a laparoscope and requires only tiny incisions in the abdomen. To perform the fundoplication, surgeons use small instruments that hold a tiny camer Laparoscopic fundoplication has been used safely and effectively in people of all ages, even babies. When performed by experienced surgeons, the procedure is reported to be as good as standard fundoplication. Furthermore, people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.

In 2000, the U.S. Food and Drug Administration (FDA) approved two endoscopic devices to treat chronic heartburn. The Bard EndoCinch system puts stitches in the LES to create little pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny cuts on the LES. When the cuts heal, the scar tissue helps toughen the muscle. The long-term effects of these two procedures are unknown.

Implant

Recently the FDA approved an implant that may help people with GERD who wish to avoid surgery. Enteryx is a solution that becomes spongy and reinforces the LES to keep stomach acid from flowing into the esophagus. It is injected during endoscopy. The implant is approved for people who have GERD and who require and respond to proton pump inhibitors. The long-term effects of the implant are unknown.

What are the long-term complications of acid reflux symptoms GERD?

Sometimes GERD can cause serious complications. Inflammation of the esophagus from stomach acid causes bleeding or ulcers. In addition, scars from tissue damage can narrow the esophagus and make swallowing difficult. Some people develop Barrett's esophagus, where cells in the esophageal lining take on an abnormal shape and color, which over time can lead to cancer.

Also, studies have shown that asthma, chronic cough, and pulmonary fibrosis may be aggravated or even caused by GERD.

For information about Barrett's esophagus, please see the Barrett's Esophagus fact sheet from the National Institute of Diabetes and Digestive and Kidney Diseases.

Points to Remember

• Heartburn, also called acid indigestion, is the most common symptom of GERD. Anyone experiencing heartburn twice a week or more may have GERD.
• You can have GERD without having heartburn. Your symptoms could be excessive clearing of the throat, problems swallowing, the feeling that food is stuck in your throat, burning in the mouth, or pain in the chest.
• In infants and children, GERD may cause repeated vomiting, coughing, and other respiratory problems. Most babies grow out of GERD by their first birthday.
• If you have been using antacids for more than 2 weeks, it is time to see a doctor. Most doctors can treat GERD. Or you may want to visit an internist--a doctor who specializes in internal medicine--or a gastroenterologist--a doctor who treats diseases of the stomach and intestines.
• Doctors usually recommend lifestyle and dietary changes to relieve heartburn. Many people with GERD also need medication. Surgery may be an option.

Hope Through Research

No one knows why some people who have heartburn develop GERD. Several factors may be involved, and research is under way on many levels. Risk factors--what makes some people get GERD but not others--are being explored, as is GERD's role in other conditions such as asthma and bronchitis.

The role of hiatal hernia in GERD continues to be debated and explored. It is a complex topic because some people have a hiatal hernia without having reflux, while others have reflux without having a herni

Much research is needed into the role of the bacterium Helicobacter pylori. Our ability to eliminate H. pylori has been responsible for reduced rates of peptic ulcer disease and some gastric cancers. At the same time, GERD, Barrett's esophagus, and cancers of the esophagus have increased. Researchers wonder whether having H. pylori helps prevent GERD and other diseases. Future treatment will be greatly affected by the results of this research.

For More Acid Reflux and Heartburn Information

American College of Gastroenterology (ACG) 4900-B South 31st Street Arlington, VA 22206-1656 Phone: (703) 820-7400 Fax: (703) 931-4520 Internet: www.acg.gi.org

American Gastroenterological Association (AGA) National Office 4930 Del Ray Avenue Bethesda, MD 20814 Phone: (301) 654-2055 Fax: (301) 652-3890 Email: webinfo@gastro.org Internet: www.gastro.org

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) P.O. Box 6 Flourtown, PA 19031 Phone: (215) 233-0808 Fax: (215) 233-3939 Email: naspghan@naspghan.org Internet: www.naspghan.org

Pediatric/Adolescent Gastroesophageal Reflux Association Inc. (PAGER) P.O. Box 1153 Germantown, MD 20875-1153 Phone: (301) 601-9541 Email: gergroup@aol.com Internet: www.reflux.org

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The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, this does not mean or imply that the product is unsatisfactory.

National Digestive Diseases Information Clearinghouse

2 Information Way Bethesda, MD 20892-3570 Email: nddic@info.niddk.nih.gov

The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.

Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This fact sheet was reviewed by G. Richard Locke, M.D., Mayo Clinic; and Joel Richter, M.D., Cleveland Clinic Foundation.

Heartburn & Acid Reflux - Orange Peel Extract - A Natural Cure

Decker Weiss: NMD, AACVPR

Dr. Weiss is considered an expert in integrative cardiology. He is the first naturopathic physician to complete a conventional residency program in the Columbia Hospital System, the Arizona Heart Hospital and the prestigious Arizona Heart Institute. Dr. Weiss has a unique perspective in that he has experience with both naturopathic and conventional practice. Dr. Weiss holds several appointments, including Assistant Professor of Medicine at the Southwest College of Naturopathic Medicine and Chief Medical Officer of Naturopathic Paradigms, a private practice in Phoenix.

Because there are so many prescription and over-the-counter heartburn medicines to choose from today, a person could easily think all Americans suffer from it. This assumption is not that far-fetched. More than 60 million Americans experience heartburn at least once a month and more than 25 million suffer heartburn symptoms every day, according to a 1998 Gallup Organization national survey. The good news is, a natural product that relieves heartburn pain is now available. Orange peel extract, made from fresh orange peels, works safely and effectively and without side effects. The great majority of people who have used orange peel extract report huge reductions in their heartburn pain.2

What is heartburn?

Heartburn is the pain caused by the splashing up of fluids from the stomach into the esophagus (the tube that carries food from the mouth to the stomach). The stomach secretes fluid made of hydrochloric acid, an enzyme called pepsin, and sometimes bile (which is created in the liver). Stomach fluid helps digest the food we eat. The hydrochloric acid in stomach fluid helps prevent bacteria from growing in the stomach and intestines. It also helps with vitamin and nutrient absorption. Hydrochloric acid is very strong and corrosive. However, the stomach has a special lining that protects it from the acid and other stomach fluids.3,4

The end of the esophagus (where it connects to the stomach) is actually a circular band of muscle called the lower esophageal sphincter (or LES). The LES is the stomach’s gatekeeper, using pressure to open and close. When food travels from the mouth down through the esophagus, the LES opens, allowing food to enter the stomach. When the LES narrows and closes, it keeps food from leaving the stomach and going back up the esophagus.3

Sometimes, the LES opens at the wrong time. When this happens, hydrochloric acid and other stomach fluids splash up into the esophagus. While the stomach has a special lining to protect it from the hydrochloric acid, the esophagus does not. As the stomach fluid enters the esophagus, the result is burning pain.4

What’s the difference between heartburn and ulcers?

A stomach ulcer is a sore or erosion in the stomach lining or intestine. Stomach ulcers are most often caused by bacterial infection of the stomach (caused by Helicobacter pylori) or chronic use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).5 Heartburn and ulcers are in the same family of acid-related maladies. They also may be aggravated by the same factors and share some symptoms and treatment. Both of these health problems can become serious if left untreated.3-5

What’s the difference between heartburn and GERD?

If you suffer from persistent heartburn two or more days a week, the problem may be gastroesophageal reflux disease (GERD). That can be serious because, over time, the reflux of stomach acid can erode or wear away the delicate esophagus lining (erosive esophagitis). Some people with esophagitis develop scar tissue, which narrows the esophagus’ lining, causing problems swallowing food or pills.6

GERD also can contribute to asthma, pneumonia, hoarseness, and chronic cough.3,4,6 Acid refluxed from the stomach into the mouth also can erode teeth.7,8 Also, people who have GERD have a higher risk of developing Barrett’s esophagus, a condition marked by severe damage to the esophagus lining and linked to an increased risk of esophageal cancer.10

A recent study discovered GERD is a risk factor for cancer of the larynx (voice box) and pharynx (throat).10

Licensed health care practitioners often make a GERD diagnosis when heartburn happens frequently or is particularly severe. While expensive X-ray procedures can accurately diagnose GERD, the diagnosis most often is made from patient reports.

What causes heartburn?

Many factors can cause heartburn to develop. While it may seem like a simple hollow tube, the esophagus has an important function, called esophageal peristalsis. The esophagus is made up of muscle fibers that contract when you swallow. These rhythmic waves of peristalsis move food down the esophagus and into the stomach. Slowdown of esophageal peristalsis often occurs as we age. When peristalsis slows, so does LES functioning and heartburn can then develop.11-13

Heartburn sometimes happens after eating a big meal. Large meals overfill the stomach and can force acid past even a strong LES.3 Lying down right after eating also causes heartburn. Even bending over or lifting heavy objects can bring on the uncomfortable burning sensation.14

Certain foods, such as citrus fruits, chocolate, tomatoes or tomato-based products, raw onions, garlic, black pepper, vinegar and fatty or spicy foods may cause the LES to relax and open. Beverages such as citrus juices, and caffeinated, carbonated, and alcoholic beverages have similar effects.15

Studies show cigarette smoking relaxes the LES, making smokers more prone to heartburn.16,17

Who else is prone to developing heartburn?

Overweight people often experience heartburn. Abdominal fat leads to a higher pressure in the abdomen.16 Pregnancy causes a higher pressure in the abdomen and there also is evidence that changing hormone levels cause relaxation of the muscle valve. More than 25% of pregnant women experience heartburn at some time in their pregnancy.18,19

People who have hiatal (pronounced high-Ay-tul) hernias often have heartburn. This condition occurs when a portion of the stomach slides above the diaphragm, the thin muscle separating the stomach from the chest. The hernia may allow food and acidic stomach fluid to flow back into the esophagus, causing heartburn.20

While heartburn is a common complaint, it’s certainly not a trivial one. Heartburn hurts. It can interfere with sleep and keep us from enjoying our favorite foods. And, while numerous heartburn remedies are available, none cure the problem and all have side effects, some potentially serious.

What side effects do many heartburn medications have?

Some interfere with vitamin and calcium absorption, block digestive activities, and shut down stomach secretions —and none cure the problem; they only relieve heartburn pain.

While some heartburn medications work for some people some of the time, there’s a lack of consistent symptom relief. Many people with heartburn switch from brand to brand, trying to find the one product that takes away their pain consistently.1

Antacid products use sodium bicarbonate, aluminum hydroxide, magnesium hydroxide, calcium carbonate, aluminum phosphate, or a combination of these substances to neutralize stomach acid. Thus, hydrochloric acid is no longer able to perform its vital functions: digesting food, inhibiting bacterial growth, and absorbing vitamins and nutrients.3,4 When hydrochloric acid is neutralized, the stomach responds by producing even more acid. As more acid is produced, more heartburn follows, and a vicious cycle known as “acid rebound” begins.21

Antacids can have serious side effects. Antacids can make the stomach more vulnerable to food poisoning. Normally, Vibrio vulnificus, a potentially fatal bacteria found in raw shellfish, is killed by stomach juices. But, the bacteria can survive up to two hours in the presence of antacids, causing severe vomiting, diarrhea, and stomach cramps.23

Antacids interact with or prevent the absorption of many medications including:
• allopurinol
• aspirin, salicylates
• benzodiazepines
• blood thinners
• chloroquine
• corticosteroids
• diabetic medicines
• digoxin
• ethambutol
• flecainide
• iron
• isoniazid
• nitrofurantoin
• penicillamine
• phenothiazines
• phenytoin type drugs
• quinidine
• tetracycline
• thyroid medications
• ticlopidine
• ulcer medications23,24

H2-receptor blockers, such as Tagamet®, are a different type of heartburn medication. H2-receptor blockers sharply decrease hydrochloric acid production, impairing vitamin B12 and calcium absorption from food. Vitamin B12 in food is attached to proteins. Stomach acid separates them and allows the B12 to be absorbed. Without adequate stomach acid, the B12 remains attached to the proteins.24

Proton pump inhibitors (PPIs) work by inhibiting the hydrochloric acid production. In fact, they almost completely shut down the stomach’s ability to produce acid.25

Nexium®, Prevacid®, and Prilosec® are some of the most prescribed medications in the U.S. In 1999, Americans spent more than $7 billion on Prilosec and other PPIs. While PPIs may be safe for short-term use, the long-term consequences of total hydrochloric acid blocking are unknown.26 The package insert in the Physicians’ Desk Reference states these medications are only for short-term use, but they are generally being used for long periods of time.

In contrast to all these remedies, orange peel extract is a safe and effective option for complete resolution of symptoms.

How does orange peel extract work?

While this compound has been studied for quite some time, new information on how orange peel extract works is continually being discovered. Researchers have developed several possible theories for the way orange peel extract stops heartburn.

Scientists believe orange peel extract helps esophageal peristalsis, moving food through to the stomach effectively and efficiently. Food doesn’t stay in the esophagus longer than required, lessening the chances for heartburn to develop.2

Orange peel extract also may work as a surfactant. A surfactant is a substance that reduces the surface tension of liquids. Orange peel extract may reduce the surface tension of the liquid contents in the stomach, decreasing the potential for the fluid to splash up into the esophagus.2

How much orange peel extract should I take?

I recommend what was used in the studies: 1,000 mg of orange peel extract every other day for 20 days. Look for a product standardized for a minimum of 98.5% (the highest purity) of d-limonene, a compound found in orange peel extract.2

How does orange peel extract cure heartburn?

Orange peel extract has been studied in several clinical trials. In many of the studies, participants were asked to rate their heartburn for severity and frequency. Using a pre-study questionnaire, heartburn severity was rated on a scale from 1-10 (1 = mild and 10 = severe), as was heartburn frequency (1 = occasional and 10 = all the time).2

Participants took 1,000 mg of orange peel extract and were asked to rate their heartburn every day using a 1-to-10 scale (1 = relief and 10 = no relief). Heartburn relief ratings were taken while participants took the extract and several times after stopping.2

Almost 90% of participants reported resolution of heartburn symptoms two weeks (14 days) after starting orange peel extract. Almost one-third of participants experienced resolution of heartburn symptoms as early as the second day of the study.2

What’s more, even though participants stopped taking the orange peel extract, they reported symptom resolution on days 21, 28, and 35. That means they hadn’t experienced heartburn even two weeks after they stopped taking orange peel extract.

These study participants had an average pre-study rating of their heartburn of 7.8 and a frequency rating of 7.3. After only 20 days of taking orange peel extract, almost all these heartburn sufferers experienced no more heartburn.2

Occasionally, after completing the 20-day treatment period, some people may experience mild heartburn after eating foods they had previously avoided. The study scientists concluded these individuals overindulged on these “forbidden” foods. Taking a single orange peel extract capsule as needed usually solves this problem.

Is orange peel extract safe?

Orange peel extract is an all-natural product and its safety has been evaluated.27 Always follow the recommended dosages on the label for best results.

Pregnant or nursing women shouldn’t take orange peel extract. You shouldn’t take it if you have an ulcer or suspect you have an ulcer, because a burning and irritating sensation may result. Until clinical trials on all age groups have been completed, orange peel extract shouldn’t be given to children.2

In fact, orange peel extract has been used in cancer studies for many years with no adverse effects.29

Does orange peel extract affect cancer?

Orange peel extract has pronounced cancer preventative activity. Based on several studies, researchers have determined orange peel extract inhibits the way cancer cells divide and grow. In laboratory studies, orange peel extract prevented breast, skin, liver, lung, pancreatic, colon and stomach cancers.29-33

A clinical study examined the safety of orange peel extract in cancer patients. A group of 32 cancer patients took orange peel extract for 21 days. Ten additional breast cancer patients took orange peel extract for 15 days. No toxicities were demonstrated in any of the patients. Analysis of the patient’s blood levels revealed orange peel extract was well absorbed. The study’s authors urged further research of orange peel extract and cancer prevention.28

Some important last notes Frequent and persistent heartburn can signal other more serious conditions and may eventually lead to complications. You should consult a licensed health care professional if you:

• Suffer from heartburn symptoms even after taking orange peel extract for the full 20 days or other heartburn remedies.

• Have severe hoarseness or wheezing.

• Notice swallowing is painful or difficult, especially with solid foods or pills.

• Experience vomiting for more than three days or notice weight loss that happens without dieting.

• Find your discomfort interferes with your lifestyle or daily activities.

• Notice your heartburn symptoms become more severe over time.

The following conditions may be associated with serious conditions other than heartburn, including heart attack. Therefore, get medical help immediately if you experience any of the following:

• Chest pain accompanied by pain in the neck, jaw, arms or legs, shortness of breath, weakness, irregular pulse or sweating.

• Continuous nausea, vomiting, or diarrhe

• Extreme stomach discomfort.

• Vomiting of bloody or black material.

• Black or bloody bowel movements.

Conclusion

Heartburn is a serious problem for millions of American. We spend literally billions of dollars trying to ease our burning pain. Orange peel extract offers a safe and effective option for relieving heartburn pain.

Reference:

1. Gallup Survey. Heartburn across Americ Princeton, NJ: Gallup Organization, 1998 Mar 24.

2. Harris Group. Feb. 5,2001. Proton Pump Inhibitor Use and Barriers to Successful Treatment. Harris Interactive/Acuity HealthGroup. Available at:
www.businesswire.com/
webbox/bw.020501/
210362364.htm.
Accessed Aug. 21, 2001.

3. Wilkins J, Heggers J, Willette R, Wilkins JS. Relief of heartburn naturally. Proprietary study. Wilkins Research, Galveston Texas.

4. Norris J, Ed. Gastroesophageal reflux. In: Professional Guide to Diseases. 5th ed. Springhouse, Pa: Springhouse Corporation, 1995: 660-663.

5. Porth CM. Gastroesophageal reflux. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998: 722-723.

6. Norris J, Ed. Peptic ulcers. In: Professional Guide to Diseases. 5th ed. Springhouse, Pa: Springhouse Corporation, 1995: 676-678.

7. Dajani EZ. Gastroesophageal reflux disease: pathophysiology and pharmacology overview. J Assoc Acad Minor Phys. 2000;11:7-11.

8. Bartlett DW, Evans DF, Smith BG. The relationship between gastroesophageal reflux disease and dental erosion. J Oral Rehabil. 1996;23:289-297.

9. Silva MA, Damante JH, Stipp AC, Tolentino MM, Carlotto PR, Fleury RN. Gastroesophageal reflux disease: New oral findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;91:301-10.

10. Eckardt VF, Kanzler G, Bernhard G. Life expectancy and cancer risk in patients with Barrett’s esophagus: a prospective controlled investigation. Am J Med. 2001;111:33-37.

11. El-Serag HB, Hepworth EJ, Lee P, Sonnenberg Gastroesophageal reflux disease is a risk factor for laryngeal and pharyngeal cancer. Am J Gastroenterol. 2001;96:2013-2018.

12. Diener U, Patti MG, Molena D, Fisichella PM, Way LW. Esophageal dysmotility and gastroesophageal reflux disease. J Gastrointest Surg. 2001;5:260-265.

13. Wetscher GJ, Glaser K, Gadenstaetter M, Profanter C, Hinder R The effect of medical therapy and antireflux surgery on dysphagia in patients with gastroesophageal reflux disease without esophageal stricture. Am J Surg. 1999;177:189-192.

14. Clouse RE, Richter JE, Heading RC, Janssens J, Wilson J Functional esophageal disorders. Gut. 1999;45:II31-1136.

15. Clark CS, Kraus BB, Sinclair J, Castell DO. Gastroesophageal reflux induced by exercise in healthy volunteers. JAM 1989;261:3599-3601.

16. National Digestive Diseases Information Clearinghouse. Gastroesophageal reflux disease. Available at: www.niddk.nih.gov/
health/digest/pubs/heartbrn/. Accessed Aug. 17, 2001.

17. Smit CF, Copper MP, van Leeuwen JA, Schoots IG, Stanojcic LD. Effect of cigarette smoking on gastropharyngeal and gastroesophageal reflux. Ann Otol Rhino Laryngol. 2001;110:190-193.

18. Kahrilas PJ. Cigarette smoking and gastroesophageal reflux disease. Dig Dis. 1992;10:61-71.

19. Fisher RS, Roberts GS, Grabowski CJ, Cohen S. Altered lower esophageal sphincter function during early pregnancy. Gastroenterology. 1978;74:1233-1237.

20. Olans LB, Wolf JL. Gastroesophageal reflux in pregnancy. Gastrointest Endosc Clin N Am. 1994;4:699-712.

21. Scott VF. Gastroesophageal reflux disease: diagnosis and management. J Assoc Acad Minor Phys. 2000;11:12-14.

22. Lehne R Antacids: adverse effects. In: Pharmacology for Nursing Care. 3rd ed. Philadelphia, Pa: W.B. Saunders; 1998: 783-784.

23. Young LE, Koda-Kimble M Drug interactions associated with antacids. In: Applied Therapeutics: The Clinical Use of Drugs. 6th ed. Vancouver, Wash: Applied Therapeutics, Inc; 1995:chapter 23, page 9.

24. Koo, J., Marshall, D. L. & DePaola, Antacid increases survival of Vibrio vulnificus and Vibrio vulnificus phage in a gastrointestinal model. Appl Environ Microbiol. 2001;67: 2895 – 2902.

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Nexium, Pepcid and Prilosec can make people more susceptible to pneumonia

Widely used heartburn and ulcer drugs such as Nexium, Pepcid and Prilosec can make people more susceptible to pneumonia, probably because they reduce germ-killing stomach acid, Dutch researchers found in a study of more than 300,000 patients.

Heartburn Health Fact:

Some people experience discomfort of hearburn after eating citrus fruits, including oranges. This is caused by the citric acid present in the fruit; this acid is not present in the orange peel extract d-limonene.

Where can I get D-Limonene?

Enzymatic Therapy's Heartburn Free Relieves occasional heartburn, acid indigestion, & upset stomach The all-natural key ingredient in Heartburn Free™,--orange peel extract--delivers lasting relief from occasional heartburn, acid indigestion, and upset stomach. Unlike many traditional products, clinically studied Heartburn Free will not reduce mineral absorption or inhibit protein digestion, and it does not shut down acid production nor adversely affect acid-producing cells. Instead, Heartburn Free† works with your body's natural digestive processes. Notes: The all-natural active ingredient, orange peel extract (ROH10®), provides you with lasting relief in a convenient, every other-day dosage.

Visit the Vitamin Shoppe to order Heartburn Free by Enzymatic Therapy

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