You have probably felt the sensation before: a burning pain just above your stomach, behind the sternum. You’re suffering from heartburn, the result of stomach acid backing up into your esophagus. If you are like most people, you reach for a proton pump inhibitor (PPI) such as Nexium or Prilosec.

These drugs do provide some temporary relief, and used occasionally, are reasonably safe. Used habitually over an extended period, however, the health consequences can be dire – and even fatal. If you find that alarming, you will be interested to know that in over half of all cases, PPIs are not even necessary. Most of the time, relief can be received from a simple, over-the-counter antacid or a histamine 2 (H2) blocker.

What are H2 Blockers?

H2 blockers such as Pepcid, Tagamet and Zantac are normally used to treat gastritis and peptic ulcers. However, they are also prescribed to relieve chronic heartburn, i.e. gastroesophageal reflux disease (GERD). On occasion, a doctor may prescribe an H2 blocker for “off-label” purposes, such as pancreatic inflammation or allergic reactions.

How are H2 Blockers Different from PPIs?

Both classes of drugs decrease the production of stomach acid by targeting the parietal cells lining the stomach. These are the cells that are responsible for secreting hydrochloric acid, the major component of digestive juices. Within these cells is a system known as the proton pump. To use an analogy, H2 blockers temporarily cut off the “fuel supply” to the proton pump, while PPIs permanently disable it. PPIs act faster to reduce stomach acid, and are usually prescribed for those who suffer from GERD. H2 blockers, on the other hand, are less powerful, targeting stomach acid production in the evening – a common cause of peptic ulcers.

Physicians recommend that H2 and PPIs blockers not be taken together, as the former can interfere with the mechanism of the latter.

What are the Side Effects of H2 Blockers v. PPIs?

PPIs have been linked to cardiovascular events (heart attack and stroke), kidney disease, colitis, dementia, and osteoporosis, as well as cancer. However, these side effects usually present themselves only after several months or years of normal to heavy usage. This is why doctors recommend that PPIs be used at the lowest possible dose for as short a period as possible (generally, no more than 12 weeks).

H2 blocker side effects are suffered by no more than 1.5 percent of those who take them. The more common ones are constipation, diarrhea, insomnia, headaches, tinnitus, and dryness of the skin and mucus membranes. In rare cases, more serious reactions can include blisters and peeling skin, vision impairment, respiratory distress, and psychological effects such as confusion, agitation, and even hallucinations.

What about OTC Antacids?

Over the counter antacids such as Rolaids or Tums contain calcium carbonate, which can help to neutralize excess stomach acid. These are fine to use on occasion, but when taken too often, they can impair immune function, since stomach acid is the first line of defense against harmful bacteria that can cause illness.

What Else Can be Done?

For those who suffer from attacks of heartburn regularly, a physician may recommend changes in diet and lifestyle, such as reducing alcohol intake, stopping the use of tobacco, and switching to a low-fat diet. Alternative therapies such as biofeedback and acupuncture may also be effective in treating some cases of GERD.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.