Sour Stomach?

The 1988 Nobel Prize in Physiology or Medicine was shared between James Black, Gertrude Elion, and George Hitchings "for their discoveries of important principles for drug treatment.”  In 1964, histamine was known to stimulate the secretion of stomach acid, but traditional antihistamines had no effect on acid production. Tagamet was one of the first drugs discovered using a rational drug design approach. 

Hundreds of modified compounds were synthesized in an effort to find a specific antihistamine to decrease production of stomach acid. Tagamet was approved by the FDA for prescriptions in 1976. By 1979, Tagamet was being sold in more than 100 countries and became the top-selling prescription product in the U.S. 

Tagamet became the first drug ever to reach more than $1 billion a year in sales, thus making it the first blockbuster drug.  Before the introduction of the drug, treatment of peptic ulcers relied on extensive bed rest, imposition of a bland diet, treatment with antacids, and often involved surgery if the ulcer recurred.  Tagamet's mode of action is to block the Histamine H2 receptor.

There are 3 types of heartburn medication: 

• antacids such as Maalox, Mylanta, and Tums
• Histamine H2 receptor antagonists such as Pepcid and Tagamet
• proton pump inhibitors (PPIs) such as Prilosec and Prevacid

In seeking a course of treatment for heartburn, it is best to progress from antacids to Histamine H2 receptor antagonists to proton pump inhibitors (PPIs), each more aggressive than the next.  There is a risk of osteoporosis and vitamin B12 deficiency if PPIs are taken over a long period of time, although PPIs are usually more effective than the older Histamine H2 blockers.

Prilosec was the first proton-pump inhibitor (PPI) on the market, in 1988. It was sold as a racemic mixture of R and S isomers. Prevacid was the second of the PPI drugs to reach the market, being launched in Europe in 1991 and the US in 1995. In 2001 Nexium was launched in USA, containing the S-isomer only of the same molecule as Prilosec, providing higher bioavailability and improved efficacy.

Aside from medication, there are dietary changes that can address acid reflux. Limit fried foods and fatty foods, such as butter, mayonnaise, cream sauces, gravies. Try lower fat or skim milk, as this may also help reduce heartburn. Limit foods that cause gas, like rich spicy foods. Sit upright for at least one hour after a meal. 

The Top Pharmaceuticals That Changed The World, Chemical & Engineering News Vol. 83, Issue 25 (6/20/05) http://pubs.acs.org/cen/coverstory/83/8325/8325list.html 

Lars Olbe, Enar Carlsson & Per Lindberg. Nature Reviews Drug Discovery 2, 132-139 (February 2003) http://www.nature.com/nrd/journal/v2/n2/fig_tab/nrd1010_F2.html

Are Heartburn Medications Safe for Long-Term Use? - Everyday Health (2/19/16)

http://www.everydayhealth.com/digestive-health/experts-are-heartburn-medications-safe.aspx

5 Steps to an Effective Acid Reflux Diet - RefluxMD (6/15/16)

http://www.refluxmd.com/5-steps-effective-acid-reflux-diet/

Nausea and Vomiting Heartburn: - WIC Works (2005)

https://wicworks.fns.usda.gov/wicworks/Sharing_Center/NJ/complaints_pregnancy.pdf