Be Still, My Heartburn
What's the best way to treat acid reflux?
Notes: This drug benefited, I'm sure, from being chosen on day two of the trial, when my stomach acid had not yet been agitated. Still, after a jumbo lunch and an active day of moving-related errands, it kept the burn away. I did, however, have the signature "ahem" cough of reflux all day.
Pepcid AC (10 mg) 30 tabs/$9.99
Type: H2; OTC
Lunch: 1 grilled steak/black bean burrito with spicy red salsa; 1 beer; 2 slices of blueberry pie; 2 coffees; 1 Peppermint Pattie; quarter of a Lindt chocolate mint bar
p/H (10/2) = 5
Notes: Before the trial, I had never tried Pepcid AC; I'm not sure why. I ate a monster lunch and packed a ton of boxes, but I experienced only the slightest preliminary twinge of heartburn, which I addressed with a couple of precautionary Tums.
Ranitidine (150 mg) 60 tabs/$10.99
Type: H2; Rx
Lunch: 1 bacon-onion omelet with hot sauce; 1 beer; 1 slice of blueberry pie; 1 coffee
p/H (7/1) = 7
Notes: TA picked this prescription-strength generic on the last day of the trial, when my innards were scrambled after two weeks of acid-bating, and yet it still kept the acid where the acid ought to be.
Nexium (40 mg) 30 caps/$120.99
Type: PPI; Rx
Lunch: 1 hot dog with "the works"; 1 chili-cheese dog; 1 bag of chips; 1 beer; 2 Peppermint Patties; 1 chocolate ice cream cone
p/H (9/1) = 9
Notes: According to a spokesman from AstraZeneca, the company that makes both Nexium and Prilosec, Nexium has a "higher degree of bioavailability," which means either that it works better than Prilosec, or—as some critics have argued—that AstraZeneca has slightly tweaked an old drug to get patent protection for a too-similar product, guaranteeing a steady influx of dollars. However tempting it is to believe the latter, Nexium gave the superior performance of my trial. The meal was a bruiser; I experienced no symptoms; and the special stress factors that day included the installation of a window unit, a kitten under the radiator, and TA's mounting displeasure over my eating habits.
As a class, the PPIs ruled: Three of them finished in my top five. Was the difference between Nexium and Prilosec OTC enough to justify spending more for the Nexium if you don't have insurance? In a word, no. My insurance covers only generics, and, since I've made some lifestyle changes that have helped control my heartburn—less beer, less junk, more exercise—I plan to go with the prescription Ranitidine (which costs me only $10 for 60 tablets). That's a much better deal than any of the PPIs—even the Prilosec OTC—not to mention the less powerful OTC H2s. If, for some reason, I couldn't get to my Ranitidine, I'd go with Pepcid AC or Axid. And for what I hope are rare middle-of-the-night attacks, I'll keep a jar of Tums by the bed.
Chip Brantley is the author of The Perfect Fruit, a book about pluots.
Illustration by Mark Alan Stamaty.