Acid reflux and heartburn: treatment by video in Puerto Rico

Reflux happens when stomach contents come back up into the esophagus, the tube that carries food from your mouth to your stomach. Occasional reflux, for example after a big meal, is common. If what you feel is mostly an urge to throw up, see nausea.

When the muscle at the bottom of the esophagus becomes weak or relaxes when it should not, reflux becomes frequent or long-lasting, and it is called gastroesophageal reflux disease (GERD). Not everyone with GERD has heartburn; some mainly have a cough or hoarseness.

It works the same from anywhere in Puerto Rico:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If you already take a reflux medicine and only need a refill, choose a follow-up visit: anyone can book it. A review of lab results is also a follow-up visit, for existing patients. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

The most common symptoms are:

• Heartburn: a painful, burning feeling in the middle of the chest
• Regurgitation: stomach contents coming back up into the throat or mouth
• Nausea
• Trouble swallowing
• A chronic cough or hoarseness

There are three main groups. Antacids relieve mild symptoms, but the NIDDK advises against using them every day or for severe symptoms without medical advice. H2 blockers reduce how much acid the stomach makes. Proton pump inhibitors such as omeprazole control symptoms best and heal the esophagus best, according to the NIDDK.

The doctor decides with you which medicine is appropriate. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you already take one, the refill is part of our prescription refills service.

Omeprazole lowers the amount of acid your stomach makes; it is a proton pump inhibitor. According to MedlinePlus, over the counter it is used for frequent heartburn (heartburn 2 or more days a week) in adults. By prescription, doctors use it for gastroesophageal reflux disease (GERD), to heal an esophagus damaged by acid, for stomach and intestinal ulcers and, with antibiotics, to clear H. pylori bacteria.

It is not for immediate relief: the label says it may take 1 to 4 days for full effect.

How over-the-counter omeprazole is used. Under the FDA-approved over-the-counter label (for example, Prilosec OTC), you take one tablet a day, in the morning before eating, for 14 days in a row. You may repeat a 14-day course no more than once every 4 months, which means no more than 3 courses a year, unless a doctor tells you to.

When to talk to the doctor. The label says to stop and ask a doctor if your heartburn continues or gets worse, if you need it for more than 14 days or more than one course every 4 months, if you get diarrhea, or if you get a rash or joint pain. It also says to ask before use if you have had heartburn for more than 3 months, have nausea, vomiting, stomach pain or unexplained weight loss, or take a prescription medicine. The doctor handles all of that by video: book your visit.

Do not use over-the-counter omeprazole, and get care, if you have trouble or pain swallowing, vomit with blood, black or bloody stools, or heartburn with dizziness, sweating or chest pain: these are warning signs (see when to go to the ER below).

Pantoprazole belongs to the same family as omeprazole: it also lowers stomach acid. According to MedlinePlus, it is used to treat gastroesophageal reflux disease (GERD) and conditions in which the stomach makes too much acid, such as Zollinger-Ellison syndrome.

In the United States and Puerto Rico, pantoprazole (Protonix and its generics) is prescription only: the FDA approves it only as a prescription medicine. If you were prescribed it before, or over-the-counter omeprazole was not enough, the doctor evaluates you by video and, if appropriate, prescribes and we send your prescription to your pharmacy. If you already take it and only need a refill, choose an online follow-up visit.

According to the FDA-approved label, taking an acid-lowering medicine every day for a long time (for example, more than 3 years) can reduce how well you absorb vitamin B12; rarely it lowers magnesium, mostly after a year of use; and high doses for a year or longer are linked to hip, wrist and spine fractures.

The same label warns that these medicines are linked to a higher risk of diarrhea caused by Clostridioides difficile (C. difficile) bacteria. MedlinePlus says to call your doctor if you have severe diarrhea with watery stools, stomach pain or a fever that does not go away.

That is why the doctor looks for the lowest dose that works for you, checks whether you still need it and, if needed, gives you a lab order.

What if it is gastritis? If the burning is mostly in the upper belly, it may be gastritis, often caused by H. pylori bacteria. Lowering acid alone is not enough there: the bacteria are found with a test and, if you have them, treated with antibiotics together with a proton pump inhibitor. MedlinePlus explains that you may need to stop some medicines for two weeks to a month before the test, so tell the doctor if you take omeprazole.

If your symptoms do not improve with habit changes and medicine, or you have trouble or pain swallowing, unexplained weight loss, loss of appetite, vomiting that will not stop, vomit with blood or black stools, the doctor refers you to a gastroenterologist for an in-person evaluation. The specialist may do an endoscopy, which looks inside your esophagus and stomach with a thin camera.

These changes, recommended by the NIDDK, help many people and are the first step of treatment:

• Eat at least 3 hours before you lie down or go to bed.
• If reflux bothers you at night, raise the head of your bed 6 to 8 inches with a foam wedge or pillows under your head and upper back.
• Lose weight if you are overweight.
• If you smoke, try to quit smoking.
• Notice which foods bother you. Common ones are acidic foods (citrus, tomatoes), alcohol, chocolate, coffee and other caffeine, high-fat foods, mint and spicy foods.

Losing weight is one of the steps that helps reflux most. In Puerto Rico, adult obesity rose from 26.3% in 2011 to 36.2% in 2024, according to BRFSS surveillance data published by the Puerto Rico Institute of Statistics. If you want a plan for your weight and your reflux, the doctor works through it with you during the visit.

We see children of all ages, with a parent or legal guardian on camera. Spitting up is very common in babies, and the doctor helps you tell it apart from reflux that needs treatment. For their safety, if a child vomits forcefully, vomits green or blood, or is very drowsy or limp, take them to the emergency room.

Heartburn feels like burning in the middle of the chest, and a heart attack can also be felt in the chest. For your safety, call 911 if the pain is severe or squeezing, spreads to your arm, jaw or back, or comes with shortness of breath, a cold sweat, nausea or dizziness. This matters even more if you have high blood pressure, diabetes or high cholesterol, or if you smoke.

Also go to the ER if you have any of these signs. See when to go to the ER.

• Vomit with blood or that looks like coffee grounds
• Black, tarry or bloody stools
• Food getting stuck so you cannot swallow