JAMES FRESTON, MD, PhD: Well, acid coming up into
the esophagus -- where acid doesn't belong -- is what causes the pain.
When one is lying down at night, one doesn't have gravity to pull the acid
back down in the stomach, like if you were upright.
The other thing is, when one is asleep, there is less
swallowing. Swallowing clears the esophagus of acid, and also saliva
helps neutralize the acid.
MICHAEL WOLFE, MD: A natural antacid. Saliva
has --
DAVID R. MARKS, MD: Saliva.
MICHAEL WOLFE, MD: -- has bicarbonate inside it.
DAVID R. MARKS, MD: And it's free.
MICHAEL WOLFE, MD: It's free.
DAVID R. MARKS, MD: Now, we all think that medication
-- medication does work very well for heartburn. And we probably
think that it helps us all the time. But, in some cases, at night,
it -- you get some breakthrough. How -- is that a common situation.
MICHAEL WOLFE, MD: Well, the classic example are
the proton pump inhibitors. They're wonderful medication, and most
people actually do get by by taking one pill a day in the morning.
But there's significant number of people who actually will breakthrough
at night. So-called "nocturnal acid breakthrough." And it'll
occur right in the middle of the night, when someone is sound asleep.
Not a good way to start the next day.
DAVID R. MARKS, MD: But if these medications are
turning off the acid production, how is there acid that's actually there
to get through?
