Heartburn Relief: Medication and Prevention

Nothing ruins an evening gathered around the dinner table like heartburn. Instead of kicking up your feet and reclining on the couch to rest and digest after a satisfying meal, your GI tract has other plans. That burning sensation in the chest affects millions of people in the U.S. every month.

Heartburn is not a health condition, but a symptom of either acid reflux. When acid reflux occurs chronically and causes troublesome symptoms, it is called gastroesophageal reflux disease (GERD). GERD is more common in adults, affecting 10-20% of adults in Western countries, but up to 8% of children in the US may experience symptoms related to GERD.

For anyone experiencing these symptoms, lifestyle changes and over-the-counter (OTC) medications may help manage heartburn. It’s important for anyone experiencing persistent heartburn to seek a medical evaluation from a health care provider.

In this article:

What is heartburn?

Despite its name, heartburn does not take place within the heart. Rather, the action takes place between the stomach and the esophagus at the lower esophageal sphincter. Our stomach acid breaks down the foods we eat. When these gastric contents flow back up into the esophagus, a person may experience heartburn. More serious conditions, such as stomach ulcers, gallstones, esophageal cancer, angina, and even a heart attack can mimic heartburn.

"Because heartburn can mimic other serious health conditions, it's important to be evaluated by a health care if you're concerned about your symptoms, especially if persistent," says board-certified Internal Medicine Physician Dr. Brennan Kruszewski.

Definition and symptoms

Heartburn is “an uncomfortable, burning feeling in the mid-chest, behind the breastbone, or in the upper part of the abdomen.” It tends to occur later in the day, after a meal, or when a person is bent over or reclined on their back. Smoking, pregnancy and being overweight or obese are risk factors. Heartburn is caused by either acid reflux or GERD, which may present similarly but share a few key differences.

Causes of heartburn

Acid reflux may result in heartburn, coughing, wheezing or difficulty swallowing. There may also be an unpleasant, bitter taste in the mouth. Heartburn that strikes every once in a while isn’t uncommon; think about the last time a particularly powerful burp snuck up on you, for example. Eating a large meal or consuming foods like hot salsa or citrus fruits can cause heartburn, but triggers may differ from person to person. If heartburn occurs less than once a week, medical treatment may not be necessary.

GERD is a chronic condition that occurs more regularly, sometimes upwards of twice a week to as much as multiple times a day. This is because the muscles of the lower esophagus have weakened or remain open instead of constricting to keep stomach acid down. This makes symptoms of heartburn, regurgitation and chest pain more likely.  GERD may also make a person more prone to cancer of the esophagus.

Lifestyle changes to prevent heartburn

Certain lifestyle changes may reduce acid reflux. While these lifestyle changes may improve symptoms, medical treatment may also be required for patients with GERD. Here’s more about implementing different changes and how they may help prevent heartburn.

Dietary adjustments

Some foods can aggravate acid reflux. Knowing which foods are the common culprits can make life easier for people experiencing frequent heartburn. Dietary triggers are often different for everyone. Keeping a food diary can help patients determine if specific foods are causing their discomfort. Bringing this diary to your health care provider can help them make a diagnosis.

Some foods that may cause symptoms include fried foods, acidic foods or spicy foods, as well as chocolate, tomatoes, tomato sauce, citrus fruits, onion and garlic.  Alcohol and coffee may also prompt symptoms. On the other hand, increasing one’s intake of lean meat, poultry, tofu, certain fish, oatmeal, brown rice, low-fat dairy, and certain fruits and vegetables may improve symptoms. A personalized dietary approach is typically recommended.

Eating habits

Altering one’s eating habits may also help prevent heartburn. Because eating too quickly can increase the chances of acid reflux, eating meals at a slower pace may lower this risk. Larger meals also tend to prompt heartburn. Reducing portion size and eating smaller-sized meals throughout the day may help prevent acid reflux. Avoiding nighttime snacking or meals right before bed may also improve symptoms.

What we do after we eat can also make a difference. Once you’ve finished a meal, try to remain sitting up for about three hours before lying down. It may not be as relaxing as lounging on the couch, but lying down right after eating makes it easier for the contents of your stomach to move backward into the esophagus.

Sleep position

Symptoms of GERD may affect sleep, but sleep position may also affect the risk of nighttime heartburn. Instead of lying flat in bed, elevate the head of the bed to allow gravity to help keep the stomach contents in the stomach.

Sleeping on the left side instead of on their right may also help. Right-side sleeping has been linked with a greater incidence of reflux at night because of how the esophagogastric muscles are positioned when sleeping on our right. It may also take more time for acid to clear from the esophagus when patients sleep on their right side compared to sleeping on their left side, back or stomach.

Other lifestyle modifications

Two important lifestyle changes for GERD include losing weight if you are overweight or obese and quitting smoking if you smoke. In addition, increasing physical activity and avoiding tight-fitting clothing, especially around the waist, may help.

Over-the-counter medications

While prescription medications are sometimes recommended, proton pump inhibitors (PPIs), antacids and histamine-2 (H2) blockers are over-the-counter (OTC) medications that may relieve heartburn. Here’s how each of these medications works and some side effects. Talk to your health care provider or pharmacist about potential drug interactions before taking these medications, and follow all dose instructions on the label.

Proton Pump Inhibitors (PPIs)

Proton pump inhibitors (PPIs) suppress stomach acid production and may be recommended if antacids are ineffective. Unlike fast-acting antacids, PPIs can take a few days before patients experience full symptom relief. These medications are intended for people who experience heartburn at least twice a week. Consult with a health care provider or pharmacist before taking PPIs. PPIs should not be taken long-term without consulting a health care provider.

Commonly used PPIs include Nexium 24HR (esomeprazole), Prevacid 24HR (lansoprazole), and Prilosec OTC (omeprazole magnesium).

Antacids

Antacid medications relieve symptoms by reducing the acidity of stomach acid. Many come as liquids or tablets. Antacids are used for on-demand heartburn relief. These medicines should be used when experiencing symptoms or as directed by a health care provider. Liquid antacids tend to kick in more quickly than tablets, although tablets may be more user-friendly. The onset of action for antacids depends on the dose, dodge forms and the extent of chewing (for tables).

Antacids fall into one of five categories based on their active ingredients: magnesium hydroxide, aluminum hydroxide or calcium carbonate.

Some examples of antacid products include TUMS Antacid Chewable Tablets, Ultra Strength for Heartburn Relief and Wonderbelly Chewable Antacid, Tropical Fruit.

H2 blockers

Instead of neutralizing stomach acid like antacids do, histamine-2 (H2) blockers minimize stomach acid production for several hours. They do this by blocking the body’s activity of histamine, which plays a role in activating stomach acid secretions after eating. Patients usually start to feel the effects within one to three hours of taking these medications. Consult with a health care provider or pharmacist before taking H2 blockers as they can interact with other drugs and may cause side effects, such as diarrhea, headache, drowsiness and more.

Surgical options

For some patients, preventative lifestyle changes and medications may not be effective. In these cases, surgical treatment options may be explored. Fundoplication surgery is the most common surgery used for long-term GERD relief.

In this surgery, the surgeon makes small incisions in the abdomen and surgically attaches the top of the stomach to the base of the esophagus. This creates pressure on the lower esophageal sphincter (LES) to help it constrict and prevent gastric backflow. For open fundoplication procedures, a larger surgical incision is made. Patients may experience scarring following fundoplication surgery, meaning they may develop an esophageal sphincter or will be unable to vomit, so they will need to stick to a liquid diet as soft foods are slowly reintroduced over the course of several weeks.

When to see a health care provider

Lifestyle modifications and OTC medications may be effective in getting rid of heartburn, but anyone with persistent heartburn should be evaluated by a health care provider. Untreated GERD may cause esophagitis, esophageal cancer, or chronic scarring of the lungs. Additionally, it could be a sign of a more serious underlying health condition. Anyone experiencing persistent heartburn should seek a medical consultation from a health care provider.

Warning signs

Go to the emergency room if there are serious warning signs such as vomiting blood, trouble swallowing or bowel movements that produce dark stool. Alarm features suggestive of a gastrointestinal (GI) malignancy include the new onset of heartburn in patients over 60 years of age, evidence of GI bleeding (vomiting blood, dark stools, blood in stools), iron deficiency anemia, weight loss, difficulty swallowing, pain with swallowing, persistent vomiting, and a family history of GI cancer.

 The same is true if there is severe chest pain, particularly if pain comes on after exercising or spreads to other areas of the body, which may indicate a heart attack. "I never advise that patients who are experiencing chest pain for the first time chalk it up to heartburn,” says Dr. Kruszewski. “If you're experiencing chest pain, it's important to seek care from a health care right away, and not attempt to self-diagnose."

Diagnostic tests

In addition to discussing symptoms and medical history, health care providers may use various tests to rule out any alternate health problems and confirm a diagnosis. Using a tube attached to a small camera, an upper endoscopy may be performed to get a look at the inside of the esophagus, stomach and small intestine. During the procedure, a small esophageal tissue sample may be extracted for biopsy testing. These test results can give health care providers a good idea of whether the esophagus has been damaged or if another medical condition may be the underlying cause.

Esophageal pH monitoring is another test health care providers may use. Using a catheter or an endoscope, these tools detect acid in the esophagus. The test lasts between 24 to 48 hours, and allows a health care provider to track when changes in pH occur, such as during sleep or with specific foods.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.