Effective Treatment of Heartburn

Nearly everyone has heartburn occasionally. It can be a temporary condition, or one that becomes chronic. Although it can be treated easily with changes in diet, lifestyle, and over-the-counter (OTC) medications, it can also be a symptom of more serious problems.

When you swallow food, the sphincter muscle at the lower end of your esophagus relaxes and opens to admit food to your stomach. The muscle then closes to prevent stomach acid from washing back up the esophagus.

Heartburn—usually a painful, burning sensation in the chest after a heavy meal, or while bending over, lying on your back, or lifting—occurs when the sphincter doesn't close completely. Acid from the stomach comes back up into the esophagus, causing a burning sensation. Other symptoms may include chronic cough, chronic sore throat, persistent hiccups, sensation of having lump in the throat, and trouble swallowing. Pregnant women often experience heartburn as the growing fetus increases pressure within the abdomen.

More serious conditions

Heartburn that won't go away needs medical attention because it may be a symptom of gastroesophageal reflux disease (GERD). The lining of the esophagus may also be irritated by medication (esophagitis), Barrett’s esophagus, cancer of the esophagus,  ulcers, or other gastrointestinal problems. Chest pain, for instance, can be a symptom of GERD, esophageal spasm, angina, or heart attack. Pain from any of these can occur following a heavy meal. So, if you suffer from severe or chronic heartburn or chest pain, it's vital to find out if your problem is digestive or heart-related.

In men, it's usually fairly easy to tell the difference between a heart attack and heartburn: The symptoms of a heart attack include crushing chest pain. But in women, the symptoms of a heart attack may include heartburn, as well as vomiting and nausea. If you are a woman, particularly one who is postmenopausal, and you have heartburn, don't wait to seek medical help.

You can do many things to reduce or relieve heartburn symptoms. The self-care steps below will help reduce acid levels in your stomach, reduce pressure on your stomach and esophagus, and neutralize the effects of acid.

Self-care steps for heartburn

• Avoid foods and beverages that aggravate the problem. The most common irritants are caffeinated beverages, alcohol, fried and high-fat foods, chocolate, tomato products, and citrus juices.

• Avoid eating within four hours of bedtime and drinking within two hours of bedtime.

• Don't wear tight-fitting clothes.

• Don't smoke.

• Don't overeat. Try eating smaller, more frequent meals.

• Make mealtimes relaxed. Eat slowly and chew thoroughly.

• Lose weight if you're overweight to reduce the pressure on the esophagus.

• Loosen or remove tight-fitting clothing when you eat.

• Don't lie down immediately after eating.

• Sleep with the head of your bed elevated. (Put the legs at the head of the bed on four- to six-inch blocks, or slip a wedge support under the mattress.)

• Avoid aspirin, ibuprofen, and other arthritis medications, except acetaminophen. 

• Avoid antacids that contain aluminum if you are a dialysis patient.

• Drink lukewarm—not cold—water with your meals. 

OTC medications

Effective OTC medications are available to treating heartburn and GERD:

• Antacids. These often provide quick but short-lived relief. Antacids are available as calcium (for example, Tums); sodium bicarbonate; magnesium (for example, Milk of Magnesia); and aluminum compounds (for example, Amphogel). Maalox and Mylanta contain both aluminum and magnesium, which balance the side effects of diarrhea and constipation. Avoid antacids that are high in sodium if you have high blood pressure and heart disease. A common side effect of magnesium compounds is diarrhea. Constipation is a common side effect of calcium and aluminum compounds. Antacids can prevent the absorption of other medications, or they can increase the potency of other drugs. To avoid these interactions, take the other drugs an hour before or three hours after taking an antacid. Sodium bicarbonate may provide quick relief, but because of its high sodium content, it isn't suitable for repeated use.

• Histamine (H2) receptor blockers. These medications decrease the production of stomach acid.  OTC H2 blockers include famotidine (Pepsid), cimetidine (Tagamet), and ranitidine (Zantac). These drugs can interact with other drugs, so make sure your health care provider knows if you are taking these drugs.

• Proton pump inhibitors. This potent group of drugs stops the production of acid in the stomach. Currently, only one OTC medication is available: omeprazole (Prilosec OTC). Other proton pump inhibitors are available by prescription.

Because these medications may mask the symptoms of serious disease, it is extremely important that you first know you do not have a serious problem. Before using OTC H2 blockers or proton pump inhibitors, you should talk with your doctor if you have had trouble swallowing, heartburn for more than three months, chest pain, wheezing (with a history of heartburn), stomach pain, nausea or vomiting, blood in your stool, or unexplained weight loss. When taking these medications, see your health care provider if symptoms have not eased after 14 days.

At the doctor's

If you can't control your symptoms, see your doctor, who can determine if stomach acid is the problem. If it is, your doctor may prescribe an eight-week trial period of dietary restrictions, plus medication.