How Heartburn Is Treated

Most people experience heartburn occasionally, usually after a meal, but some people have more frequent or serious heartburn. You can use a variety of home remedies, lifestyle changes, and over-the-counter products to relieve this symptom. If you experience heartburn and need to use a heartburn remedy more than twice a week, you should see your doctor. You may have gastroesophageal reflux disease (GERD) and your doctor will be able to recommend more effective treatment, including prescription medications.

Heartburn is also called acid reflux because it occurs when stomach acid comes into contact with the lining of the esophagus, causing irritation. This can happen when the lower esophageal sphincter (LES)—the muscle that opens and closes between your esophagus and stomach—is weakened or relaxed and doesn't do its job properly. Some treatments aim to avoid substances that weaken the LES and physical impairment of its function. Other treatments aim to reduce stomach acid production, buffer it, or avoid irritation of the esophagus.

Home Remedies and Lifestyle

You can alleviate heartburn by avoiding food that causes heartburn and making lifestyle choices that can minimize heartburn.

Don't Smoke

Nicotine relaxes the esophageal sphincter. Smoking also stimulates the production of stomach acid. Stop smoking and avoid secondhand smoke.

Lose Weight If Overweight

Being overweight or obese places pressure on the abdomen and increases the risk of heartburn. Reducing heartburn is one of many health reasons you should aim to keep your weight below a body mass index of 30.

Loosen Your Waistband

Tight clothing around the waist increases abdominal pressure. Belts, pantyhose, and compression garments such as Spanks are common sources.

Avoid Food and Drink Triggers

Some heartburn triggers are common while others will vary for each individual.

  • Drinking alcohol before, during, or after meals can worsen heartburn because alcohol weakens the LES muscle. In addition, drinking alcohol can result in eating more than you intended and making poorer food choices.
  • Avoid foods and beverages that weaken the LES muscle. These foods include chocolate, peppermint, caffeinated beverages, carbonated beverages, alcohol, fatty foods, and greasy or fried foods.
  • Avoid foods and beverages that may irritate the esophagus. These include citrus fruits and juices, tomatoes and tomato-based products, chili peppers, and black pepper.
  • Create a heartburn-friendly diet by keeping a food diary to record which foods are safer for you and which are more likely to trigger heartburn. You may be able to enjoy some foods occasionally or in smaller amounts, while you will find others need to be avoided most of the time.

Eating Habits

Beyond what you eat and drink, how and when you do so may also trigger heartburn.

  • Eat smaller, more frequent meals. Eating large meals increases pressure in the stomach and on the LES muscle. Eating five or six small meals instead of three larger ones is better. Remember not to eat too quickly. Putting your fork or spoon down between bites can help you do this.
  • Don't lie down for two to three hours after eating. If you like relaxing on the sofa reading or watching TV or videos, do so sitting up or at least with your head and shoulders elevated.
  • Don't eat within two to three hours of going to bed. Nighttime heartburn is common and having food still in the stomach can provoke it. You may also eat a smaller meal for supper and you should avoid late-night snacking.
  • Foods and drinks that have been used as natural antacids include bananas and chamomile tea. Fresh ginger and turmeric have also been used traditionally to aid digestion.
  • Chewing gum or sucking on a lozenge or hard candy for 30 minutes after a meal is known to stimulate the production of saliva, which may help relieve heartburn symptoms. Since saliva is alkaline, it can help neutralize the acid. Saliva bathes the esophagus and washes refluxed acid back down to the stomach. However, this solution does not work for everyone as it can result in swallowing excess air, which can result in bloating and an increase in flatulence.
  • Drinking warm liquids or herbal tea after a meal can dilute and flush stomach acid from the esophagus.

Sleeping Habits

Nearly 80 percent of people with heartburn experience heartburn at night. Besides avoiding eating too soon before bedtime, there are ways to calm that burn to get a good night's sleep. Some of these methods include:

  • Sleep with your head and shoulders elevated. Lying down flat presses the stomach's contents against the LES. With the head higher than the stomach, gravity helps reduce this pressure. You can elevate your head a few inches in a couple of ways. Place bricks, blocks, or anything that's sturdy securely under the legs of your bed at the head. You can also use an extra pillow, or a wedge-shaped pillow, to elevate your head.
  • Lie on your left side
  • Wear loose-fitting pajamas

Baking Soda

Baking soda, also known as sodium bicarbonate, is a natural antacid. If you dissolve a teaspoon of baking soda into 8 ounces of water and drink it, it can neutralize stomach acid and temporarily alleviate heartburn caused by acid reflux. There are some drawbacks to this method. When you add baking soda to water, it releases carbon dioxide, causing it to fizz. This fizz can open the LES, letting you burp and helping relieve the pressure from bloating. Unfortunately, opening the LES can also allow the contents of your stomach to reflux up into the esophagus. While many people have used baking soda, there haven't been any clinical trials to support baking soda's effect on heartburn.

Unproven or Disproved Home Remedies

Fans of apple cider vinegar theorize that heartburn occurs because there isn't enough stomach acid. They think taking apple cider vinegar brings the stomach acid level up, allowing the stomach to digest food properly and causing heartburn to subside. However, this is the opposite of what medical experts believe. Doctors recommend taking antacids and medications to reduce stomach acid and control acid reflux symptoms. There are no published clinical trials that support using apple cider vinegar for heartburn, and one master's degree thesis found no difference in using vinegar or a placebo for heartburn. Taking apple cider vinegar undiluted could irritate your mouth and esophagus and erode your tooth enamel as it is very acidic. Dilute it with water if you plan to use it, such as one to three teaspoons of vinegar to a cup of water. Vinegar may interact with other medications you are taking at the same time. Instead of relieving heartburn, the vinegar may actually make it worse. If you are considering using apple cider vinegar as a treatment for heartburn, it is important that you talk to your doctor first.

Drinking cool milk may ease the burn of acid reflux initially. But there may be a rebound action later when this same drink of milk triggers the production of stomach acid or slows down stomach emptying (which also plays a role in heartburn and GERD). This appears to be especially true of whole-fat milk. In GERD diets, skim milk is typically recommended—not as a cure for heartburn, but as part of a heartburn-friendly meal plan.

Over-the-Counter Therapies

You have several options today for OTC remedies for heartburn, some of which were only available by prescription a few years ago. However, it is important to note that these are meant for short-term relief and you should see your doctor for continuing heartburn symptoms.

Antacids

Antacids are commonly used heartburn medications. They may relieve occasional heartburn and indigestion. The active ingredients in antacids neutralize stomach acid, which is what is causing the pain.

Antacids are sold under the following brand names, and each may have different formulations that can have the same or different ingredients:

  • Rolaids: Rolaids is available over the counter in different strengths including Ultra Strength, Extra-Strength, and Regular as well as in different forms, such as soft chews and liquid. All formulations contain calcium carbonate and magnesium hydroxide.
  • Mylanta: Mylanta is an antacid containing aluminum hydroxide and magnesium hydroxide. Mylanta ultra tabs, chewable tablets, and gelcaps contain the antacid calcium carbonate.
  • Tums: The active ingredient in Tums is calcium carbonate, which tends to be stronger and work slightly longer than some antacid products, Calcium carbonate may also increase motility (movement) in the esophagus, lessening the exposure to acid.
  • Gaviscon: Gaviscon contains alginic acid and sodium bicarbonate in addition to the acid-neutralizing ingredients found in most antacids (aluminum hydroxide and magnesium carbonate). The combination creates a foam barrier which floats on the stomach acid. This gel-like barrier displaces the acid pocket present at the junction of the esophagus and stomach and may help reduce the number of reflux episodes. It may also provide longer lasting action against heartburn in people with gastroesophageal reflux disease (GERD).
  • Chooz: This is a sugar-free gum with calcium carbonate antacid. You chew one to two pieces after each meal.

Women who are pregnant should not use antacids that contain sodium bicarbonate or magnesium trisylicate. Discuss any antacid use during pregnancy with your doctor and what you should use for heartburn relief instead.

Antacids are not meant for long-time use. If you're taking antacids for longer than two weeks, then the heartburn may be caused by a more serious medical problem. Consult your doctor for a further evaluation. You should see your doctor even sooner if you're experiencing any symptoms severe enough to interfere with your lifestyle.

Side effects from using antacids are more likely to occur when taken for longer periods or at higher doses than recommended. Side effects such as constipation or stomach gas usually do not require medical attention unless they continue or become bothersome.

Report to your doctor immediately if you experience:

  • A skin rash, itching or hives, swelling of the face, lips, or tongue (which may indicate an allergic reaction)
  • Confusion
  • Headache
  • Irritability
  • Nausea or vomiting
  • Unexplained weakness or tiredness

H2 Blockers

H2 blockers (also called H2-receptor antagonists) are medicines that reduce the amount of acid in the stomach. Histamine-2 stimulates parietal cells in the stomach lining to produce acid. H2 Blockers reduce acid production by blocking signals from histamine that tell the stomach to make acid.

H2 blockers are sold as the following brands:

Side effects when taking H2 blockers are rare. Most people tolerate H2 blockers well when they are taken as directed. Other medical conditions or medications could increase the risks of experiencing side effects.

Side effects that you should report to your doctor or healthcare professional:

  • Allergic reactions like a skin rash, itching or hives, swelling of the face, lips, or tongue
  • Agitation, nervousness, depression, hallucinations
  • Breast swelling, tenderness
  • Redness, blistering, or peeling of the skin, including inside the mouth
  • Dark urine
  • Diarrhea
  • Headache
  • Nausea or vomiting
  • Yellowing of the skin or whites of the eyes

If you have been taking a maximum OTC dose of an H2 blocker for two weeks and you still have heartburn, you should see your doctor.

Proton Pump Inhibitors (PPI)

The proton pump inhibitors (PPIs) work by completely blocking the production of stomach acid. They do this by shutting down a system in the stomach known as the proton pump. In this system, a non-acidic potassium ion is taken out the stomach and replaced with an acidic hydrogen ion. By stopping the action of the pump, acid secretion into the stomach is stopped.

These PPIs are available in nonprescription as well as prescription strength:

  • Nexium 24H (esomeprazole)
  • Prilosec OTC (omeprazole)
  • Prevacid 24H (lansoprazole)
  • Zegerid OTC (omeprazole/sodium bicarbonate)

PPIs are generally taken in a two-week regimen and should not be taken for an extended period. If you need to do this more than once every four months, you should see your doctor.

Side effects of taking PPIs may occur. See your doctor if you experience any of these possible side effects:

  • Headache
  • Diarrhea
  • Constipation
  • Upset stomach
  • Vomiting
  • Stomach pain
  • Cough
  • Cold symptoms
  • Dizziness
  • Mild rash

Report to your doctor immediately if you experience:

  • Severe skin rash with swelling or peeling
  • Hives
  • Swelling of the face, mouth, lips, or tongue
  • Swelling of hands, feet, or ankles
  • Severe diarrhea
  • Hoarseness

Prescriptions

Heartburn is a symptom of GERD. If you see your doctor for frequent heartburn you may be given a prescription for medications used for GERD.

Prescription H2 Blockers

Besides the OTC strength H2 blocker products, you may be prescribed a stronger dosage. Axid (nizatidine), Pepcid (famotidine), Tagamet (cimetidine), and Zantac (ranitidine) are available in prescription strength.

Prescription Proton Pump Inhibitors (PPIs)

Doctors prescribe PPIs to treat people with gastroesophageal reflux disease (GERD), peptic ulcer disease, or other digestive disorders that may cause excess stomach acid.

Prescription proton pump inhibitors are available under the following brand names and may have generic formulations:

  • Prilosec (omeprazole)
  • Prevacid (lansoprazole)
  • Protonix (pantoprazole)
  • Nexium (esomeprazole)
  • Aciphex (rabeprazole)
  • Dexilant (dexlansoprazole)

Prescription PPIs are meant to be taken under a doctor's supervision and only for a limited amount of time. Chronic use of PPIs has been associated with heart attacks, kidney disease, and bone fractures.

Complementary Medicine (CAM)

There are a couple of types of CAM that have some evidence to support their use for heartburn.

Aloe Vera Syrup Products

Aloe vera juice has been used in traditional medicine to heal irritation of the esophagus. It is unwise to use unprocessed aloe vera sap as it contains laxative compounds, but some products are formulated for internal use. AloeCure contains organic aloe juice and is marketed as an all-natural remedy for digestive disorders, including heartburn. Some trials, including a 2015 study, have found aloe vera syrup to be effective for heartburn symptoms. Note that consuming aloe can lower your blood sugar levels. Discuss the use of aloe with your doctor if you have diabetes, hypoglycemia, thyroid disorders, kidney disease, heart disease, or electrolyte abnormalities.

Deglycyrrhizinated Licorice

Deglycyrrhizinated licorice (DGL) is a natural remedy that is sometimes recommended to soothe the symptoms of heartburn and other digestive ailments. Licorice can raise blood pressure and have undesirable effects; as a result, deglycyrrhizinated licorice is sometimes used, since this form of licorice does not seem to have the same side effects. However, you should not use DGL if you have been diagnosed with hypertension and/or are receiving treatment for hypertension. You will find DGL or licorice marketed in chewable tablets, powder, or tea. Scientific studies are few and don't provide enough evidence that licorice is effective against heartburn. However, there are some small studies like one in 2012 that show some positive results.

Keep in mind that supplements and herbal products are not regulated or monitored for purity, safety, or effectiveness.

How to Prevent Heartburn
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