You're starting to notice that it's not only obvious things -- like too much spicy food or coffee -- that trigger painful heartburn symptoms. Now you're getting heartburn in the middle of the afternoon, just working at your desk, or sitting on the sofa at home. Sometimes you wake up at night with pain in the back of your throat and that awful taste of yesterday's dinner. You groan: not again. Sit up in bed and wonder: Is this more serious than simple heartburn?
Is It Acid Reflux Disease?
"If someone's experiencing frequent heartburn, first I'd look at their eating pattern," says Tara O'Brien, PharmD, a pharmacy manager at Pharmaca in Seattle, a national, integrative pharmacy combining Western medicine with self-care. "It could be from a lot of different things: diet, size of your meals, how frequently or infrequently you're eating," she says.
If you have frequent heartburn and you're not seeing your doctor or pharmacist for heartburn relief, you may be flirting with trouble. Your heartburn may be a sign of deeper trouble -- more than a grouchy stomach rebelling against a big, spicy meal.
You may have acid reflux disease, also called GERD, a condition that makes food and stomach acid "burp" back up into the base of your esophagus (the tube that carries food from your mouth to your stomach). People with acid reflux often have a too-weak or too-relaxed LES muscle -- that's the tiny muscle at the base of your esophagus that closes to keep food in your stomach after swallowing.
If the LES is less strong, up comes the food -- along with the burning, acidic irritation in your chest that we call "heartburn." Left untreated, frequent acid reflux can lead to chronic gastroesophageal reflux disease, or GERD, says the American Gastroenterological Association (AGA).
Stop Heartburn and Acid Reflux
Fortunately, you have several options for heartburn relief:
- Try eating smaller meals, and don't eat two to three hours before bedtime.
- Avoid foods that may trigger heartburn, such as fried food, citrus, tomato, spices, peppermint, chocolate, and carbonated drinks.
- Cut back on alcohol and caffeine.
- Stop smoking if you smoke.
- Lose weight if your doctor says you're overweight.
- Cut back on aspirin and pain relievers if you take them often.
Talk with your pharmacist about other self-care tips you can use. If changing your style of eating isn't enough, consider trying one of these heartburn medications.
Over-the-Counter (OTC) Antacids
The same OTC antacids can work for frequent heartburn as well as rare heartburn symptoms, says O'Brien. Most antacids - such as Maalox, Rolaids, and Tums -- contain calcium carbonate, which neutralizes stomach acid. Antacids can also be aluminum or magnesium based. Aluminum-containing antacids have a tendency to cause constipation, while magnesium-containing antacids tend to cause diarrhea.
Another group of drugs works by blocking how much stomach acid you produce. Not as fast-acting as antacids, these acid blockers last longer and can be effective for several hours at a time, says the AGA. Over-the-counter (OTC) acid blockers include Axid, Pepcid, Tagamet, and Zantac. These medications are also available in prescription strength if the milder, OTC forms don't provide enough relief.
These drugs block one type of histamine, produced by your stomach, which in turn blocks acid production. Histamine blockers are typically taken twice a day, 30 to 60 minutes before eating to be most effective, says O'Brien. They're best used as a preventive measure rather than sudden, fast relief of symptoms, she says.
Proton Pump Inhibitors (PPIs)
Proton pump inhibitors, or PPIs, shut down tiny proton pumps in the stomach that produce acid, lowering acid levels dramatically. They're often used when histamine blockers don't provide enough relief or you have erosions in the esophagus or other complications from GERD. One proton pump inhibitor, Prilosec, is available over the counter. Others, such as Aciphex, Nexium, Prevacid, Protonix and stronger Prilosec require a doctor's prescription. Another PPI product consists of a combination of omeprazole and sodium bicarbonate (Zegerid). PPIs (except for Zegarid) are best taken an hour before meals.
Other Heartburn Treatment
Reglan is another prescription drug that works to stop acid reflux by speeding up how quickly your stomach empties. Reglan strengthens the digestive contractions that move food through your esophagus. Faster digestion means less heartburn.
Gaviscon, an over-the-counter heartburn treatment, works as both an antacid and a foam barrier where your esophagus empties into the top of your stomach. You swallow the tablet, the antacid neutralizes excess stomach acid, and the foaming agent creates a physical barrier that helps prevent acid reflux.
Call Your Doctor or Pharmacist If:
Here are some warning signs to trigger a call to your doctor or pharmacist, from the American Gastroenterological Association:
- You're using more than the package directs for any heartburn treatment.
- You've been using OTC antacids for a prolonged time.
- Your symptoms aren't relieved, no matter what you do.
One final precaution: Always talk to your doctor about any chest pain that you may have. Sometimes a mild heart attack can masquerade as heartburn, and people have ignored chest pain that was really a heart attack.