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Treatment Tips for Severe, Chronic Heartburn

If you have chronic heartburn or acid reflux, try these heartburn treatments from the experts.
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No matter what you eat, you worry that chronic heartburn will always be there. You've tried all the antacids, followed a bland diet, given up on certain foods completely. But still you wake up in the middle of the night, sometimes with pain deep in your throat, other times with a sore throat and trouble breathing, as if you were having an asthma attack. You try to sleep sitting up in a chair, and realize with dismay: This has been going on for years.

Is It Chronic Heartburn or GERD?

When severe heartburn and acid reflux happen nearly all the time, it could be GERD, or gastroesophageal reflux disease, says the American Gastroenterological Association (AGA). GERD is the chronic form of acid reflux, when food and stomach acids "burp" back up from your stomach after eating.

Chronic sufferers often have other symptoms, as well: a sore throat, cough, asthma symptoms, and laryngitis. Left untreated, constant heartburn and GERD can result in permanent damage to the esophagus -- even cancer of the esophagus.

Treatment for Chronic Heartburn

As with any kind of heartburn, start by looking at what you're eating and when, says Tara O'Brien, PharmD, a pharmacy manager at Pharmaca in Seattle, a national, integrative pharmacy combining Western medicine with self-care.

Are you overindulging in spicy foods like tomato sauce and pizza? Citric foods like orange or grapefruit juice? Overly large meals just before bed, or too many cups of coffee or alcoholic drinks? It can't hurt to cut back -- or cut them out completely. Here are a few self-care tips:

  • 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.

When you have chronic heartburn, however, diet and lifestyle changes usually aren't enough to provide relief, O'Brien says. It may be time to find the right medication for your heartburn symptoms.

Over-the-Counter Antacids

Antacids like Maalox, Rolaids, and Tums can all work for occasional heartburn - although they may not be as effective for chronic heartburn.

"Digestion works with a cascade of different chemicals produced when you eat," says O'Brien, "which tell your stomach to produce stomach acid to help digestion." Antacids contain calcium, magnesium, or aluminum to neutralize excess stomach acid. But for chronic, severe heartburn, that may not be enough.

Acid Blockers for Heartburn and Acid Reflux

These drugs work 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 acid blockers include Axid, Pepcid, Tagamet, and Zantac. These brands are also available in prescription strength if the more mild forms don't bring enough relief.

These drugs work by blocking a type of histamine produced by your stomach, which in turn blocks acid production, says O'Brien. These histamine blockers are typically taken twice a day, 30 to 60 minutes before eating to be most effective, she says. Her advice: They're best used as a preventive measure, rather than sudden, fast relief of symptoms.

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