How to deal with heartburn

Consumer Reports has no financial relationship with any advertisers on this site. Most of us have experienced the burning sensation of heartburn at least occasionally, perhaps after eating a lot, eating too quickly or indulging in a spicy meal. Heartburn, which is caused by acid reflux — when stomach contents back up into your esophagus and even mouth — also tends to crop up more often as we get older. “Your esophageal sphincter, the muscle that prevents acid from rising up into your esophagus, loses tone as you age,” says Yi Qin, a gastrointestinal specialist at Cleveland Clinic. In addition, she says, as you age or gain weight, you’re more vulnerable to a hiatal hernia, where the upper part of the stomach protrudes up through the diaphragm and into the chest cavity. Both stimulate acid reflux and heartburn. Advertisement “Many cases of heartburn can be eased with simple lifestyle strategies and short-term use of over-the-counter medications as needed,” says Michael S. Smith, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York. But chronic heartburn — more than twice a week — can require more serious steps. That’s because it may signal a condition called gastroesophageal reflux disease (GERD), says Kyle Staller, a gastroenterologist at Massachusetts General Hospital in Boston. In addition to heartburn, GERD can cause chest pain, a dry cough, shortness of breath or difficulty swallowing, and it can damage your esophagus or even raise your risk of esophageal cancer. <b>Lifestyle changes</b> Lifestyle measures can be quite effective at keeping heartburn at bay in the first place. A 2021 Harvard study published in JAMA Internal Medicine found that women who maintained a healthy body weight; didn’t smoke; got 30 minutes of exercise daily; limited coffee, tea and soda to no more than two cups a day; and ate a “prudent diet” — rich in fruits, vegetables, whole grains and fatty fish — were almost 40 percent less likely to develop new heartburn. Advertisement It’s wise to avoid lying down for two to three hours after you eat to prevent stomach acid from rising in your esophagus and causing heartburn. “I recommend patients elevate the head of their bed, which takes advantage of gravity to keep acid in your stomach,” says Jacob Kurlander, a gastroenterologist at the University of Michigan in Ann Arbor. (Do this by placing a foam wedge at the head of your bed. Adding more pillows will elevate only your head and neck, which often isn’t effective.) And try sleeping on your left side, which keeps stomach fluid away from your esophagus, Qin says. <b>For occasional heartburn</b> If you have heartburn once or twice a week, it’s generally fine to handle it on your own, Staller says. Start by looking at when it seems to occur. For some people, consuming things like caffeine, fatty food, chocolate, alcohol or peppermint may trigger it. “If you notice heartburn after you eat certain foods, try to avoid them,” he says. Advertisement To cool the burning sensation, you can try an over-the-counter antacid, such as calcium carbonate (Tums and generics) or aluminum hydroxide and magnesium hydroxide (Maalox and generics). “They work quickly to neutralize the acid in your stomach and esophagus,” Smith says. But the effects usually last only 30 to 60 minutes. If you have heartburn primarily after eating and it tends to last longer than an hour, Smith recommends OTC drugs known as alginates. (Two popular ones are Gaviscon and Reflux Gourmet.) He says they’re like a buffer between your esophageal wall and stomach acid. For even longer-term relief, you might consider the occasional use of an OTC H2 blocker such as cimetidine (Tagamet and generic) or famotidine (Pepcid, Zantac and generic). They reduce the production of stomach acid, and their effect can last several hours. <b>When to see a doctor</b> If you’re over age 60 and have never had heartburn but suddenly do, see a doctor, even if your discomfort is only occasional. Your doctor may want to rule out inflammation, precancerous changes or esophageal cancer. Advertisement Do you have heartburn more than twice per week? It’s also wise to check in with your health-care provider, who may suggest a trial of a proton pump inhibitor (PPI). These are OTC or prescription-strength drugs such as lansoprazole (Prevacid and generic), esomeprazole (Nexium and generic) or omeprazole magnesium (Prilosec and generic) that block a pump in the stomach that produces stomach acid. Avoid lying down for two to three hours after you eat to prevent stomach acid from rising in your esophagus and causing heartburn. Some research suggests a connection between long-term use of these drugs and bone fractures, serious infections and chronic kidney disease, although they’re not common side effects. Still, using them for a couple of weeks is usually safe, says Fouad Moawad, a gastroenterologist at the Scripps Clinic in San Diego and a spokesperson for the American Gastroenterological Association. And most of the research done so far on potential harm has been observational, which doesn’t prove cause and effect. <b>Who needs meds long term?</b> If you try a two-week course of PPIs and your symptoms don’t improve or they go away and then return, your doctor may want to do an endoscopy, Moawad says. In this procedure, a small, flexible tube with a camera on it is passed through your mouth into your esophagus to examine it closely for reflux-related damage. Advertisement “If you have severe reflux,” Staller says, “you may actually see an ulceration of your esophageal lining.” Your doctor may also want to take a tissue sample (a biopsy) to check for a condition called Barrett’s esophagus or even for esophageal cancer. Barrett’s esophagus, marked by damage to cells that line the esophagus, raises your risk for esophageal cancer. “If we see damage to your esophagus, you will need long-term therapy to reduce your risk for more damage or even cancer,” Moawad says. In these cases, the benefits of an extended use of a PPI — indefinitely, if you have Barrett’s esophagus — outweigh the risks, he says. If testing reveals you have no esophageal damage from GERD but you continue to have frequent, severe heartburn, talk with your doctor about the pros and cons of using a PPI long term. Advertisement Your doctor may also suggest that you switch to the newer prescription acid blocker vonoprazan (Voquezna) for a number of weeks or even months. It’s effective at reducing stomach acid and relieving GERD-related heartburn symptoms, but Moawad says it may carry the same potential health risks as PPIs. Whether you’re taking a PPI or Voquezna, your doctor should regularly check to determine whether you still need the drug or can be weaned off it. The American Gastroenterological Association advises that people take the lowest effective dosage for the shortest time possible. These meds are often used for longer than necessary. <b>If you’re having trouble swallowing</b> Can you have reflux without the heartburn? It’s possible. Some older adults may have atypical or “silent” reflux, or laryngopharyngeal reflux (LPR). Symptoms can include a chronic sore throat or cough, hoarseness, trouble swallowing, or “even the sense you’ve got something stuck in your throat,” says Kurlander. If you have any of these, testing to measure the amount of acid passing from your stomach into your esophagus can help determine whether reflux is the cause. Lifestyle steps like maintaining a healthy weight may help. If they don’t, your doctor may suggest a short course of meds to reduce acid production. Copyright 2024, Consumer Reports Inc.