What is the treatment for heartburn?

Your health care provider will recommend treating heartburn in a stepwise fashion. For mild or occasional symptoms, simple lifestyle modifications may be enough. The next step is nonprescription antacids such as Maalox, Mylanta, Tums, or Rolaids. Other treatments include acid blockers and even surgery. In most cases, one or more of these treatments provide relief from heartburn and prevent it from turning into a more serious disease.

I take nonprescription antacids for heartburn, but they don't seem to help.

Nonprescription antacids are only part of the treatment for heartburn. They can work very well, but these antacids alone usually can't stop heartburn. Your health care provider will probably recommend that you make changes in your lifestyle as well.

What kind of lifestyle changes are we talking about?

Try any or all of the following:

• Avoid large meals.



• Avoid caffeine (coffee, teas, some soft drinks).



• Avoid foods or drinks that relax the lower esophageal sphincter such as chocolate, peppermint, caffeine-containing beverages, and fatty or fried foods.



• Avoid foods that may damage the esophagus such as spicy foods, citrus fruits and juices, tomatoes and tomato sauces, or any food that causes symptoms.



• After eating, avoid activities that force acid back into your esophagus. Such activities include lifting, straining, coughing, and wearing tight clothing.



• Use gravity to your advantage. Avoid lying down for 3 hours after a meal. If you suffer from nighttime heartburn, elevate the head of your bed when sleeping. Place 6-inch blocks underneath the head of the bed, or place a wedge under the mattress. Simply using more pillows under your head will not help. In fact, it may increase heartburn because it increases pressure on your stomach.



• Lose weight if you are overweight.



• Stop smoking.



• Limit alcohol intake.

Will these changes stop the heartburn?

They may. If they don't, adding a nonprescription antacid can be helpful.

How do antacids work?

Antacids work by neutralizing acid. They should be taken 1 hour after meals or when heartburn symptoms occur. Liquid antacids usually work faster than tablets or chewables.

Antacids are useful because they relieve heartburn rapidly, especially if it is caused by foods or certain activity. But relief is only temporary. Over-the-counter antacids do not prevent heartburn from returning or allow an injured esophagus to heal. If you need antacids for more than 2 weeks, talk with your health care provider to get a better diagnosis of your condition and appropriate treatment.

Most varieties of antacids you can buy in drugstores are combinations of aluminum hydroxide and magnesium hydroxide. Antacids containing these ingredients may produce unwanted diarrhea or constipation. Antacids containing calcium carbonate are the most potent in neutralizing stomach acid. Popular brands are Tums and Titralac.

When taking antacids, follow label instructions and do not take more than the recommended daily dose. Take antacids after meals and at bedtime-or when you have symptoms.

Always tell your health care provider about your antacid use.

What if lifestyle changes and antacids don't work?

If you still have symptoms after lifestyle modifications and antacids, your health care provider probably will prescribe a stronger drug. The usual choice is one of the histamine-2 (H2) blockers, or acid blockers. These drugs block the biochemical process that creates acid in the stomach.

What are acid blockers?

The name says it all. Acid blockers reduce production of acid by the stomach. Less acid in the stomach means less acid back-up into the esophagus. Some examples are cimetidine (Tagamet), ranitidine (Zantac), and famotidine (Pepcid). Low doses of these drugs are available without a prescription. More potent doses require a prescription. These drugs relieve symptoms within 30 minutes and are taken twice a day.