Antacids and H2 Blockers
Best for: Occasional post-meal heartburn.
How they work: Heartburn occurs when digestive stomach acid migrates to the esophagus, the tube that connects the throat to the stomach. (The acid in the esophagus eventually flows back into the
stomach.) Antacids, like Tums and Maalox, offer 30 to 45 minutes of relief by neutralizing the acid, while H2 blockers, like Pepcid and Zantac, soothe heartburn for six to eight hours by reducing acid production. When taken at the onset of symptoms, both types of medications need about 15 minutes to work, says Lauren Gerson, an associate professor of gastroenterology at Stanford University. Antacids come as chewable tablets or liquids, are cheaper and are good for treating mild symptoms; H2 blockers are pills that may work best for slightly more severe cases. Gerson suggests starting with antacids and, if symptoms persist, moving on to H2 blockers.
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Good to know: Popping an antacid or an H2 before eating suspect foods may help prevent heartburn. Fats are common culprits: They cause the valvelike muscle between the esophagus and the stomach, called the lower esophageal sphincter (LES), to relax, allowing acid to leak. Big meals can also mean trouble. They stretch the stomach, which puts reflux-inducing pressure on the LES. No medicine handy? Try gum. According to a study published in the Journal of Dental Research, chewing gum for half an hour immediately after meals reduced acid levels and heartburn. “The gum increases saliva, which, as you swallow, clears and neutralizes acids,” says study coauthor Rebecca Moazzez, Ph.D., a lecturer and consultant at King’s College London Dental Institute. Opt for sugar-free to help prevent cavities, and avoid mint flavors, which can, in some people, relax the LES and exacerbate the problem.
Bed-Wedge Pillow
Best for: Middle-of-the-night heartburn.
How it works: Acid flows easily when you’re horizontal. So for some people, particularly those with a very relaxed LES, heartburn is a persistent bedtime problem. A bed-wedge pillow, designed specifically for heartburn, keeps the head and the torso up at an angle and uses gravity to keep stomach acid where it belongs. (The slope will differ depending on the brand.)
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Good to know: You can also elevate the head of your bed by placing 6- to 10-inch wood or cement blocks under the two bed-frame legs. Forgoing nightcaps and turndown truffles can help, too: Alcohol and chocolate may worsen heartburn by relaxing the LES. And wait at least two to three hours after the last meal of the day before turning in.
Getting to a Healthy Weight
Best for: Frequent heartburn that doesn’t respond well to drugs.
How it works: “Excess weight may trigger hormonal changes, which could lead to heartburn,” says Gerson. It can also cause a type of hernia that could allow acid to flow upward. A recent study published in the journal Obesity reported that 81 percent of weight-loss–program participants experienced a reduction in gastroesophageal-reflux-disease symptoms, including heartburn. The more pounds shed, the bigger the improvement. Sixty-five percent saw their gastroesophageal issues vanish completely.
Good to know: Focus on healthy behaviors, such as eating smaller meals and reducing fats. Besides leading to weight gain, excess fats increase heartburn risk. And keep this in mind, too: Smoking exacerbates heartburn.
Proton Pump Inhibitors (PPIs)
Best for: Chronic post-meal heartburn.
How they work: These over-the-counter drugs, like Prilosec and Prevacid, are taken every day, regardless of what you eat, and decrease stomach-acid levels around the clock, says Bernard Aserkoff, a gastroenterologist at Massachusetts General Hospital, in Boston. So PPIs are a good alternative for those who would otherwise need to take more than 12 antacids most days of the week (which can lead to diarrhea or constipation).
Good to know: PPIs interfere with calcium absorption, and large doses over a long period of time may increase the risk of osteoporosis. Start by taking them for only two weeks. If heartburn returns after that, see a doctor before continuing with additional doses.
Surgery
Best for: Severe, chronic heartburn.
How it works: If heartburn is affecting your quality of life, this one-to two-hour procedure, called fundoplication, tightens the LES so acid can’t flow back up.
Good to know: The LES may loosen again over time. Up to half of patients still need PPIs post-surgery. It’s a last-resort option, and an overnight hospital stay is required.
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