Heartburn

Home Treatment

Home treatment, such as lifestyle changes and non-prescription medicines, may be all that is needed to treat mild to moderate heartburn. However, if your symptoms do not get better with home treatment, or if your symptoms occur frequently and last longer than 2 weeks, see your doctor to find out whether other medical conditions may be causing your symptoms.

Keep a record of your heartburn symptoms before and after making lifestyle changes or using non-prescription medicines so you can discuss any improvement with your doctor. See an example of a heartburn symptom record(What is a PDF document?).

Lifestyle changes to treat heartburn

Try lifestyle changes first to control your symptoms before you take non-prescription medicines. If you take medicines to relieve your heartburn without making lifestyle changes, your heartburn is likely to return.

• Change what and how you eat.
  • Eat smaller meals. Having a very full stomach increases your chances of having heartburn.
  • Do not lie down or exercise for 2 to 3 hours after you eat. When you are sitting up, gravity helps drain food and stomach acid into your stomach. Avoid eating large meals and snacks just before bedtime.
  • Avoid chocolate, fatty or fried foods, and peppermint- or spearmint-flavoured foods.
  • Do not drink alcohol, including beer or wine; coffee and other caffeinated drinks; or carbonated drinks.
  • Limit acidic foods, such as grapefruit, oranges, tomatoes, or vinegar.
  • Limit spicy foods that contain lots of pepper or chilies.
  • Eat foods that are high in protein and low in fat. For more information, see the topic Healthy Eating.
• Decrease pressure on your stomach.
  • Avoid tight clothing. Tight belts, waistbands, and panty hose that press on your stomach may make your symptoms worse.
  • Put blocks underneath your bed frame or use a foam wedge under your mattress to raise the head of your bed 15 cm (6 in.) to 20 cm (8 in.). Using extra pillows to raise your head does not work because pillows cause you to bend at your waist, which squeezes stomach acid up farther and can make heartburn worse.
  • Avoid lying on your right side.
  • Be careful when lifting and bending. Bending over tends to increase reflux. When lifting, bend at the knees.
• Do not take ASA and similar drugs, which can irritate the esophagus and stomach, or take them with food or an antacid. For mild to moderate pain relief, try taking another non-prescription medicine, such as acetaminophen (for example, Tylenol).
• Make sure that you stand or sit up when you swallow pills. Take a few sips of water to moisten your throat before you swallow the medicine. Drink a full glass of water to swallow the medicine. Do not lie down right after you take a medicine.
• Do not smoke or use other tobacco products. Smoking causes the valve between the esophagus and the stomach to relax and not close completely. This allows stomach acid to back up (reflux) into the esophagus.
• Maintain a healthy weight. Lose weight if you are overweight. Being overweight puts added pressure on your stomach and increases the chances that stomach acid will back up into the esophagus. Even losing a few kilograms can decrease your chance of developing heartburn or reduce your symptoms. For more information, see the topic Healthy Weight.
• Avoid alcohol.
• Decrease stress. For more information, see the topic Stress Management.

Medicines to treat heartburn

Note:

If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant. For more information, see the topic Pregnancy-Related Problems.

Antacids

Many people take non-prescription antacids for mild or occasional heartburn. If you use antacids more than just once in a while, talk with your doctor.

• Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
• Some antacids, such as Gaviscon, have a foaming agent (alginate) that acts as a barrier between stomach acid and the esophagus.
• Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks and you should not take it if you can't take ASA. It may make your tongue or stools black. The black colour is usually not serious. Brushing your teeth and tongue after taking Pepto-Bismol may keep your tongue from turning black. If your child or teen gets chicken pox or flu, do not treat the symptoms with non-prescription medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). If your child has taken this kind of medicine and he or she has changes in behaviour with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye's syndrome, a rare but serious illness. Ask your doctor if your child younger than 12 should take these medicines.

Antacids work faster than acid reducers (H2 blockers), but their effect does not last more than 1 to 2 hours. H2 blockers can provide relief for up to 12 hours.

Antacids do have side effects. They may cause diarrhea or constipation. Also, antacids can interfere with how your body absorbs other medicines.

If you have any health risks, talk with your doctor before you start taking an antacid. If you have kidney disease, it is especially important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of magnesium or aluminum in people who have kidney disease.

Stomach acid reducers

H2 blockers

Acid reducers, also called histamine receptor (or H2) blockers, decrease the amount of acid that the stomach makes, which may reduce irritation to the stomach lining and decrease heartburn. Some examples of non-prescription acid reducers are Pepcid AC, Tagamet HB, Zantac 75, or Axid AR. Talk with your doctor if you take an H2 blocker for more than 2 weeks.

Proton pump inhibitors

Proton pump inhibitors (PPIs), such as omeprazole, reduce stomach acid and effectively treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn has not gotten better with other home treatment measures, antacids, or H2 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn but they are safe to use for long-term management. They also are safe to use if you have kidney or liver problems. PPIs are available without a prescription.

Acid reducers can sometimes change the way other medicines work. If you are taking prescription medicines, be sure to talk with your doctor before you take a non-prescription acid reducer.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Heartburn is not relieved by home treatment and medicine.
• Blood appears in your vomit.
• Blood appears in your stools or you have black, tarry stools.
• You have symptoms of mild heartburn for more than 2 weeks.
• Swallowing problems are not improving.
• You continue to lose weight for no reason.
• Your symptoms become more severe or frequent.

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Author:	Jan Nissl, RN, BS	Last Updated: October 15, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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