Heartburn is a common problem. It’s caused by the backwash of stomach acid into the esophagus, the tube connecting the mouth and stomach. This is formally called gastroesophageal reflux disease (GERD). More than just a minor discomfort, heartburn can significantly reduce quality of life. “Heartburn can cause damage to the esophagus and even increase the risk of cancer if ignored and untreated,” says Dr. William Kormos, editor in chief of Harvard Men’s Health Watch and a primary care physician at Massachusetts General Hospital.
These eight steps can help ease heartburn.
1. Eat in a heartburn-smart way. Large meals put pressure on the muscle that normally helps keep stomach contents from backing up into the esophagus. The more you eat, the longer it takes for the stomach to empty, which contributes to reflux. Try smaller, more frequent meals and don’t wolf down your food.
2. Avoid late-night eating. Having a meal or snack within three hours of lying down to sleep can worsen reflux, causing heartburn. Leave enough time for the stomach to clear out.
3. Don’t exercise right after meals. Give your stomach time to empty; wait a couple of hours. But don’t just lie down either, which will worsen reflux.
4. Sleep on an incline. Raising your torso up a bit with a wedge-shaped cushion may ease nighttime heartburn. Wedges are available from medical supply companies and some home goods stores. Don’t just prop your head and shoulders up with pillows. Doing so can increase pressure on the stomach by curling you up at the waist.
5. Identify and avoid foods associated with heartburn. Common offenders include fatty foods, spicy foods, tomatoes, garlic, milk, coffee, tea, cola, peppermint, and chocolate. Carbonated beverages cause belching, which also causes reflux.
6. Chew sugarless gum after a meal. Chewing gum promotes salivation, which helps neutralize acid, soothes the esophagus, and washes acid back down to the stomach. Avoid peppermint gum, which may trigger heartburn more than other flavors.
7. Rule out medication side effects. Ask your doctor or pharmacist whether any of the medications you take might cause pain resembling heartburn or contribute to reflux.
8. Lose weight if you need to. Being overweight puts more pressure on the stomach and pushes stomach contents into the esophagus. Tight fitting clothing and belts that come with weight gain may also be a factor.
When to consider medication
If the lifestyle steps above don’t get heartburn under control, the most effective treatment is a type of drug called a proton pump inhibitor (PPI). It works by drastically reducing acid secretion by the stomach. You can get some PPIs over-the-counter — for example lansoprazole (Prevacid) and omeprazole (Prilosec). Others are available by prescription only.
A PPI can get heartburn under control, but many people end up taking one indefinitely. This isn’t ideal since research has linked PPIs to increased susceptibility to bacterial infection and long-term risk of hip fracture, among other potential risks.
After a PPI cools your heartburn symptoms, ask your doctor if you can taper it off and then combine good preventive measures with targeted use of other medicines to keep heartburn from returning. H2 blockers are good for this purpose. They include cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid).
If your symptoms persist, you may need additional testing such as endoscopy. Reflux sufferers who have damage to the esophagus (esophagitis) or precancerous changes (Barrett’s esophagus) may have to take a PPI indefinitely.