If you feel uncomfortable in the middle of your chest every time you finish a meal, you may have chronic heartburn. This is when the acid from your stomach leaks up into the tender tissue of your esophagus (food pipe), causing pain and burning. You need treatment. If you don’t control your heartburn, it could damage your esophagus and even lead to cancer. There are some simple ways to make sure this doesn’t happen to you.
Watch What You Eat, Drink, and Do
Making some changes to your lifestyle can go a long way toward easing the pain of heartburn.
Say goodbye to cigarettes. Smoking causes your body to make less saliva, a liquid that helps stamp out stomach acid. That can lead to burning in your esophagus. Tobacco may also cause your stomach to make more acid and relax the muscles at the lower end of your esophagus that can shut down the opening between the stomach and the esophagus. Chewing gum and sucking on lozenges can help you make more saliva.
Avoid trigger foods. For many people, these are spicy and high-fat foods, chocolate, peppermint and other mints, coffee, citrus fruits or juices, tomato products, carbonated drinks, and onions.
Don’t lie down after you eat. If you need an afternoon siesta, snooze upright (or almost upright) in a chair. Eat dinner at least 2-3 hours before you go to bed, and don’t make the last meal of the day your biggest one.
Raise the head of your bed. If the top of your bed is higher than the bottom, it’s harder for the acid to travel up. You can do this with a block of wood under the bed or a foam wedge under the mattress.
Be careful what medications you use. Aspirin, ibuprofen, and other medications, such as some sedatives and blood pressure drugs, can trigger heartburn. Ask your doctor if any of your medications might be causing your symptoms. There may be something else you can take.
Eat several small meals during the day. Your stomach produces acid based on how much food you eat. Less food means less acid. Don’t overload your stomach.
Limit alcohol. Alcohol can relax the muscles around the lower end of your esophagus, making it easier for acid to bubble up.
Stay slim. One study found that overweight people who lost weight were more likely to have their heartburn go away. Another reason to lose weight: You’ll respond better to heartburn medications.
Wear loose clothing. Tight clothing, including belts, can cause stomach contents to push upward.
Relax. Stress causes stomach acid to bubble up.
Treatments
If you have chronic severe heartburn, you may need medications. Both over-the-counter and prescription drugs are available.
Antacids are usually the first type of drugs doctors recommend for chronic heartburn. You can get them over the counter. They work by stamping out the acid in your stomach. Antacids work right away, but they don’t last long. They also don’t help a damaged esophagus heal. Look for products that have both magnesium and aluminum salts. They’re less likely to cause diarrhea and constipation.
H2 blockers are available over the counter and by prescription. Although they don’t kick in as quickly as antacids, they last longer. They work by slowing down how much acid your stomach makes. They include cimetidine (Tagamet) and famotidine (Pepcid, Zantac 360). Ranitidine was removed from the market in 2020 after it was found to contain a cancer-causing agent.
Proton pump inhibitors (PPIs) also block acid production. You can get them over the counter or with a prescription. They are the most potent medication prescribed for acid reflux and are indicated after the bid dosing of H2 blocker fails. They are taken daily because they take up to 4 days for symptom relief.
Ideally, you don't want to stay on any heartburn treatment indefinitely to avoid side effects.
You may need more than one type of medication. Talk to your doctor about the best treatment plan for you. Make sure you’re aware of the side effects of all the medication you take.
Surgery
The most common surgery for extreme heartburn is fundoplication. The surgeon wraps the top of your stomach around the bottom of your esophagus to strengthen it and help keep the acid where it belongs. This often can be done laparoscopically -- it involves only a small cut and typically lets you go home in 3 days or less.
Endoscopic Treatment
The goal of this treatment is the same as surgery. But instead, your doctor puts a thin tube called an endoscope down your throat and into your esophagus. They then use stitches or heat to create scar tissue to tighten the sphincter and stop stomach acid from leaking.
Newer treatments involve using implants (such as the LINX system, which involves titanium beads linked together to form a retaining wall) to keep acid from seeping out of the stomach.
Transoral Incisionless Fundoplication (TIF) is the newest therapy performed with an endoscope, which seems to have good short-term results.
