In most cases, heartburn problems can be resolved through dietary or lifestyle changes or with a short course of an over-the-counter medication. However, severe heartburn that recurs frequently should not be ignored, and you must see a doctor for an accurate diagnosis and proper treatment. (1)

At-home treatment for heartburn

Try the following tips for heartburn relief: (2)

1. Avoid foods that trigger heartburn, such as:
   • Spicy food.
   • High-fat food.
   • Coffee, soft drinks, and caffeinated beverages.
   • Oranges and citrus fruits.
   • Tomatoes and tomato sauce.
   • Chocolate.
   • Peppermint.
   • Onions and garlic.‍
2. ‍Break meals into 5 to 6 small portions throughout the day, and avoid overeating.‍
3. Do not lie down or sleep for at least two hours after eating.
4. Raise your head when you sleep by using 2-3 pillows to prevent acid reflux.‍
5. Avoid smoking, as it is a significant risk factor for heartburn.‍
6. Lose excess weight through diet and physical exercise.‍
7. Wear loose-fitting clothes, especially around the waist and abdomen, and avoid wearing belts, as they can push the acid up.

Heartburn medications

There are 3 main types of heartburn medications, ranked from the least to most potent: (1)(3)

1. Antacids:
   
   • These work by directly neutralizing stomach acid and provide immediate but temporary relief.
   • Suitable for mild cases as they can neutralize excess acid but cannot reduce its production. They are not sufficient alone for treating ulcers or severe inflammation. (In such cases, they may be used temporarily alongside one of the more potent medications below.)
   • They are usually available as liquid or chewable tablets.
   • Examples include: Gaviscon, Rennie, and Tums.

2. H2 receptor blockers:
   
   • These are more potent than antacids as it can reduce stomach acid production and provide relief for up to 12 hours.
   • They usually start working within 15-30 minutes.
   • Available in tablet or capsule form, they are typically taken once or twice a day before meals or at bedtime.
   • Examples include: Zantac (Ranitidine) and Famodar (Famotidine).

3. Proton pump inhibitors (PPIs):
   
   • These are the most potent type of heartburn medication, significantly reducing stomach acid production. They effectively treat ulcers and severe inflammation in the stomach or esophagus. 
   • They start working within an hour, but their effect lasts all day (relief for 24 hours). 
   • Available in tablet or capsule form, they are taken once a day, half an hour before breakfast.
   • Examples include: Nexium (Esomeprazole), Lanzotec (Lansoprazole), and Omeprazole.

Which treatment is best for you?

If you’ve just started experiencing heartburn, don’t jump to medication right away. Start with home remedies first. If they don’t work, try antacids (the simplest medication type) for a short time. If heartburn persists, try H2 receptor blockers for a few weeks before moving on to proton pump inhibitors (PPIs). If heartburn continues even after two weeks of PPIs, consult your doctor for further testing and treatment. (4)

If your heartburn is chronic and requires frequent medication, it’s important to identify and treat the underlying cause. Long-term use of heartburn medications may carry health risks, also heartburn could indicate a more serious condition, such as ulcers or gastritis. (4)

When to see a doctor?

Consult your doctor as soon as possible if: (5)

• Heartburn persists more than 3 times a week for over two weeks, despite treatment.
• You have pain or difficulty swallowing.
• You vomit blood or something that looks like coffee grounds.
• Your stools are black or contain blood.
• You experience neck or chest pain.
• You feel dizzy or short of breath.

With our wide experience in treating digestive problems and our team of top consulting experts, you can rest assured you’re in the best hands! Book an appointment with the Gastroenterology Department at Dr. Soliman Fakeeh Hospital today.

References

1. NIH - Treatment for GER & GERD
2. ChoosingWiselyCanada - Treating Heartburn and Gastro-Esophageal Reflux (GERD)
3. Mayo Clinic - Heartburn
4. Harvard Health - Heartburn medication update
5. AAFP - Heartburn