How to Make Heartburn Go Away
The right meds and eating and sleeping habits can help you feel better fast
Most of us have experienced the burning sensation of heartburn at least occasionally, perhaps after eating a lot, eating too quickly, or indulging in a spicy meal.
Heartburn, which is caused by acid reflux—when stomach contents back up into your esophagus and mouth—also tends to crop up more often as we get older. “Your esophageal sphincter, the muscle that prevents acid from rising up into your esophagus, loses tone as you age,” says Yi Qin, MD, a gastrointestinal specialist at Cleveland Clinic. In addition, as you age or gain weight, you’re more vulnerable to a hiatal hernia, where the upper part of the stomach protrudes up through the diaphragm and into the chest cavity. Both stimulate acid reflux and heartburn.
“Many cases of heartburn can be eased with simple lifestyle strategies and short-term use of over-the-counter medications as needed,” says Michael S. Smith, MD, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York City.
But chronic heartburn—more than twice a week—can require more serious steps. That’s because it may signal a condition called gastroesophageal reflux disease (GERD), says Kyle Staller, MD, a gastroenterologist at Massachusetts General Hospital in Boston. In addition to heartburn, GERD can cause chest pain, a dry cough, shortness of breath, or difficulty swallowing, and it can damage your esophagus or even raise your risk of esophageal cancer.
Pointers on Prevention
Lifestyle measures can be quite effective at keeping heartburn at bay in the first place. A 2021 Harvard study published in JAMA Internal Medicine found that women who maintained a healthy body weight, didn’t smoke, got 30 minutes of exercise daily, limited coffee, tea, and soda to no more than two cups a day, and ate a “prudent diet”—rich in fruits, vegetables, whole grains, and fatty fish—were almost 40 percent less likely to develop new heartburn.
It’s wise to avoid lying down for 2 to 3 hours after you eat to prevent stomach acid from rising in your esophagus and causing heartburn.“I recommend patients elevate the head of their bed, which takes advantage of gravity to keep acid in your stomach,” says Jacob Kurlander, MD, a gastroenterologist at the University of Michigan in Ann Arbor. (Do this by placing a foam wedge at the head of your bed. Adding more pillows will only elevate your head and neck, which often isn’t effective.) And try sleeping on your left side, which keeps stomach fluid away from your esophagus, Qin says.
For Occasional Heartburn
If you have heartburn once or twice a week, it’s generally fine to handle it on your own, Staller says. Start by looking at when it seems to occur. For some people, consuming things like caffeine, fatty food, chocolate, alcohol, or peppermint may trigger it. “If you notice heartburn after you eat certain foods, try to avoid them,” he says.
When to See a Doctor
If you’re over age 60 and have never had heartburn but suddenly do, see a doctor, even if your discomfort is only occasional. Your doctor may want to rule out inflammation, precancerous changes, or esophageal cancer.
Do you have heartburn more than twice per week? It’s also wise to check in with your healthcare provider, who may suggest a trial of a proton pump inhibitor. These are OTC or prescription-strength drugs such as lansoprazole (Prevacid and generic), esomeprazole (Nexium and generic), or omeprazole magnesium (Prilosec and generic) that block a pump in the stomach that produces stomach acid.
Avoid lying down for 2 to 3 hours after you eat to prevent stomach acid from rising in your esophagus and causing heartburn.
Some research suggests a connection between long-term use of these drugs and bone fractures, serious infections, and chronic kidney disease, although they’re not common side effects. Still, using them for a couple of weeks is usually quite safe, says Fouad Moawad, MD, a gastroenterologist at the Scripps Clinic in San Diego and a spokesperson for the American Gastroenterological Association. And most of the research done so far on potential harm has been observational, which doesn’t prove cause and effect.
Who Needs Meds Long Term?
If you try a two-week course of PPIs and your symptoms don’t improve or they go away and then return, your doctor may want to do an endoscopy, Moawad says. In this procedure, a small, flexible tube is passed through your mouth into your esophagus to examine it closely for reflux-related damage.
“If you have severe reflux,” Staller says, “you may actually see an ulceration of your esophageal lining.” Your doctor may also want to take a tissue sample (a biopsy) to check for a condition called Barrett’s esophagus, or even esophageal cancer. Barrett’s esophagus, which is marked by damage to cells that line the esophagus, raises your risk for esophageal cancer.
“If we see damage to your esophagus, you will need long-term therapy to reduce your risk for more damage or even cancer,” Moawad says. In these cases, the benefits of an extended use of a PPI— indefinitely, if you have Barrett’s esophagus—outweigh the risks, he says.
If testing reveals you have no esophageal damage from GERD but you continue to have frequent, severe heartburn, talk with your doctor about the pros and cons of using a PPI long term.
Your doctor may also suggest that you switch to the newer prescription acid blocker vonoprazan (Voquenza) for a number of weeks or even months. It’s effective at reducing stomach acid and relieving GERD-related heartburn symptoms, but Moawad says it may carry the same potential health risks as PPIs.
Whether you’re taking a PPI or Voquenza, your doctor should regularly check to determine whether you still need the drug or can be weaned off it. The American Gastroenterological Association advises that people take the lowest effective dosage for the shortest time possible. These meds are often used for longer than necessary.
Trouble Swallowing? What to Do.
Can you have reflux without the heartburn? It’s possible. Some older adults may have atypical or “silent” reflux, or laryngopharyngeal reflux (LPR). Symptoms can include a chronic sore throat or cough, hoarseness, trouble swallowing, or “even the sense you’ve got something stuck in your throat,” says Jacob Kurlander, MD. If you have any of these, testing to measure the amount of acid passing from your stomach into your esophagus can help determine if reflux is the cause. Lifestyle steps like maintaining a healthy weight may help. If they don’t, your doctor may suggest a short course of meds to reduce acid production.
Editor’s Note: This article also appeared in the September 2024 issue of Consumer Reports On Health.
