Heartburn — a short-lived burning pain that rises up from your stomach, often after a large meal — is a symptom of gastro-oesophageal reflux (GOR). Heartburn occurs when acid from your stomach enters the lower part of your oesophagus (the food pipe that connects your mouth with your stomach). Heartburn can be occasional and of little concern to you, or it may be troublesome every day.
How often heartburn occurs and how much it impacts on your life help determine the type of treatment that is appropriate for you.
The following changes can benefit most people who get heartburn, even when heartburn medicine is also prescribed.
- Losing weight, if you need to. If you are overweight, losing some weight can reduce your heartburn or, in some people, even eliminate it.
- Avoiding large meals. Heartburn often occurs after eating a large meal, but may not occur when you eat smaller servings.
- Recognising and avoiding foods that cause you heartburn. Foods that trigger heartburn vary among different people, but common triggers include spicy foods, fatty foods, alcohol, tomatoes, orange juice, coffee and chocolate. Keep a food and symptom diary to work out which foods are your heartburn triggers and try to avoid them.
- Avoiding lying down soon after a meal, or bending or straining (e.g. lifting).
- Giving up smoking.
- Elevating the head of the bed. This can help people who get heartburn during the night.
Certain medicines, such as some of those used for depression and high blood pressure, can make heartburn worse. Some medicines used to treat arthritis can cause heartburn as a side effect. Ask your doctor if any of your regular medicines are likely to be making your heartburn worse.
If your symptoms do not get better after making the above changes, effective heartburn medicines are also available. However, it's a good idea to keep up these lifestyle changes, even when taking heartburn medicine.
Intermittent medicine use
If your heartburn occurs infrequently and is mild, you may need to take medicine only ‘as needed’ to soothe the symptoms when they arise. These medicines are available over-the-counter from a pharmacy.
Antacids neutralise the acidity of stomach juices and relieve heartburn quickly, although their effect is fairly short-lived. They are taken as a liquid (e.g. Gastrogel, Mylanta) or as a chewable tablet (e.g. Mylanta original tablets, Rennie Spearmint Flavour, Andrews TUMS Antacid) and usually contain aluminium, magnesium and/or calcium salts.
Antacids can interfere with the absorption of many regular medicines, so check with your doctor about their suitability for you.
Some preparations (e.g. Gaviscon, Mylanta Heartburn Relief) also contain alginic acid, which forms a gel (a raft) that floats on top of the stomach juices to impede their regurgitation into the oesophagus.
Also called ‘H2 blockers’, these medicines reduce the amount of acid that is produced in the stomach. They do not relieve heartburn as quickly as antacids, but do have a longer lasting effect. They are taken as a tablet when needed e.g. ranitidine (brand names Zantac Relief, Zantac Relief Extra Strength).
Proton pump inhibitors (PPIs)
These medicines are powerful suppressors of acid production in the stomach — reducing the production of acid in response to food by up to 90 per cent. They can be used as required to treat mild, intermittent symptoms of GOR.
Proton pump inhibitors that are available from pharmacies without a prescription include rabeprazole (Pariet 10), pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief), esomeprazole (Nexium 24HR Once-Daily Dosing) and omeprazole (Maxor Heartburn Relief). These medicines can be used to control symptoms in the short term.
Prescription medicines for heartburn
If your heartburn symptoms occur twice or more per week or your symptoms are severe and impairing your quality of life, see your doctor.
Your doctor may prescribe a medicine to take every day that suppresses acid production in your stomach.
PPIs (proton pump inhibitors)
Proton pump inhibitors are very effective in the majority of people who have troublesome heartburn. Examples include omeprazole (e.g. Losec), esomeprazole (e.g. Nexium), rabeprazole (e.g. Pariet), pantoprazole (e.g. Somac) and lansoprazole (e.g. Zoton FasTabs).
Your doctor may trial you on this medicine for 4 to 8 weeks to see if your symptoms improve. However, if your symptoms do not sound like typical heartburn, or if your symptoms do not improve with this medicine, your doctor may suggest tests such as an endoscopy to further investigate the cause of your pain.
If taking a proton pump inhibitor resolves your heartburn, your doctor may reduce the dose, switch you to intermittent treatment (used as needed), or perhaps even try withdrawing the medicine.
After initial treatment with a proton pump inhibitor, your doctor may prescribe regular or on-demand therapy with H2-antagonists to help control your heartburn. Examples include famotidine (e.g.Pamacid, Pepzan), nizatidine (e.g. Tazac, Tacidine, Nizac), cimetidine (e.g. Magicul) and ranitidine (e.g. Zantac, Rani 2).
Talk to your doctor about the treatment approach that's right for you.
Surgical treatment for heartburn
Occasionally surgery may be performed, which aims to ‘tighten’ the junction between the stomach and the oesophagus, and reduce the amount of acid that enters the oesophagus. This type of surgery is generally reserved for people who still have severe heartburn, despite taking a proton pump inhibitor every day, or for those who do not want to take medicines long term.
2. Keung C, Hebbard G. The management of gastro-oesophageal reflux disease. Australian Prescriber 2016;39:36-9. https://www.nps.org.au/australian-prescriber/articles/the-management-of-gastro-oesophageal-reflux-disease (accessed Mar 2017).