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Heartburn

Heartburn is an uncomfortable feeling or burning pain behind the breastbone. It may occur after eating, soon after lying down, when bending forward, or after taking certain medicines.

Heartburn occurs when stomach acid backs up (refluxes) into the tube that leads from the mouth to the stomach (esophagus), causing pain or discomfort behind the breastbone, in the center of the chest, and occasionally in the back of the throat. Sometimes there may be a sour or bitter taste in the mouth.

Antacids or other nonprescription medicines (such as acid reducers or acid blockers) may relieve heartburn.

Heartburn can be a symptom of gastroesophageal reflux disease (GERD).

  • Symptoms

    Heartburn

    Heartburn from stomach to esophagus

    Heartburn is a feeling of burning, warmth, heat, or pain that often starts in the upper abdomen just beneath the lower breastbone (sternum). This discomfort may spread in waves upward into your throat, and you may have a sour taste in your mouth. Heartburn is sometimes called indigestion, acid regurgitation, sour stomach, or pyrosis.

  • Controlling heartburn

    Changing your habits to control heartburn from GERD

    Symptoms of gastroesophageal reflux disease (GERD) can be painful and, if allowed to continue, can lead to complications including esophagitis. Esophagitis is irritation or inflammation of the esophagus.

    You can make changes to your lifestyle to help relieve your symptoms of GERD. Here are some things to try.

    • Change your eating habits.
      It's best to eat several small meals instead of two or three large meals. After you eat, wait 2 to 3 hours before you lie down. Late-night snacks aren't a good idea. Chocolate, mint, and alcohol can make GERD worse. They relax the valve between the esophagus and the stomach. Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people. If your symptoms are worse after you eat a certain food, you may want to stop eating that food to see if your symptoms get better.
    • Do not smoke or chew tobacco.
    • Raise your bed If you have GERD symptoms at night.
      Put the frame on blocks or place a foam wedge under the head of your mattress to raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm). (Adding extra pillows does not work.)
    • Avoid or reduce pressure on your stomach.
      Don't wear tight clothing around your middle.
    • Lose weight if you need to.
      Losing just 5 to 10 pounds can help.

    Changing your sleep habits to control heartburn from GERD

    Here are some things you can try.

    • Raise the head of your bed 6 in. (15 cm) to 8 in. (20 cm).
      This will help keep stomach acid from flowing into your esophagus when you are sleeping. You can do this by putting blocks underneath your bed frame or by placing a foam wedge under the head of your mattress. Using extra pillows will not work.
    • Wait 2 to 3 hours after you eat before you lie down.
      Lying down soon after eating will also increase the chance of getting heartburn. Late-night snacks aren't a good idea.

    Quitting tobacco to control heartburn from GERD

    If you smoke or chew tobacco, stop. The nicotine from tobacco relaxes the valve between the esophagus and stomach (lower esophageal sphincter). This can allow stomach acid and juices, the chemicals that break down food in the stomach, to back up (reflux) into the esophagus, which causes heartburn.

    Because the nicotine in tobacco is addicting, stopping the use of tobacco is more difficult than simply changing a habit. Those who successfully quit using tobacco usually use a combination of these strategies.

    • Seek professional counseling, either by telephone or in person.
    • Use medicines to help overcome the addiction to nicotine.
    • Participate in a proven smoking cessation program.
    • Join a support group of peers who are also quitting or who do not smoke.

    Reducing pressure on your stomach to control heartburn from GERD

    Putting pressure on your stomach may push stomach juices into your esophagus, causing heartburn. Here are some things you can try.

    • Wait 2 to 3 hours after you eat before you lie down.
      When you are lying down, the contents of your stomach can push against the valve between the esophagus and stomach (lower esophageal sphincter). Sitting up allows gravity to help food and stomach juices from the esophagus drain back into your stomach. Late-night snacks aren't a good idea.
    • Avoid tight clothing over your stomach.
      Tight belts, waistbands, or panty hose may push against your stomach and make your heartburn worse.
    • Use care when lifting and bending.
      Bending over tends to increase the amount of stomach acid that can get into your esophagus. When lifting, bend your knees to avoid bending over at the waist.
  • Treatment

    Nonprescription antacids to treat heartburn: Overview

    Many people take nonprescription antacids for mild or occasional heartburn.

    • Antacids are substances that neutralize some of the stomach acid.
    • Some antacids have a foaming agent (alginate) that floats on top of the stomach's contents. This may reduce the amount of acid that comes in contact with your esophagus.

    Examples of nonprescription antacids include:

    • Rolaids.
    • Maalox.
    • Mylanta.
    • Gaviscon.
    • Tums.

    Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful. If you are pregnant, do not take aspirin or medicines that contain aspirin unless your doctor says it is okay.

    Some nonprescription antacids are safe to use during pregnancy to treat heartburn symptoms. Antacids that contain sodium bicarbonate should not be taken by pregnant women because they can cause fluid buildup. And do not use antacids that have magnesium trisilicate, because they may not be safe for your baby.

    If you need to use antacids frequently, talk with your doctor or pharmacist about his or her recommendations and cautions. Be sure to follow the package directions.

  • Self-care

    How can you care for yourself when you have heartburn?

    Home treatment, such as lifestyle changes and nonprescription medicines, may be all that's needed to treat mild to moderate heartburn. But if your symptoms don't get better with home treatment, or if your symptoms occur often, there may be other medical problems may be causing your symptoms.

    Keep a record of your heartburn symptoms before and after you make lifestyle changes or use nonprescription medicines so you can track any improvement or changes.

    Medicines to treat heartburn

    The two main types of medicines for heartburn are antacids and stomach acid reducers.

    Antacids

    Many people take nonprescription antacids for mild or occasional heartburn.

    • Antacids such as Tums, Mylanta, or Maalox neutralize some of the stomach acid. They work for 30 minutes to 2 hours, depending on whether the stomach is full or empty. Liquid or dissolving antacids usually work faster than tablet forms.
    • Some antacids, such as Gaviscon, have a foaming agent (alginate). It acts as a barrier between stomach acid and the esophagus.
    • Antacids such as Pepto-Bismol coat the esophagus and act as a barrier to reflux acid. Pepto-Bismol should not be used for more than 3 weeks. And you shouldn't take it if you can't take aspirin. It may make your tongue or stools black. The black color usually isn't serious. Brushing your teeth and tongue after you take Pepto-Bismol may keep your tongue from turning black.

    Antacids work faster than acid reducers (H2 blockers). But their effect doesn't last more than 1 to 2 hours. H2 blockers can provide relief for up to 12 hours.

    Antacids have side effects. They may cause diarrhea or constipation. And they can interfere with how your body absorbs other medicines.

    Be careful when you take over-the-counter antacids. Many of these medicines have aspirin in them. Read the label to make sure that you aren't taking more than the recommended dose. Too much aspirin can be harmful.

    Stomach acid reducers

    H2 blockers.

    Histamine receptor (or H2) blockers decrease the amount of acid that the stomach makes. This may reduce irritation of the stomach lining and decrease heartburn. Some examples of nonprescription acid reducers are Pepcid AC (famotidine) and Tagamet HB (cimetidine).

    Proton pump inhibitors.

    Proton pump inhibitors (PPIs), such as omeprazole (for example, Prilosec), reduce stomach acid and treat severe heartburn symptoms. These acid-reducing medicines are used when your heartburn hasn't gotten better with other home treatments, antacids, or H2 blockers. You may need to use a PPI for up to 5 days before you have relief of your heartburn. You can buy PPIs without a prescription.

    Cautions

    Many people may use over the counter medicines for occasional heartburn. There are some cautions you should be aware of.
    • If you are pregnant and have heartburn symptoms, be sure to talk to your doctor before you take any heartburn medicines. Some medicines may not be safe to take while you are pregnant.
    • If you use antacids more than just once in a while, talk with your doctor. If you have any health risks, be sure to talk with your doctor before you start to take an antacid. If you have kidney disease, it's even more important to discuss antacid use with your doctor. Regular use of antacids that contain magnesium or aluminum can cause a dangerous buildup of these two substances in people who have kidney disease.
    • Talk with your doctor if you take an H2 blocker for more than 2 weeks.
    • Acid reducers can sometimes change the way other medicines work. If you take prescription medicines, be sure to talk with your doctor before you take a nonprescription acid reducer.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.