Heartburn — a short-lived burning pain that rises up from your stomach, often after a large meal — is a symptom of gastro-oesophageal reflux disease (GORD). Heartburn occurs when acid from your stomach enters the lower part of your oesophagus. It 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 ‘burny’ foods. 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 or Rolltabs, 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) 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 no more than twice a day when needed e.g. ranitidine (e.g. Zantac Relief) and famotidine (e.g. Pepzan).
Proton pump inhibitors
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 GORD.
Low-dose proton pump inhibitors that are available from pharmacies without a prescription include rabeprazole (Pariet 10) and pantoprazole (Salpraz Heartburn Relief, Somac Heartburn Relief, Suvacid Heartburn Relief). Omeprazole (Maxor Heartburn Relief) is a proton pump inhibitor that is available in standard dose from pharmacies without a prescription. These medicines can be used to control symptoms in the short term.
Regular or long-term medicine use
If your heartburn symptoms occur twice or more per week or your symptoms are impairing your quality of life, see your doctor.
Your doctor will be able to prescribe a medicine to take every day that suppresses acid production in your stomach.
Proton pump inhibitors
Proton pump inhibitors can be taken long-term, and 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).
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 using 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.
However, many people find that their symptoms return when they stop taking their medicine and that taking daily acid-suppressing medicine long term is the only way to control their heartburn effectively.
Continuous medication with a proton pump inhibitor is likely to resolve your symptoms completely or almost completely.
After initial treatment with a proton pump inhibitor, your doctor may switch you to regular or on-demand therapy with H2 -antagonists to control your heartburn. Examples include famotidine (e.g. Pepcidine), nizatidine (e.g. Tazac) and ranitidine (e.g. Zantac).
Talk to your doctor about the treatment approach that's right for you.
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.
Last Reviewed: 1 June 2011
1. Gastro-oesophageal reflux (revised February 2011). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2011 Mar. http://online.tg.org.au/complete/ (accessed May 2011).
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