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Symptoms and causes of heartburn
Heartburn happens when your esophagus becomes irritated due to stomach acid. You can stop heartburn instantly with over-the-counter medications like antacids.
Heartburn happens when your esophagus — the tube that joins your throat to your stomach — becomes irritated due to stomach acid. The pain caused by heartburn can be treated quickly with over-the-counter medicines like antacids.
The main symptoms of heartburn include:
- a burning sensation in the chest
- pain in the chest when bending over
- a hot, acidic, or bitter taste in the throat
- difficulty swallowing
Heartburn symptoms can last anywhere from a couple of minutes to a few hours.
Heartburn is caused by stomach acid backing up into the esophagus. The acid leaks into the tube through a valve called the lower esophageal sphincter (LES), which connects the esophagus with the stomach. If the LES is weak or not tight enough, the acid flows into the esophagus, causing a burning sensation in your chest.
While heartburn is fairly common and can happen to anyone, certain risk factors make you more likely to have it:
- Being overweight
- Use of anti-inflammatory painkillers
- Being pregnant
- Smoking
- Stress and anxiety
- A hiatal hernia
Acidic foods or foods high in fat often trigger heartburn. The most common culprits are tomatoes, citrus fruits, cheese, onions, garlic, chocolate, coffee, and peppermint. Eating spicy or indulgent meals can also cause the condition.
Antacids for heartburn
Heartburn pain can be treated immediately with antacids, the effects of which last a few hours. These are medicines that neutralize the acid in your stomach and come in liquid form or chewable tablets that can be bought over-the-counter. Antacids don't address the root cause of heartburn and should be treated as a temporary, rather than a long-term, solution.
When buying antacids to treat heartburn pain, look for products with the following effective ingredients:
- magnesium trisilicate
- calcium carbonate
- sodium bicarbonate
- magnesium hydroxide
- aluminium hydroxide
- magnesium carbonate
Antacids are best taken after eating food, as this is when you're most likely to get heartburn. Don't take other medications with antacids, because they can affect the efficacy of other drugs. Always follow the instructions on the medication packet.
The most common side effects of antacids are stomach cramps, feeling sick, flatulence, constipation, and diarrhea. Some antacids contain ingredients that aren't safe for people with liver disease, kidney disease, or heart failure, high blood pressure, or cirrhosis. Check with your doctor first if you have these conditions. Some antacids aren't suitable for children under 12 years.
H2-blockers for heartburn
Unlike antacids, Histamine-2 blockers (H2 blockers) target the root cause of heartburn by reducing the amount of acid made by the stomach. H2-blockers may take two to three hours to work and effectively reduce stomach acid for a few hours.
Histamine is a chemical that triggers cells in the stomach, causing them to produce hydrochloric acid, more commonly known as stomach acid. H2-blockers block the histamine receptors, which in turn reduces acid production. Lower dose H2-blockers are available over-the-counter but more potent versions require a prescription. These include:
H2-blockers are recommended for cases where heartburn doesn't go away with lifestyle changes, like avoiding triggering foods or eating fewer rich meals. If heartburn is also accompanied by esophagus inflammation with bleeding, you'll need an even stronger treatment.
PPIs for heartburn
Proton pump inhibitors (PPIs) are not an immediate or short-term treatment for heartburn — they can take one to four days to kick in. PPIs are recommended for people who experience frequent heartburn at least twice a week.
PPIs work by stopping certain stomach cells from producing acid in the stomach. Over-the-counter PPIs are usually recommended as a 14-day course of treatment and can only be used three times a year. They include Zegerid (omeprazole and sodium bicarbonate) and Prilosec (omeprazole magnesium). Check with your doctor first if you take other prescription medications.
The stomach can sometimes produce more acid if you take a PPI for longer than a couple of weeks. Once you stop taking the PPI, your acid levels may be higher than before the course of treatment.
This is known as the rebound period and your heartburn symptoms can get worse during this time. For this reason, it's important to stick to a limited treatment period and step down from PPIs gradually rather than all at once.
Your doctor may suggest certain measures to help you during the rebound period:
- Reducing the dose for a few weeks before stopping
- Changing the way you take the PPI
- Taking alginate to reduce rebound symptoms
- Lifestyle changes
See a doctor if you experience unintended weight loss, regular vomiting, blood when vomiting, or difficulty swallowing while taking a PPI.