How to help reflux?

10 Ways to Prevent GERD

“You could drink a cup of coffee, and you could be fine. Someone else could and be symptomatic.”

Top 10 Ways to Prevent GERD

Here are 10 tips you can try to prevent GERD.

1. Lose weight. Obesity is the leading cause of GERD, Dr. Vaezi says. Extra stomach fat places pressure on your abdomen, pushing gastric juices up into your esophagus. “Lose weight if you’re overweight, and don’t gain weight if you’re not,” he says.

2. Avoid foods known to cause reflux. If you’re at risk for GERD, avoid:

  • Fatty foods
  • Spicy foods
  • Acidic foods, like tomatoes and citrus
  • Mint
  • Chocolate
  • Onions
  • Coffee or any caffeinated beverage
  • Carbonated beverages

3. Eat smaller meals. Large meals fill the stomach and put pressure on the LES, making reflux and GERD more likely.

4. Don’t lie down after eating. Wait at least three hours before you lie down after a meal. Gravity normally helps keep acid reflux from developing. When you eat a meal and then stretch out for a nap, you’re taking gravity out of the equation. As a result, acid more easily presses against the LES and flows into the esophagus.

5. Elevate your bed. Raising the head of your bed six to eight inches can help gravity keep gastric acid down in your stomach. You could also use a wedge-shaped support. Don’t use extra pillows, as they only raise your head and will not help with GERD. You need your entire upper body elevated to get relief.

6. Review your medications. There are a number of medications that can increase your risk of GERD, either by relaxing the LES, interfering with the digestive process, or further irritating an already inflamed esophagus. These medications include:

  • Non-steroidal anti-inflammatory drugs, or NSAIDs
  • Calcium channel blockers (often used to treat high blood pressure)
  • Certain asthma medications, including beta-agonists like albuterol
  • Anticholinergics, medications used to treat conditions such as seasonal allergies and glaucoma
  • Bisphosphonates, used to boost bone density
  • Sedatives and painkillers
  • Some antibiotics
  • Potassium
  • Iron tablets

If you are taking any of these medications, talk to your doctor about switching to another drug that does not have the same effect on the upper digestive tract. However, never stop taking a prescribed medication without first consulting your doctor.

7. Quit smoking. Some studies have found that nicotine can relax the muscles of the LES and can also interfere with your saliva’s ability to clear acid out of the esophagus.

8. Cut back on alcohol. As with smoking, alcohol can cause the LES to relax. Alcohol can also cause the esophageal muscles to spasm.

9. Wear loose-fitting clothes. Do not wear tight clothing or belts that can constrict your stomach.

10. Try a gluten-free diet. At least one study has found that gluten, a protein found in grains like barley, rye, and wheat, may cause or exacerbate GERD symptoms. Try eliminating gluten from your diet and see if it makes a difference.

If after trying the above tips, you are still experiencing GERD, see your doctor. There are medications you can take to ease the symptoms of GERD.

Gastroesophageal Reflux (GERD)

Are you troubled with frequent heartburn, difficulty swallowing, or tasting your food again after you’ve swallowed it? Do you have a hard time sleeping after eating, chronic coughing or wheezing, hoarseness or a sore throat at least once a month?

If you experience one or several of these symptoms, you may have a more serious condition than heartburn called gastroesophageal reflux disease (GERD).

Symptoms

Heartburn is a harsh burning sensation, usually located in the center of your chest. The sensation may move through your upper abdomen, chest, throat, or neck.

Food passes from your mouth through the esophagus, the tube connecting your throat to your stomach, and through a valve called the lower esophageal sphincter (LES) into the stomach. The LES is a one-way valve permitting food to pass to the stomach.

This valve normally prevents food from backing up or “refluxing” back into your esophagus. GERD occurs when the valve fails and stomach acids flow back and burn the lower esophagus.

If reflux persists over time, the esophagus becomes irritated and inflamed, causing heartburn and sometimes damage.

Causes

“People are sometimes born with a weak valve,” explains Horacio Asbun, MD, FACS, medical director of the advanced laparoscopic surgery program at John Muir Health. “Others may be affected by eating fatty or spicy foods, taking certain medications, drinking alcohol…”

Sometimes there is a physical abnormality. “Some develop a hiatal hernia when an opening in the diaphragm enlarges and allows a portion of the lower esophagus and upper stomach to move into the opening,” Asbun points out.

For others, the cause is not always clear. Factors that sometimes contribute to GERD include:

  • Obesity
  • Pregnancy
  • Smoking

Treatment

You and your physician can work together to treat GERD through three progressive steps: lifestyle changes, drug therapy, and when needed, surgical intervention.

The first step is to change your diet to reduce or ease symptoms. Certain foods can relax the LES or increase acid in your stomach.

Avoid carbonated drinks, coffee, and tea; chocolate; fatty and fried foods; onions; peppermint; spicy foods; and acidic food like oranges and tomatoes.

Lifestyle changes

To relieve the symptoms of GERD, Dr. Asbun suggests the following steps:

  • Eat several small meals daily instead of three large meals
  • After eating, avoid bending over, lying down, or sleeping for several hours
  • Stop smoking and drinking alcohol (both increase stomach acid and irritation, and alcohol opens the LES)
  • Maintain your recommended weight or lose weight if necessary
  • Exercise regularly after speaking with your physician about an appropriate program
  • Wear loose-fitting clothing and belts
  • Raise the head of your bed six to eight inches with books or blocks, or put a wedge under the head of your mattress or sleep over several pillows

Other treatments

If your symptoms persist after lifestyle changes, discuss drug therapy with your physician.

Antacids are usually the first drugs your doctor will recommend for mild symptoms of heartburn or GERD. Using antacids can help to neutralize and decrease stomach acids and relieve symptoms.

Half of all people with GERD find relief with drugs called H-2 blockers. H-2 blockers reduce the amount of acid your stomach produces.

Depending on your symptoms, your physician may prescribe more powerful medications called proton pump inhibitors. Proton pump inhibitors heal the esophageal lining in almost everyone with GERD.

Also check with your physician about avoiding taking aspirin or anti-inflammatory drugs that can irritate the protective lining of your stomach.

Surgery

If you do not respond well to lifestyle changes or drug therapy, you may consider undergoing surgery.

New, minimally invasive surgery uses a laparoscope to avoid a large abdominal incision. Pain is significantly less than other kinds of surgery, and the length of a hospital stay averages two days. Many can return to work within two weeks.

A surgeon performs this technique on the esophagus and stomach with the patient under general anesthesia. A laparoscope attaches to a camera that sends images to a video monitor. Through several tiny incisions, the surgeon repairs tissue in the abdomen.

This surgery is a safe and effective treatment for GERD when other medical management is insufficient.

Many studies show most patients who undergo surgery are either free of symptoms or have significant improvement of symptoms from GERD and usually do not require any further medications.

If you are concerned about GERD, talk with your physician.

16 Lifestyle Tips for Nighttime Heartburn Relief

  1. Steer clear of tight clothes. Tight belts, waistbands, and pantyhose can press on your stomach, triggering heartburn.
  2. Strive for a less stressful life. Stress may increase stomach acids, boosting heartburn symptoms.
  3. Heavy? Try losing weight. The pressure of excess weight increases the chance stomach acid will backup into the esophagus.
  4. Popping antacids more than once a week? You may have GERD, not heartburn, and need more aggressive treatment.
  5. Try chewing gum at night. This can boost the production of saliva, which neutralizes stomach acid.
  6. Not all “trigger” foods cause GERD symptoms in everyone. Keep track of your symptoms to find your personal triggers.
  7. Pregnant? You may experience heartburn or GERD. Talk to your doctor about finding relief.
  8. Heartburn worse after exercise? Drink plenty of water. It helps with hydration and digestion.
  9. Untreated GERD can radically increase your risk of esophageal cancer. But reflux can be managed. Talk with your doctor.
  10. Try keeping a diary or heartburn log to keep track of activities that might trigger incidents.
  11. A full tummy can mean a night full of heartburn pain. Wait at least 2-3 hours after you eat before going to bed.
  12. Wait for your workout. Don’t want to trigger heartburn? Wait at least two hours after a meal before exercising.
  13. Nicotine can cause your esophageal sphincter to relax. If you smoke, kick the habit.
  14. Some medicines can worsen reflux. Talk with your doctor about alternatives.
  15. Use blocks or bricks under the bedpost to raise the head of your bed 6 inches so you can sleep with head and chest elevated. You can also try a wedge pillow.
  16. Bend with your knees. Bending over at the waist tends to increase reflux symptoms.

Published April 10, 2007.

7 Natural GERD Home Remedy Solutions

No one likes the feeling, and we’ve all felt it. The hot, burning acid creeping up your throat, putting pressure on your chest. But for those who suffer from gastroesophageal reflux disease, or GERD, it becomes incredibly bothersome, impacting your lifestyle.

But before you rush to your local pharmacy, there are natural GERD home remedy solutions you can try to alleviate the unwanted side effects of this uncomfortable problem.

Here are seven natural GERD home remedy solutions to help reduce the frequency of symptoms.

  • Baking Soda: A teaspoon of baking soda (a base substance) neutralizes stomach acid so that even if it comes up, you won’t feel that burning sensation. Mix 1 teaspoon of baking soda with 8 ounces of water and drink all of it. Repeat as needed, but don’t exceed seven doses in one day. Avoid using this GERD home remedy for more than a week, due to its high salt content and other side effects like swelling or nausea.
  • Chew Gum: People experiencing GERD can get some relief by chewing sugar-free gum for 30 minutes after they eat, according to a study conducted by the Journal of Dental Research. Chewing a piece of gum stimulates the salivary glands, which increases saliva. The saliva helps wash away any acid. Chew one piece after you eat and note the difference.
  • Don’t Lie Down After Eating: When you eat a meal and then lie flat, the contents of your stomach can more easily be pushed back up, as it puts pressure on your esophageal sphincter. If you’re upright, however, gravity works in your favor, helping to keep food down. It’s best to eat three to four hours before you know you’ll be lying down to allow time for your food to fully digest. Help capitalize on this GERD home remedy solution by lying slightly elevated in your bed with a pillow wedged under you.
  • Eat Fruit: And not just any fruit—bananas have natural antacid properties that counteract acid reflux. Eat a fully ripened banana each day to reduce the discomfort of acid coming back up. Another great fruit to try is an apple. To prevent discomfort at night, slice up an apple and enjoy it a few hours before bedtime. Other fruits that can reduce instances of GERD are honeydew, cantaloupe and watermelon. Be sure to avoid fruits with high acidic content such as oranges, grapefruit and pineapple.
  • Ginger Tea: Ginger tea is great for many stomach ailments, from the common stomachache to nausea to chronic acid reflux. For full flavor, simmer slices of ginger root in water for 30 minutes. For maximum benefit, drink the tea before a meal to maximize the impact of this GERD home remedy.
  • Mustard: Mustard is full of minerals and contains vinegar, a weak acid. It also contains alkaline, which neutralizes the acid that comes up due to GERD. Try taking 1 teaspoon of straight mustard when you feel a bout of heartburn coming on, or if you’re already experiencing symptoms.
  • Chamomile Tea: To balance the acidity levels in your stomach, drink a cup of chamomile tea 30 minutes to an hour before bedtime. Chamomile also reduces stress levels, which can contribute to heartburn. Instant chamomile tea is available for purchase, or you can make your own fresh. Simply boil water, stir in chamomile petals and let them simmer for about 45 seconds. Strain them out and pour the tea into a mug, adding honey or lemon as preferred.

If you’re struggling with GERD, know that you’re not alone. Learn more about the symptoms, testing that can be done and treatment options with our guide, Your Guide to GERD.

Acid reflux (also known as GERD) is when stomach acid or bile escapes from your stomach and irritates the lining of your esophagus. Cases can range from mild irritation to severe pain. If left untreated, stomach acid can have long-term negative effects, including cancer.

This extremely common disease affects 60% of the population at varying degrees, according to Social & Scientific Systems.

Acid reflux is traditionally treated with proton pump inhibitors. While these synthetic inhibitors are very effective at reducing heartburn, they have also been linked to bone loss and vitamin B12 deficiency when taken consistently.

17 Safe & Natural Ways to Treat Acid Reflux

1. Ginger Tea

Ginger is marvelous for all kinds of health related issues. It can help relieve motion sickness and improve blood circulation. It helps ward off heart disease, improves your immune system, and helps you fight bacterial infections. Plus, it can help you ward off acid reflux. Place a few thin slices of ginger root tea in a mug and steep in hot water for 10 – 20 minutes. Then drink. It can help calm an upset tummy or stop it from even occurring.

2. Baking Soda

With its high pH level, baking soda helps neutralize acid in your stomach. If acid is rising from your stomach into your esophagus, the baking soda will help stop the acid from burning the lining. Simply swallow a teaspoon of it when you’re experiencing pain.

Chewing gum is about a lot more than blowing bubbles and saving your breath. It activates your salivary glands. All the excess saliva you swallow helps dilute the contents of your stomach and reduce acid reflux.

3. Gum

Chewing gum stimulates the production of saliva. As you swallow this excess saliva, it helps dilute and clear the acid from unwanted areas. This can significantly reduce your symptoms and provide relief.

4. Sleep on an Incline

Imagine a big bottle filled half way with water. When set on its bottom the water remains at the bottom. However, when you lay the bottle on its side, the water sloshes around and extends all the way to the mouth of the bottle!

The same thing happens to your stomach. While you’re standing, your stomach acid remains in the bottom of your stomach. However, when you lay down for the night, that acid sloshes around and extends from one end of your stomach to the other. This can increase the chance of acid escaping. Sleeping on an incline helps reduce these instances.

5. Wear Loose Fitting Clothes

Tight clothes that cinch your waist can press on your stomach and cause acid to rise. This is especially true of tight jeans, belts, and corsets. Try instead to wear loose fitting clothes that won’t press on your stomach, even when you sit down.

Kimchi can add layers of flavor and texture to your food, while supporting your immune system and helping prevent acid reflux.

6. Fermented Foods

Fermented foods, like kimchi, can be incredibly helpful for your digestive system. Known as an alkaline food, the fermentation process involves breaking down a raw vegetable into amino acids and peptides. This raises the pH level of the food and typically produces a strong ammoniacal smell. These fermented foods have been shown to relieve inflammation in your stomach and actually heal your stomach’s lining.

7. Mustard

Mustard is another alkaline food. It’s loaded with minerals and has trace amounts of acid from vinegar. Consuming a spoonful of it during the onset of acid reflux symptoms can help soothe your heartburn by balancing your pH levels.

8. Don’t Smoke

Nicotine causes your body to relax. In particular, smoking makes the valve separating your stomach from your esophagus relax. This can allow stomach acid to escape and the onset of symptoms to occur.

9. Avoid Alcohol

Like cigarettes, alcohol weakens the valve between your stomach and esophagus. Additionally, alcohol causes your stomach to produce an excess of stomach acid. This can cause severe stomach pain, vomiting, and diarrhea.

A great on the go snack, many patients experienced acid reflux relief by eating almonds.

10. Almonds

While no study has concretely confirmed why almonds help relieve acid reflux, many patients have seen significant benefits from snacking on these tasty nuts. It’s best if the almonds you are consuming are raw, organic and salt-free. This helps you avoid also consuming any harmful chemicals.

11. Watch Your Weight

When a patient is overweight, more pressure is put on all of their internal organs. This includes your stomach. Overtime, this can loosen the valve between your stomach and esophagus, allowing acid to escape.

12. Stay Away From Spicy Food

Think of the way your tongue burns when it comes into contact with an extremely hot pepper. The same thing occurs in your stomach. This burning sensation triggered by spicy foods can trigger acid reflux symptoms, causing pain and discomfort. Some of the spicy foods to avoid if you commonly experience acid reflux include:

  • Hot peppers
  • Hot sauce
  • Horseradish
  • Wasabi paste
  • Red chili pepper flakes
  • Cayenne
  • Chili Powder

13. Aloe Juice

Aloe is typically associated with soothing burns, especially sunburns. But, it can also help soothe the inside of your body. By drinking a glass of aloe vera juice, you can calm your esophagus, avoid irritation, and limit inflammation.

14. Track & Avoid Your Triggers

Everyone’s body is unique. Not all foods will be triggers for all patients. One of the best ways to ward of acid reflux symptoms is to pay attention to your own body. When you identify a trigger, stay away from it.

15. Eat a Banana or Apple

An apple a day won’t keep the doctor away. But it could keep your acid reflux at bay. Both bananas and apples contain natural antacids that can help relieve or prevent an onset of acid reflux.

16. Consume More Acid like Apple Cider Vinegar

While it may seem counterintuitive, acid reflux is often caused when a patient doesn’t have enough acid in their stomach. A great way to introduce more acid into your stomach is with raw apple cider vinegar. Quite tasty, it can be used in dressing and marinades, bringing a bright touch your meals.

17. Chamomile Tea

Chamomile tea is another way to help balance your stomach’s acid levels. Plus, if you drink it before bed, it provides soothing relief that can help you sleep through the night.

Get Professional Help

While these natural home remedies can be extremely effective, sometimes they aren’t enough. At Tru Health we help patients discover and treat the unique cause of their acid reflux so they can get rid of it naturally.

I need help with my acid reflux!

Additional Tips

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3 Paleo & Vegan Friendly Fall Dishes

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9 ways to relieve acid reflux without medication


Image: Bigstock

Updated: September 10, 2019Published: November, 2015

A few lifestyle changes are worth trying before resorting to drugs for controlling gastroesophageal reflux.

If you are sounding a little hoarse and have a sore throat, you may be bracing for a cold or a bout of the flu. But if you’ve had these symptoms for a while, they might be caused not by a virus but by a valve—your lower esophageal sphincter. That’s the muscle that controls the passage between the esophagus and stomach, and when it doesn’t close completely, stomach acid and food flow back into the esophagus. The medical term for this process is gastroesophageal reflux; the backward flow of acid is called acid reflux.

Acid reflux can cause sore throats and hoarseness and may literally leave a bad taste in your mouth. When acid reflux produces chronic symptoms, it is known as gastroesophageal reflux disorder, or GERD. The most common symptom of GERD is heartburn—pain in the upper abdomen and chest that sometimes feel like you’re having a heart attack.

Three conditions—poor clearance of food or acid from the esophagus, too much acid in the stomach, and delayed stomach emptying—contribute to acid reflux, says Dr. Jacqueline Wolf, a gastroenterologist and associate professor of medicine at Harvard Medical School and author of A Woman’s Guide to a Healthy Stomach: Taking Control of Your Digestive Health.

If you’ve been having repeated episodes of heartburn—or any other symptoms of acid reflux—you might try the following:

1. Eat sparingly and slowly

When the stomach is very full, there can be more reflux into the esophagus. If it fits into your schedule, you may want to try what is sometimes called “grazing”—eating small meals more frequently rather than three large meals daily.

2. Avoid certain foods

People with acid reflux were once instructed to eliminate all but the blandest foods from their diets. But that’s no longer the case. “We’ve evolved from the days when you couldn’t eat anything,” Dr. Wolf says. But there are still some foods that are more likely than others to trigger reflux, including mint, fatty foods, spicy foods, tomatoes, onions, garlic, coffee, tea, chocolate, and alcohol. If you eat any of these foods regularly, you might try eliminating them to see if doing so controls your reflux, and then try adding them back one by one. The Foodicine Health website at www.foodicinehealth.org has diet tips for people with acid reflux and GERD as well as for other gastrointestinal disorders.

3. Don’t drink carbonated beverages

They make you burp, which sends acid into the esophagus. Drink flat water instead of sparkling water.

4. Stay up after eating

When you’re standing, or even sitting, gravity alone helps keeps acid in the stomach, where it belongs. Finish eating three hours before you go to bed. This means no naps after lunch, and no late suppers or midnight snacks.

5. Don’t move too fast

Avoid vigorous exercise for a couple of hours after eating. An after-dinner stroll is fine, but a more strenuous workout, especially if it involves bending over, can send acid into your esophagus.

6. Sleep on an incline

Ideally, your head should be 6 to 8 inches higher than your feet. You can achieve this by using “extra-tall” bed risers on the legs supporting the head of your bed. If your sleeping partner objects to this change, try using a foam wedge support for your upper body. Don’t try to create a wedge by stacking pillows. They won’t provide the uniform support you need.

7. Lose weight if it’s advised

Increased weight spreads the muscular structure that supports the lower esophageal sphincter, decreasing the pressure that holds the sphincter closed. This leads to reflux and heartburn.

8. If you smoke, quit

Nicotine may relax the lower esophageal sphincter.

9. Check your medications

Some—including postmenopausal estrogen, tricyclic antidepressants, and anti-inflammatory painkillers—can relax the sphincter, while others—particularly bisphosphonates like alendronate (Fosamax), ibandronate (Boniva), or risedronate (Actonel), which are taken to increase bone density—can irritate the esophagus.

If these steps aren’t effective or if you have severe pain or difficulty swallowing, see your doctor to rule out other causes. You may also need medication to control reflux even as you pursue lifestyle changes.

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Heartburn, also called acid reflux, is when the muscles of your lower esophagus don’t work right. This causes food and acids from the stomach to flow back — or reflux — into your esophagus.

Things like food and certain medications can aggravate it. To make symptoms easier:

Don’t go to bed with a full stomach. Eat meals at least 2 to 3 hours before lying down. This will give food time to digest and get out of your stomach. Acid levels will also go down before you put your body in a position where heartburn is more likely.

Don’t overeat. Eat smaller portions at mealtimes, or try to eat four to five small meals instead of three big ones.

Eat slowly. Take time to eat. Put your fork down between bites.

Avoid heartburn triggers. Avoid foods and drinks that can bring on heartburn symptoms.

For example:

  • Onions
  • Peppermint
  • Chocolate
  • Beverages with caffeine
  • Citrus fruits or juices
  • Tomatoes
  • High-fat and spicy foods

A heartburn diary is a good way for you to figure out which foods cause your symptoms.

Shed some pounds. If you are overweight, it can help you feel better.

Stop smoking. The nicotine in cigarettes can weaken a part of your body called your lower esophageal sphincter. That muscle controls the opening between your esophagus and your stomach. When it’s closed, it keeps acid and other things in your stomach from going back up.

Avoid alcohol. If you want to unwind after a stressful day, try exercise, walking, meditation, stretching, or deep breathing instead of a drink.

Keep a diary or heartburn log. Jot down when your heartburn hits and the specific things you’re doing when it comes.

Wearing loose-fitting clothes can also help.

Dr. Rockafellow is assistant professor of pharmacy and Dr. Berardi is professor of pharmacy at the University of Michigan College of Pharmacy, Ann Arbor.

Heartburn, the most common symptom of acid reflux, indigestion, and gastroesophageal reflux disease (GERD), also may occur with other diseases such as peptic ulcer disease. Heartburn is described as a substernal burning sensation that radiates upward toward the neck or throat.1 For many individuals, heartburn is mild, infrequent, and predictable. For others, heartburn is frequent (occurs 2 or more days a week), persistent, and more severe.
GERD develops when reflux of gastric contents into the esophagus causes troublesome symptoms (eg, heartburn 2 or more days a week, sleep disturbances) or complications (eg, esophagitis, esophageal stricture), which adversely affect the patient’s well-being.2,3 Postprandial heartburn, sometimes accompanied by a sour taste in the mouth (regurgitation), usually occurs within several hours of ingesting a meal and is often precipitated by lying down or bending over. Heartburn may limit food and beverage choices and disrupt sleep or work.1,3 Frequent, nighttime (nocturnal) heartburn is associated with more severe esophageal injury. Extraesophageal manifestations of GERD include asthma, chronic cough, laryngitis, and noncardiac chest pain.1-3 Pharmacists play an important role in determining whether self-treatment of heartburn is appropriate, or whether the patient should be referred for further medical evaluation.1
Exclusions to the Self-Treatment of Heartburn
• Troublesome heartburn that has persisted for >3 months
• Painful or difficult swallowing
• Chronic coughing or hoarseness
• Heartburn or chest pain accompanied by sweating, nausea, shortness of breath, or radiation of pain to the arm, neck, back, or jaw
• Vomiting blood or black, tarry stools
• Unexplained weight loss
• Heartburn that persists or recurs after 2 weeks of treatment with an OTC histamine2-receptor antagonist (H2RA) or proton pump inhibitor (PPI)
Nonpharmacologic Measures
The self-treatment of heartburn is aimed at nonpharmacologic measures and the use of OTC medications. Individuals should keep a diary to aid in identifying troublesome dietary, lifestyle, and medication triggers so that strategies are tailored to the individual. Evidence-based measures that support improved clinical outcomes include elevating the head of the bed, weight loss, and avoiding late-night eating.2-4 Whereas there is insufficient data to support dietary and lifestyle measures for all patients,certain factors may precipitate heartburn in subsets of patients. Adoption of the following specific behavioral changes are recommended for these individuals based on their history.1,3
• Nocturnal symptoms: Elevate the head of the bed by using 6-inch blocks or a foam wedge; using stacked pillows may worsen symptoms. Avoid eating within 3 hours of bedtime.
• Postprandial symptoms: Avoid exercise, bending over, or lying down after meals. Eat smaller and more frequent meals.
• Dietary avoidance: Avoid citrus fruits, tomatoes, spicy foods, carbonated beverages, high-fat and fried foods, chocolate, mint, and beverages with caffeine.
• Lifestyle modifications: Weight reduction for overweight individuals, avoid wearing tight clothes around the abdomen, and reduce or discontinue smoking and/or alcohol.
• Medications: Certain medications may trigger or worsen heartburn by decreasing lower esophageal sphincter pressure, delaying gastric emptying, or by damaging the esophageal mucosa.
OTC Medications
Antacids, H2RAs, PPIs, and bismuth subsalicylate (BSS) are all effective OTC medications when used for the selftreatment of heartburn.1-3,5,6 The selection of a specific agent is based on the frequency and severity of the heartburn and the onset and duration of symptom relief provided by the drug.1
Antacids
Antacids provide quick (within minutes) relief of mild infrequent heartburn, but relief is only temporary (about 30 minutes on an empty stomach).1,5 Liquid formulations usually act faster than chewable tablets, but quick-dissolving tablets provide the most rapid symptom relief. Antacids are available as a single salt or a combination of salts and many have been reformulated to contain calcium. Antacids also may contain alginic acid, which forms a “foam” barrier to protect the esophagus from noxious acid refluxate, and simethicone, which may decrease discomfort associated with intestinal gas.
Magnesium-containing antacids and combination aluminum/magnesium products are associated with dose-dependent diarrhea. Aluminum-containing antacids cause constipation at higher daily dosages. Calcium carbonate– and sodium bicarbonate–containing antacids may be associated with belching and flatulence due to the release of carbon dioxide. Magnesium-containing antacids should be avoided in patients with impaired renal function. Drug interactions can usually be avoided by separating the antacid from other medications by 2 hours. Patients should not exceed the maximum daily antacid dose. If antacids are needed for >2 days a week, the patient may require an OTC H2RA or PPI.
H2RAs
OTC H2RAs (cimetidine, famotidine, nizatidine, ranitidine) are effective for the treatment of mild-to-moderate infrequent heartburn.1 The lower OTC dosages should be used for mild symptoms, whereas the higher dosages are used for patients with moderate symptoms. The onset of symptom relief is 30 to 45 minutes, and the duration lasts up to 10 hours.1 A twice-daily regimen provides improved symptom control for patients with daytime and nighttime heartburn. H2RAs should be taken preferably on a “when-needed” basis, as tachyphylaxis (tolerance) may develop to the antisecretory effect when taken every day.1,3,5 Taking an antacid with an H2RA provides immediate relief (antacid) of heartburn as well as a longer duration of symptom relief (H2RA). An H2RA may be taken 30 to 60 minutes prior to eating or exercise to prevent anticipated symptoms.
H2RAs are well-tolerated and have a low incidence of side effects, which include headache, diarrhea, constipation, dizziness, and drowsiness. Cimetidine, and to a lesser extent ranitidine, interact with numerous drugs that are metabolized by the liver, including phenytoin, warfarin, diazepam, and tricyclic antidepressants. Famotidine and nizatidine are spared the hepatic drug interaction.1 Patients who remain symptomatic after 2 weeks of treatment may require an OTC PPI or referral for medical evaluation.
PPIs
OTC PPIs are indicated for patients with frequent heartburn who have symptoms ≥2 days per week.1,7 Although omeprazole is the only currently available OTC PPI, other PPIs such as lansoprazole may soon be approved by the FDA for OTC use. The onset of symptom relief is 2 to 3 hours, and the duration may last for up to 24 hours.1 PPIs should be taken 30 to 60 minutes before eating every morning for 14 days. This regimen can be repeated after 4 months if symptoms recur.7 Tachyphylaxis does not develop to the antisecretory effect when taken daily.1,3
PPIs are well-tolerated and have a low incidence of side effects, similar to H2RAs. Omeprazole may interact with diazepam, phenytoin, and warfarin. If heartburn recurs while taking omeprazole, persists for >14 days, or recurs in <4 months, the patient should be counseled to seek further medical evaluation.
BSS
BSS is not an antacid, but it is included in some products with common antacid brand names. Bismuth salts may cause the stool and tongue to turn black. BSS should be used with caution in patients at risk of developing salicylate toxicity. Avoid BSS in children at risk of developing Reye’s syndrome.
Conclusion
Individuals with heartburn or acid indigestion often consult their pharmacists for advice. If self-treatment is indicated, counseling on diet, lifestyle, and medications should be individualized and based on symptom assessment.

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