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Acid reflux


Over 60 million Americans experience heartburn – a burning pain in the middle of the chest that may move up to the neck. Some people have the feeling that food is “coming back up,” producing an acid or bitter taste. Heartburn is painful and unpleasant, but there are steps you can take to reduce or get rid of it.

What is heartburn?

Acid is produced to break down food in the stomach. Heartburn is a sign that acid has escaped from your stomach and traveled back up towards the mouth. How does it escape? A muscle at the entrance to the stomach normally opens and closes to let food in. Sometimes, this muscle gets weak or opens at the wrong time, so that food and stomach acid can back up. This causes the burning feeling known as heartburn.

You can take several specific steps to prevent heartburn:

  • Stay away from food and drinks that can cause heartburn. These include chocolate, coffee, alcoholic beverages, tomatoes, and citrus fruits like lemons, oranges, and grapefruit.
  • Stop or decrease smoking. Tobacco weakens the muscle that keeps acid where it belongs, down in the stomach.
  • Maintain a healthy weight. Carrying extra weight puts pressure on the stomach, forcing food and acid back up.
  • Wear loose fitting clothes. Tight clothing can press on the stomach, pushing the acid back up.
  • Put 6-inch blocks under the head of your bed to reduce night symptoms. Placing your bed at a slight incline encourages acid and food to stay in your stomach. Just raising your head with pillows won’t work, because it causes you to bend at the waist and puts extra pressure on your stomach.
  • Don’t lie down for 2 - 3 hours after eating. Staying upright until your dinner is digested will help prevent it from moving back up out of the stomach.

How can I treat my heartburn?

If you do get heartburn, there are several treatments to consider. Two kinds of medicines are available without a prescription (over-the-counter): antacids and H2 blockers.

Using these over-the-counter medications and the suggestions above to prevent heartburn, 70% of people will be able to manage their heartburn without needing a prescription.

Over-the-counter medications

Antacids

These medications work by neutralizing the acid in your stomach.

Some antacids are Tums, Rolaids, Maalox, and Mylanta, plus generics: store brands work just as well. Liquid antacids may provide relief more quickly.

  • Antacids work fast. Many patients feel relief in 5-15 minutes.
  • They can be purchased without a prescription.
  • Most antacids work as well as any other. Pick one based on the cost and taste, and whether you prefer tablets or liquid.

H2 blockers

H2 blockers work by decreasing the amount of acid your stomach makes.

Some H2 blockers are: nizatidine (Axid), famotidine (Pepcid), cimetidine (Tagamet), and ranitidine (Zantac).

  • It takes about 1 hour to get relief from your heartburn after taking an H2 blocker. For this reason, some people take these pills before a meal to prevent heartburn after eating.
  • They can be purchased without a prescription.
  • They often work well if you take one dose at night before bedtime.
  • All H2 blockers work about the same. You can pick one based on the cost. The brand name versions are much more expensive and are not any better than the non-brand (generic) versions. Here is a price comparison for a month’s supply at the dose recommended for heartburn:
name brands cost* non-brand (generic) version cost*
Pepcid 10 mg $10 famotidine $4
Zantac 75 mg $10 ranitidine $4
Axid 75 mg $15 nitatidine not available
Tagamet 200 mg $16 cimetidine $9

Warning signs

See your doctor if you have:

  • Chest pain.
  • Nausea or vomiting, or if you vomit blood or material that looks like coffee grounds.
  • Pain with exercise or pain that goes into your back, neck or arm; these may be signs of a heart problem.
  • No relief after trying both the lifestyle suggestions above and non-prescription medications.

Other medications

If your heartburn does not improve when you take an over-the-counter medicine and use the prevention suggestions above, or if you have heartburn more than twice a week for over a month, talk to your doctor to see if you need a prescription for a proton pump inhibitor (PPI).

Proton Pump Inhibitors (PPIs)

PPIs work by preventing acid from being made in your stomach.

Some PPIs are: esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (AcipHex).

  • It can take 24 hours or more before you will get full relief after taking a PPI.
  • All PPIs work about the same, and no PPI is better than another.
  • PPIs are expensive, but there are cost differences among them. Talk with your doctor or your pharmacist to see which PPI would have the lowest cost for you.

One PPI is available without a prescription, at a much lower cost: Prilosec OTC.

If you don’t have health insurance or coverage for prescription drugs, Prilosec OTC is the least costly PPI and will work as well to treat heartburn.

Summary of heartburn relief options

  time until symptom relief available without a prescription? cost*
lifestyle changes You may never get heartburn! No medicine needed! None!
antacids 5-15 minutes Yes $3
H2 blocker 30-60 minutes Yes $10
PPI: Prilosec OTC 1-4 days Yes $20
PPI: all others 1-4 days No $111

*Approximate cost is based on www.drugstore.com prices for the lowest priced drug in each class for a 30-day supply