When dietary changes and natural remedies alone do not solve your heartburn or indigestion, a range of over counter options are available. But how do you choose which is the best heartburn medicine for you – an antacid, or a medicine that switches off aid production? Here are some pointers.
What causes heartburn?
Heartburn is caused by acid juices refluxing up into the gullet, or oesophagus, from the stomach. Known medically as gastroesophageal reflux disease, or GERD and GORD for short, this causes a hot, burning sensation behind the chest bone, which may spread up towards the throat. Some cases of heartburn are so severe they resemble a heart attack. If you experience chest pain that worries you, seek medical help without delay as it is not always easy for doctors to tell the two apart without specific tests.
In contrast, some people have so-called silent reflux, in which they don’t experience burning pain, but may have unexplained hoarseness, vocal fatigue, voice breaks, coughing, a sensation of a lump in the throat, or repeated swallowing or throat clearing.
Symptoms of GERD
For two out of three people, heartburn symptoms of burning pain come on in the evening and many are woken as a result.
Evening symptoms are usually related to eating a large meal (three or more courses) which is rich (eg with a cream sauce) or heavy (eg gateaux, cheesecake).
Symptoms are also associated with wearing tight evening clothes/waistbands, drinking alcohol (eg an aperitif, wine with food, after-dinner port, spirits or liqueurs), drinking strong coffee and smoking cigarettes or cigars.
After an episode of dietary indulgence, lying down increases pressure on the valve that normally closes the stomach and promotes acid reflux.
This is especially common if part of the stomach has slipped up into the chest through a natural hole in the diaphragm, through which the oesophagus passes, to cause a hiatus hernia.
How common is heartburn and GERD?
Heartburn, due to acid reflux or GERD, affects one in four people on a regular basis. At least one in ten adults experience heartburn every day, and 40% have heartburn at least once a month.
Men are twice as likely as women to report sleep disturbances every night due to heartburn, and in surveys, almost one in five say they’ve needed to take time off work as a result of heartburn. Four out of five people avoid foods they enjoy for fear of developing symptoms.
Heartburn becomes increasingly common with age, as the muscles that usually close the entrance to the stomach, and downward movements of muscles in the oesophagus which normally prevent reflux, naturally weaken.
Dietary approaches and natural remedies are often effective in preventing heartburn and are covered in my post on Natural Remedies for Heartburn and Indigestion. Lifestyle approaches include:
- Wearing loose clothing, especially around the waist – elasticated bands are better than tight buttoned bands or belts
- Avoid smoking cigarettes or cigars which can make heartburn and GERD worse
- Avoid aspirin and related drugs (eg ibuprofen) which irritate the stomach lining and cause heart burn as a common side effect
- Avoid excess stress which is a major cause of indigestion through effects on the vagus nerve
- Elevate the head of your bed about 15-20 cm (eg put books under the top two legs) if symptoms come on at night when you are lying down
- If you lie on your side to sleep, lie on your left side rather than your right side as much as possible.
Don’t sleep on your right side
Heartburn is common on lying down, as this allows stomach contents to press against the ring of muscle that normally keeps the stomach opening closed. When you like on your right side, the shape of the stomach means that stomach acid pools against the valve at the lower end of the oesophagus so that acid reflux and heartburn are likely.
If you sleep on your left side, however, this keeps the junction between the stomach and oesophagus above the level of gastric acid, and also makes it easier for trapped wind to roll up the curve of the stomach and escape as a satisfying ‘burp’.
Over counter medicines for treatment of heartburn and acid reflux
If diet, lifestyle and natural remedies have not fully controlled your symptoms, a range of medicines are now available from pharmacies and supermarkets, many of which were originally only accessible on prescription.
Silicol gel for heartburn and indigestion
Silicol gel contains silicic acid which, despite its name is a bland, non-acidic, mineral substance containing silicon and oxygen in a colloidal, hydrated form. Just a small amount of this dispersible gel creates a protective lining in the stomach and intestine. The gel acts as a magnet physically binding with substances which cause inflammation, and renders them harmless to pass through the digestive tract. It also provides a physical barrier to soothe heartburn and indigestion.
Enterosgel for heartburn and indigestion
If you experience indigestion, heartburn, bloating or flatulence after eating a particular type of food such as wheat, dairy, caffeine, alcohol, tomatoes, potatoes or peppers, for example, some naturopaths believe this could be due to a food intolerance that triggers digestive symptoms. You may find that taking a tablespoon of the toxin-binding gel, Enterosgel, before or after eating the food may help.
Antacids for heartburn and GERD
Antacids have been used to treat heartburn for over 2000 years, with ancient remedies such as calcium carbonate and drinking milk are still used today to solve short-term symptoms of heartburn.
Different antacids work in different ways to reduce indigestion, heartburn and acid reflux.
Mineral antacids contain substances (eg calcium carbonate, aluminium hydroxide, magnesium trisilicate) that react chemically with stomach contents to neutralise excess acid.
Antacids that contain magnesium salts may have a laxative action while those containing aluminium salts are more constipating. If these side effects are troublesome, then select an antacid that contains both magnesium and aluminium to reduce these intestinal side-effects.
My go-to antacid, to keep handy in the home and office, is Remegel. Remegels are chewy rather than chalky, and each chew contains 800mg calcium carbonate as an invaluable source of calcium.
Antacids are available as liquid suspensions or chewable tablets of which some are chalky, while others are more like a chewy sweet. These are ideal for keeping in your bag or a drawer to treat mild, occasional heartburn. For more troublesome heartburn, a liquid preparation (eg raft-forming antacids, below) are generally more effective than tablet preparations.
Raft-forming antacids contain sodium alginate and potassium bicarbonate which interact with stomach acid to form a foam-like raft of alginic acid gel. This floats on the surface of stomach contents. This raft forms quickly, often within a few seconds of taking a dose, and acts as a physical barrier so acid cannot break through. This raft helps to stop acid reflux and quickly relieves discomfort. If reflux does occur, the raft itself refluxes into the oesophagus to form a soothing (demulcent) film. Antacids present in the formulation also neutralise excess acidity.
Simeticone (activated dimeticone) is included in some antacids as an antifoaming agent to relieve flatulence and also helps to reduce hiccups which can occur with acid reflux due to irritation of nerves that also control the diaphragm.
Antacids reduce acidity but do not stop further acid secretion. If short-term relief is insufficient, then more powerful drugs that temporarily switch off stomach acid production and have a longer term action can be added in.
Histamine H2 receptor antagonists for heartburn
Histamine H2 receptor antagonists (eg cimetidine, famotidine, nizatidine, ranitidine) interact with stomach cells to switch off acid production for up to12 hours. At one time, these were only available on prescription, but after a thorough review of their safety and effectiveness, they are now available without needing to see your doctor first.
Always read the patient information leaflet in the pack. Click here to see a typical patient information leaflet for ranitidine (Zantac 75 Relief) and for famotidine (Pepcid).
These heartburn treatments work quickly and relieve acid reflux and indigestion more effectively than simple antacids alone. They can also reduce your need to take antacids regularly throughout the day.
Proton pump inhibitors for heartburn
Proton pump inhibitors (PPIs such as esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole) are the most powerful medicines available to relieve heartburn and GERD.
Proton pump inhibitors interact with stomach lining cells to reduced acid production by at least 80%, for up to 24 hours. Proton pump inhibitors are used to treat peptic ulcers, are combined with antibiotics to treat Helicobacter pylori (a bacterial infection that irritates the stomach lining and is associated with peptic ulcers) and to treat acid reflux, or GERD. Some proton pump inhibitors are now available over counter to provide effective relief of indigestion and heartburn symptoms.
The downside is that proton pump inhibitors take a few days to work – the maximum effect is usually achieved within 4 days. Many people do not obtain complete heartburn relief during the first one or two days of treatment, but you can take a mineral antacid or a raft-forming antacid as well, while waiting for the proton pump inhibitor to reduce your acid symptoms.
While proton pump inhibitors reduce acid production in the stomach, they do not stop reflux. Digestive juices, which contain strong enzymes, may still reflux up to irritate your oesophagus. This means that some people still get symptoms of heart burn even though they are taking these stronger medicines. If this is the case, see your doctor.
Proton pump inhibitors are usually used as a short course only, as it’s not a good idea to switch off acid production for too long – acid is needed to digest food properly, and for the absorption of some vitamins and minerals.
Always read the patient information leaflet in the pack. Click here to see a typical patient information leaflet for esomeprazole (Nexium Control) and click here to see a patient information leaflet for omeprazole (eg Prilosec).
See your doctor
If heartburn symptoms continue for more than a week or two, or if they become more frequent or severe, it’s important to seek medical advice. You may need further investigation of your symptoms to exclude a peptic ulcer, for example, or tests to look for a stomach infection with a type of bacteria (Helicobacter pylori) that irritates the stomach lining and stimulates increased acid secretion.
Don’t ignore recurrent heartburn or continue to treat it with antacids or other over counter medicines. Taking antacids long-term does not protect against damage due to acid attack on delicate tissues. Stronger medicines are available on prescription. If symptoms do not respond to drug treatment, severe reflux may need surgical correction.
Click here for information on diet and natural remedies for heartburn and indigestion.
Which over the counter medicine have you found most effective for heartburn or GERD?