Understanding acid reflux and heartburn

Heartburn is a common problem that causes a burning feeling in the chest. It happens when stomach acid goes back into the tube carrying food from the mouth to the stomach. When you swallow food, a muscle at the bottom of this tube relaxes to let the food into the stomach and then tightens again. Sometimes, this muscle doesn’t work right and relaxes at the wrong time, causing stomach acid to come back up into the throat, which leads to a burning feeling in the chest.

Symptoms of acid reflux
  • Most common
    • Heartburn, burning feeling in the chest
    • Regurgitation when acid and undigested food flow back into the throat or mouth
  • Other symptoms that can occur
    • Stomach or chest pain
    • Trouble swallowing
    • Raspy voice or sore throat
    • Unexplained cough
    • Nausea or vomiting
Treatments that don’t involve medicine
  • Avoiding foods and beverages that can worsen symptoms, such as:
    • Foods: fatty, fried, sour, and spicy foods
    • Beverages: coffee, tea, carbonated beverages, and alcohol
  • Avoiding irregular eating patterns such as large volume of meals or eating meals just before bedtime
Over-the-counter medications that can reduce or block stomach acid
Medication How it works When and how to use Common products
Antacids Neutralizes stomach acid for quick relief When heartburn feeling comes on Tums®, Mylanta®, Rolaids®
H2 Blockers Reduces the amount of acid the stomach makes and can prevent heartburn for up to 12 hours. Take it before eating food that may cause heartburn or before bedtime; it doesn’t work quickly but lasts longer compared to antacids Pepcid® (famotidine), Zantac 360® (famotidine), Tagamet HB® (cimetidine)
Proton Pump Inhibitors (PPI) The strongest over-the-counter medication that reduces stomach acid more than H2 blockers takes longer to work but provides relief for a longer time. Best for frequent heartburn and taken once a day 30 minutes before breakfast Prilosec OTC® (omeprazole), Nexium 24HR® (esomeprazole), Prevacid 24HR® (lansoprazole)
Which heartburn medication is right for you?
  • For quick relief, use an antacid; it works within minutes but doesn’t last long.
  • For relief that lasts longer, use an H2 blocker; it can last up to 12 hours.
  • For long-lasting relief, use a PPI; it works best when taken daily and may last up to 24 hours.

When to see a doctor: While over-the-counter heartburn medications can be effective for short-term relief of symptoms like heartburn and acid reflux, they are generally intended for temporary use. Without consulting a healthcare professional, these medications should not be used for more than two weeks.

  • You should speak to your doctor if:
    • Acid reflux isn’t being managed by changing habits or taking non-prescription medications
    • Symptoms last over two weeks or have been ongoing for years
    • Symptoms include severe chest pain, pressure, or discomfort with:
      • Breathing trouble, sweating, upset stomach, or cold and clammy skin
      • Pain in your arms, back, or jaw
      • Worse pain with activity like walking up stairs
      • Fast or irregular heartbeat
      • Feeling dizzy, faint, or weak
      • Radiating chest pain
  • Special population considerations:
    • Geriatric: Consult a doctor if symptoms do not resolve within two weeks, as long-term usage without being monitored by a healthcare professional can lead to potential side effects.
    • Pregnancy: if you are pregnant or planning to become pregnant, consult your doctor before starting over-the-counter medications
    • Other considerations: Some antacids contain aspirin, which can increase the risk of internal bleeding. Consult your doctor before taking medications for heartburn treatment if you have underlying health conditions or take medications that increase bleeding risk.

Prepared by Jennifer Niyazova PharmD Candidate 2025

References