Three types of medications are approved for symptoms of heartburn – antacids, H2-blockers and proton pump inhibitors. Everyone knows antacids – Tums, Rolaids, Mylanta, and Maalox. Antacids work immediately to neutralize any acid which has refluxed up from the stomach into the esophagus causing symptoms. They are best for patients who infrequently have symptoms and need instant relief when symptoms occur (i.e. after a big plate of spaghetti with red sauce). The other medications on the market do not work as quickly as antacids, but are much more potent as they block the production and secretion of acid by the stomach. Zantac, Pepcid, and Axid are H2-blockers.These medications inhibit one of the three signaling systems which trigger the stomach to produce acid. With some of the triggering mechanism blocked, the stomach does not make as much acid as it typically would and thus symptoms are lessened. These medications work great if taken a few hours before eating and will last up to 6 hours or so. Finally, proton pump inhibitors (PPI) are the strongest acid medications as they actually block the acid pump in the cells of the stomach. Prilosec, Nexium, Protonix, Aciphex, Prevacid, and Dexilant are some brand names, and these medications truly raise the pH in the stomach by preventing acid from being produced. These medications work for 12-24 hours, but they take a few days to reach optimal levels.
Beyond medications, diet is the most important treatment, though many consider this to be too cumbersome. Avoiding particular foods and changing eating habits is critical. Foods which classically trigger reflux / heartburn include: chocolate, coffee, tea, red sauces from tomatoes, spicy foods, red wine, and peppermints. Avoiding lying down within hours of the last meal and sleeping with a wedge beneath your head will help decrease nighttime symptoms. Finally, weight loss is also helpful in controlling symptoms.