Frequent Heartburn: Finding the Summertime Solution for You

Each year, many of my patients look forward to the rituals of summer: long-awaited vacations, 4th of July barbecues, and outdoor activities with family. It’s also a time when many of my adult patients enjoy some of the season’s unique foods and drinks, which aren’t always the healthiest (spicy barbecue, salsa, fries, funnel cakes, summer cocktails and… beer, anyone?). As much as we all love some summertime indulgences, our bodies don’t always love the potential consequences—such as heartburn.

More than 1 in 4 adults experience heartburn at least once a week.[1] If you’re in this camp, you know that heartburn can be a miserable experience: the burning sensation in your chest or throat starts just after finishing a meal and can last for hours afterwards. Sometimes heart issues can mimic heartburn, so it is important to seek medical care for chest discomfort that you suspect may be heart-related, or for heartburn symptoms that persist despite taking antacids. Heartburn can happen year-round, and food certainly isn’t the only cause. But often in these summer months, patients come to me seeking advice on how best to treat their heartburn symptoms.

Lifestyle considerations, like maintaining a healthy weight, not smoking and diet modification, are an important first step in helping to manage heartburn symptoms. Further treatment for heartburn symptoms can be confusing because there are so many options available—both in the forms of over-the-counter (OTC) and prescription (Rx) medicines taken under medical supervision. Different treatments can have distinctive mechanisms of action. No matter how your heartburn symptoms manifest, there are unique solutions to help you treat them.

If you’re struggling with heartburn occasionally, antacids (such as Alka-Seltzer®, Mylanta® or TUMS®) can be helpful. If you are suffering from heartburn two or more days a week, however, it’s considered to be “frequent heartburn,” which may require a different treatment approach for relief.[2] Many of my patients experiencing frequent heartburn often seek relief in the OTC aisle of the drug store—specifically to look for OTC proton pump inhibitors (PPIs), which help relieve heartburn symptoms by blocking special “pumps” that produce acid.

PPIs come in both Rx and OTC form, and OTC PPIs are the only OTC medicine indicated to treat symptoms of frequent heartburn. You might recognize them by their brand names, such as Nexium®24HR, Prevacid®24HR, Prilosec OTC®, Zegrid OTC®, or store brands of generics such as omeprazole, lansoprazole or esomeprazole. PPIs work by decreasing the amount of acid in the stomach, and you may repeat a 14-day course of the OTC forms every four months, unless directed by a healthcare provider.

The instructions for OTC PPIs are different compared to those for Rx PPIs, and it’s an important distinction that some patients don’t always know. Rx PPIs are used to treat more serious cases like chronic heartburn, gastroesophageal reflux disease (GERD), and a number of other gastrointestinal conditions. They are also prescribed at higher doses than OTC forms and are used for longer periods of time—but should only be taken under medical supervision.

PPIs are safe and effective when used as directed, but it is very important to seek professional medical care if your symptoms require taking PPIs more frequently than the labeling instructs, to ensure that the proper diagnosis is made and treatment is taken for your condition. While recent studies have shown a number of adverse effects associated with PPIs, it is important to note that an international clinical trial was published in June 2019 confirming the safety of PPIs when taken as directed.[3]

Given how common heartburn is and the many treatment options available, it’s no wonder patients can be confused. Heartburn is one of the most common reasons people visit their healthcare provider, as well as one of the most common conditions discussed with pharmacists. The CHPA Educational Foundation has created a helpful digestive health resource on their website, www.KnowYourOTCs.org, which is a good place to begin learning about heartburn. But it’s also helpful to talk with your healthcare provider or pharmacist to find the right treatment option for you, so you—and your digestive system—can enjoy all that summer has to offer.

References:

[1] Michael Camilleri et al., “Prevalence and Socioeconomic Impact of Upper Gastrointestinal Disorders in the United States: Results of the US Upper Gastrointestinal Study.” Clinical Gastroenterology and Hepatology 3, no. 6 (June 2005): 543–552, https://doi.org/10.1016/S1542-3565(05)00153-9.

[2] “Acid Reflux: Overview,” American College of Gastroenterology, accessed April 16, 2019, https://gi.org/topics/acid-reflux/.

[3] Paul Moayyedi et al., “Safety of Proton Pump Inhibitors Based on a Large, Multi-year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin.” Gastroenterology (May 2019): https://doi.org/10.1053/j.gastro.2019.05.056.

Dr. Richard L. Gelfand

Meet Our Experts

Dr. Richard L. Gelfand

Dr. Richard Gelfand is a board-certified gastroenterologist practicing in the Bethesda and Chevy Chase, Maryland area as a partner of Capital Digestive Care. He also has academic affiliations with Georgetown University Hospital and George Washington University Hospital, and he is on staff at Johns Hopkins Medicine Suburban Hospital.