3 Reasons Why Your Heartburn Medicine Isn’t Working

If you have heartburn, also known as acid reflux, relief can be as simple as trying proton pump inhibitors (PPIs). These medicines prevent your body from making stomach acid—and therefore prevent stomach acid from backing up into your esophagus and causing pain. Some PPI brand names include Nexium, Prevacid, Prilosec, and Protonix.

PPIs do not completely stop your body from producing acid. Having some acid is helpful⁠—stomach acid plays a key role in sanitizing the digestive tract and in killing off the bacteria that produce nitrosamines, a chemical compound that has been associated with an increased risk of gastric cancer.

So a little stomach acid is good for you; too much, however, can be painful. You can try managing your reflux symptoms by changing your diet and trying PPIs.

But PPIs don't work for everyone. Even if PPIs work well, you can still have "breakthrough" symptoms from time to time. According to a 2019 study, over 54% of Americans who took PPIs daily still experienced symptoms.

Why Your Heartburn Drugs Aren't Working

For some people, PPIs can provide relief of acid reflux symptoms, treat stomach ulcers, or treat damage to the esophagus. But PPIs might not work for everyone. That may be because you don't actually have acid reflux, your diet is causing heartburn, or you're taking your PPIs incorrectly. Find out why heartburn medications might not work for you—and what to do about it.

You Don't Have Acid Reflux

One reason PPIs aren't curing your heartburn could be because you were misdiagnosed, Joel Richter, MD, director of the University of South Florida School of Medicine Division of Digestive Diseases and Nutrition, told Health.

PPIs treat gastroesophageal reflux disease (GERD), a condition where people have persistent acid reflux—when stomach contents leak back into the esophagus and cause irritation. However, other conditions can also cause heartburn symptoms:

• Achalasia (when the esophagus cannot push food to the stomach)
• Eosinophilic esophagitis (when white blood cells build up in the esophagus)
• Other types of inflammation of the esophagus
• Non-acidic reflux in the esophagus

Additionally, heart disease can feel similar to heartburn. Since the esophagus and the heart are located near each other, it may be difficult to distinguish between heartburn and chest pain.

"There is a big group of people who get put on these medications and don't get better, and most of the time, it's because they don't have an acid-related problem," Dr. Richter said.

If you want to test whether your symptoms are due to reflux or another condition, follow up with your healthcare provider. They may recommend a 24-hour pH impedance test. This test measures the stomach acid levels in your esophagus and monitors the movement of fluid and gas along your esophagus. This combination can help determine whether you have acid reflux, non-acidic reflux, or another condition.

Your Diet Causes Heartburn

However, even if you have GERD, PPIs might not work well for you if you eat foods that trigger your reflux. Certain foods can trigger breakthrough symptoms like:

• Acidic foods (citrus fruits and tomatoes)
• Alcoholic drinks
• Chocolate
• Caffeine
• High-fat foods
• Mint
• Spicy foods

Eating meals at least three hours before laying down or sleeping can also trigger symptoms.

You Take PPIs Incorrectly

In many cases, people have breakthrough symptoms because they are not taking their medication correctly or at the best times.

PPIs should be taken 30 minutes before you eat the first meal of the day. If you are prescribed medications by a healthcare provider be sure to:

• Take your medications as you are told to by a healthcare provider
• Take your medications at the same time each day
• Don't stop taking your medication, unless you are instructed to do so by your healthcare provider

For most people, a single daily dose of PPI is enough to treat GERD symptoms but some people may need to take PPIs twice daily to effectively treat symptoms. Be sure to contact your healthcare provider before upping your dosage.

Tips for Managing GERD

If PPIs do not work well for you, talk to your healthcare provider about trying other anti-reflux medicines. At the same time, you can make some lifestyle changes to prevent and minimize your breakthrough symptoms.

Take Your Medication as Prescribed

If you don't know how and when to take it, call your healthcare provider for specific instructions.

Don't Sleep With a Full Stomach

Since lying down within three to four hours of consuming a meal, particularly a late-evening feast, could spell trouble, it's best to avoid sleeping with a full stomach. If you go to bed around the same time every night, try to each at least three hours before then and avoid any late night snacking.

"My big push is to keep the patients away from late eating, large meals, and recumbency (laying down)," said David A. Johnson, MD, the chief of gastroenterology at Eastern Virginia Medical School and former president of the American College of Gastroenterology. Such a triple threat may cause too much of a burden on the body, one that even PPIs can't treat.

Elevate Your Head

For nighttime symptoms (especially regurgitation of fluid back into the esophagus or mouth), you should consider elevating your head while you sleep. You can try raising the head of your bed with some blocks or placing a foam wedge (or extra pillows) under your head and upper back to elevate yourself. Try to raise your head six to eight inches.

Manage Your Weight

Research shows that weight loss is linked to fewer reflux symptoms. "A reduction of even 2.5 pounds may be enough for some patients to decrease or eliminate their reflux symptoms," Dr. Johnson added.

Try an Over-the-Counter Drug

Drugs like H2 blockers (which lower the amount of acid your stomach makes) and antacids (help to relieve mild symptoms) are very effective in managing heartburn. However, these medicines aren't meant to be taken daily. Antacids can cause side effects like diarrhea or constipation.

"What I suggest to my patients is that they take an over-the-counter H2 blocker when they have their breakthrough symptoms," Dr. Richter said. "That seems to give them better control."

Recognize the Foods That Trigger Your Reflux

If jalapeños or onions always get the better of you, consider skipping those items. Pay attention to the foods you eat before you notice acid reflux symptoms. It may be helpful to keep a food diary, or a document of the foods you eat everyday.

If you plan to eat foods that cause reflux, try taking an H2 blocker an hour before you eat, this may help prevent your symptoms.

A Quick Review

Symptoms of GERD can be treated with medication and lifestyle changes. GERD is most often treated with PPIs which reduce the amount of acid in the stomach. But PPIs are not effective for everyone. This may be because you have been misdiagnosed with GERD, your diet is causing symptoms, or you are taking your medication incorrectly.

If PPIs aren't treating your symptoms, work with your healthcare provider to figure out why they aren't working and what alternative treatments you can try.