Choosing Over-the-Counter Medicine for Acid Reflux

The ones you prefer may not always solve your acid reflux complaints.

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Do you have heartburn from acid reflux that just won't quit? You may have gastroesophageal reflux disease (GERD), a condition in which stomach acid routinely backs up into the esophagus. The most obvious and painful symptom of GERD is heartburn.

It's easy to grab over-the-counter heartburn remedies at a drugstore, and these are often the first line of defense against GERD. But a glance down the pharmacy aisle shows a vast array of choices, including Tums, Rolaids, and Pepcid, to name just a few. You may be left wondering which product will provide the best results.

A better understanding of your heartburn triggers can help you sort through the clutter and choose the right GERD remedy, said Robynne Chutkan, MD, the founder of the Digestive Center for Women in Chevy Chase, MD.

Here's a run-down of the three main categories of over-the-counter heartburn treatment, each with its own advantages and disadvantages.

Antacids

The best-known class of drugs for curbing heartburn are the antacids—including Tums, Rolaids, and Mylanta. Antacids, which contain the salt form of minerals such as magnesium or compounds such as calcium carbonate, curb heartburn by neutralizing acids in the stomach. Some antacids are also a supplemental source of calcium.

Antacids are fast-acting; they relieve reflux symptoms, especially heartburn, right away. "If you had corned beef and fries or if you overdid it at dinner and are having symptoms of heartburn, antacids are appropriate. Antacids make more sense for discretionary use and rare episodes of heartburn," said Dr. Chutkan.

Standard antacids such as Mylanta are also relatively safe, said Mitchell Cappell, MD, chief of gastroenterology at Beaumont Hospital in Royal Oak, MI. Although some people who use them may experience diarrhea and constipation, "there are not many side effects and you can take them long-term. But you have to take a lot of antacids because they are not as powerful as other heartburn remedies."

So, how long is it safe to take an antacid? Dr. Cappell said he doesn't worry so much about toxicity in patients taking antacids long term but is "concerned about patients munching them all the time because they may be suffering from more severe reflux and need a more potent therapy."

Jonathan Schreiber, MD, a gastroenterologist at Mercy Medical Center in Baltimore summed it up like this: "If your heartburn is brief and related to something you ate, an antacid is fine. It will work quickly and there is little downside, but the negative is that an hour later it's gone from your system. An antacid is not a good choice for a recurring problem.

Although they do suppress acid and will make you feel better faster, antacids do not heal the lining of the esophagus. The acid churned out by the stomach can erode the lining of the esophagus over time, which could cause Barrett's esophagus, a precancerous condition that can lead to esophageal cancer.

Histamine 2 blockers

Another class of heartburn drug that you can buy over the counter is a histamine 2 (H2) blocker. Stronger than antacids and more long-lasting, these remedies reduce the amount of acid the stomach produces by blocking histamine, an organic compound that is released when your body encounters an allergen. There are prescription and nonprescription H2 blockers. In the drugstore, you can find Tagamet-HB, Pepcid-AC, and Zantac 360, which has been reformulated to include famotidine (a type of H2 blocker).

"These drugs have been around since the 1970s and appear to be relatively safe," said Dr. Cappell. They can also be used for up to two weeks for short-term relief of heartburn.

"They are also preventive in that they block acid production in the first place," said Dr. Schreiber. What does that mean for your heartburn? If you take an H2 blocker, it works for eight to 12 hours. "Some people take these medications twice daily and they can be helpful for mild reflux or heartburn."

Side effects may include headache, dizziness, diarrhea, constipation, nausea, and vomiting. Additionally, H2 blockers help heal the esophageal lining to some extent.

Proton pump inhibitors

PPIs, which have been available in the United States since 1989, block an acid-producing enzyme in the lining of the stomach. These drugs also help heal the lining of the esophagus and do so more effectively than H2 blockers. As of March 2021, the US Food and Drug Administration (FDA) named Prevacid 24HR, Nexium 24HR, Prilosec OTC, and Zegerid OTC as over-the-counter options for heartburn.

Unlike antacids, PPIs take time to work, said Dr. Chutkan. Some people may not feel better until 24 hours or more after taking them, and that's a lot to ask of someone who feels like their chest is on fire. Side effects may include diarrhea or stomach pain.

"PPIs as a group are very effective and safe, but they don't work very quickly," said Dr. Schreiber. "Someone who has heartburn now is probably better off with an H2 blocker or even using an antacid."

Just how effective are PPIs? The best objective measure of the effectiveness of a heartburn remedy is its ability to reverse erosive esophagitis, a condition in which the lining of the esophagus is visibly irritated or injured. To diagnose this condition, a thin, flexible tube outfitted with a camera is passed into the mouth and down the esophagus.

Studies have shown that roughly 85% of people with erosive esophagitis are healed when they take a PPI, according to Dr. Schreiber. Furthermore, an April 2022 study published in Neurogastroenterology & Motility found that the success rate range of alleviating reflux symptoms for PPI groups was 34.4% to 80.8%, compared to the success rate range for placebo groups, which was 10.4% to 51.7%.

When to see a healthcare provider

Treating heartburn that comes with acid reflux involves more than just taking a pill or munching on antacids. These medications work in tandem with lifestyle changes such as cutting out caffeine; consuming smaller, more frequent meals; quitting smoking; and avoiding alcohol, a known heartburn trigger.

"You can't expect a pill to work if you are drinking eight cups of coffee and smoking two packs a day," said Dr. Chutkan. Other tips that may help extinguish heartburn include not eating after 7 p.m. and propping your head up while you sleep.

Caffeine relaxes the lower esophageal sphincter, a circular muscle that creates a valve between the esophagus and the stomach. Think of the muscle as a door. "When the door is shut, no acid comes back up. But when the door opens, the acid backs up from stomach to food pipe," said Dr. Cappell. "Caffeine, smoking, and alcohol all tend to make reflux more severe, and they may act by opening this door."

If you have classic acid reflux or heartburn such as a pain in the chest with frequent burping or nausea, it's OK to try over-the-counter remedies—especially if it occurs after a large, fatty meal or late at night, said Dr. Chutkan. Steer clear of the over-the-counter aisle and head straight to your health care provider if you have any of these red flags: pain or difficulty swallowing, vomiting, unexplained weight loss, or persistent abdominal pain.

Also, call your doctor whenever your symptoms change in character. If you used to have heartburn, but now food feels like it is stuck in your chest, for example, it might be time to seek medical attention.

"If you have very occasional reflux symptoms——and who doesn't?——it may be reasonable to take over-the-counter medication. But if you are getting it regularly, if it's severe, or if the medication that you took before stops working, definitely see a doctor, and preferably a gastroenterologist," said Dr. Cappell. "The symptoms may be due to another condition, to severe reflux that requires more powerful medicines, or to complications of reflux that require further medical evaluation and treatment."

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