Burning questions: How can heartburn sufferers minimize symptoms?

What is that pain in my throat or my chest? Was it something I ate at dinner? Am I having a heart attack or just an intense bout of heartburn?

Thumbnail of Burning questions: How can heartburn sufferers minimize symptoms?


According to the American College of Gastroenterology, acid indigestion, i.e. heartburn, affects an estimated 60 million Americans each month. If, after going out to eat a burger and fries, the familiar pain of heartburn starts to flare, then situational reflux is likely to blame. While occasional bouts of situational heartburn can be managed using over-the-counter antacids such as Rolaids® or TUMS®, they are not ideal for long-term recurrent bouts of acid. If a person experiences reflux on a regular basis several times a week, or it is accompanied by other symptoms like nausea, vomiting, regurgitation, or bloating. It may be time to schedule an appointment with a reflux specialist to discuss whether or not they are symptoms of GERD.

What are the treatment approaches for GERD?

Left untreated, the overproduction of acid can lead to peptic ulcers and, in severe cases, a pre-cancerous condition called Barrett’s Esophagus. The main treatments recommended for treating GERD are:

  • Lifestyle and dietary changes
  • Medication
  • Surgery

Lifestyle Changes

The first step in minimizing symptoms of GERD is to limit foods that trigger reflux. As reflux can sometimes be delayed in onset, it is valuable to keep a journal of the foods eaten and when symptoms begin. Foods that trigger reflux vary from person to person, but commonly fried foods, coffee, chocolate, spicy foods, carbonated drinks, and peppermint will cause reflux. Once the foods are identified, an elimination diet can be implemented to determine whether or not symptoms improve.

In addition to changing dietary patterns, there are other small day-to-day changes that can be made as well:

  • Don’t go to bed with a full stomach. Avoid lying down for two hours after a meal or drinking soda or other caffeinated beverages. Often, those experiencing GERD have a weak lower esophageal sphincter (LES). Typically, that sphincter would close and prevent acid and stomach contents from traveling backwards from the stomach. However, when the LES isn’t functioning properly, the acid from the stomach rises up into the esophagus and burns the throat and chest. By staying upright, it puts less strain on the LES, assisting in keeping the stomach contents where they belong.
  • For many of the same reasons, eat smaller portions at mealtimes. Consider spreading meals to four or five small meals in lieu of three big meals.
  • Avoid alcohol. Alcohol consumption may increase the symptoms of GERD while also causing damage in the esophagus. In many cases, GERD symptoms improve after removing alcoholic beverages from one’s diet.
  • Consider losing weight. Studies have shown that weight gain and the increase in the size of one’s belly may cause or worsen GERD. The increased risk of GERD is thought to be due to excess belly fat causing pressure on the stomach, or the development of a hiatal hernia that causes the backflow of acid.
  • Just as excess belly fat can cause extra pressure, so can tightly fitted close. Wearing loose fitting clothing can help alleviate some of the discomfort.
  • Many people experience worse heartburn when lying down. Put six-inch blocks under the bedposts at the head of the bed so one’s head and chest are higher than their feet. Don’t try using pillows as a shortcut. That simply changes the angle of the head, potentially making heartburn worse.


Since Omeprazole’s introduction in 1988, Proton-Pump Inhibitors (PPIs) have become the primary course of treatment for gastroesophageal reflux disease, with PPIs being one of the most widely prescribed medications across the world. PPIs have shown efficacy in reducing bothersome symptoms. Additionally, PPI utilization can assist a treating physician in determining if surgery or other procedures will be necessary to eliminate symptoms if PPIs don’t prove successful in eliminating symptoms.

Other medications, such as H-2 blockers like Zantac (ranitidine), are used to block acid producing cells in the stomach. However, in 2020 the FDA issued a recall of all versions due to a potential cancer risk. Recently, the medication was relaunched with a new name (Zantac 360) and a different ingredient (famotidine), which is also the active ingredient for Pepcid.

While there is no doubt that PPIs are capable of managing some of the symptoms of GERD, estimates vary, suggesting between 25% to 70% of patients remain on long-term PPI therapy unnecessarily. When the Washington State Health Care Authority introduced duration and dose limits for PPIs to one tablet/capsule per day for two months during any 12-month period unless chronic medical conditions necessitated their use, they used the following reasoning: “PPIs are commonly prescribed to treat gastroesophageal reflux disease (GERD) or heartburn, and symptoms are generally well controlled after 60 days of PPI therapy, even when cases are more severe. PPIs are known to cause rebound acid reflux when patients try to abruptly discontinue using the PPI. This rebound reflux is often mistaken for continued need of the PPI and has led to overutilization.”

With increasing amount of research suggesting correlations between PPIs and medical conditions such as increased risk of osteoporosis-related fractures, kidney disease, and stroke, not only is this potentially unnecessary long-term prescription of PPIs expensive, but it also inappropriately exposes a significant number of people to the side effects of PPI therapy. Further research still needs to be done to link causation and not just correlation, but anyone taking PPIs should discuss the potential risks of long-term use with their doctor. With the understanding that PPI’s have the potential to cause adverse long-term effects, what other options exist for the treatment of GERD when medication and lifestyle modifications don’t work?


With GERD being one of the most common conditions seen in the adult population, it is not a surprise that all patients aren’t helped by medication and/or lifestyle modifications. A Nissen Fundoplication is a procedure that creates a sphincter at the bottom of the esophagus in an attempt to prevent future acid reflux. Before performing this surgery, the surgeon may order GI x-rays, an esophageal manometry, upper endoscopy or a pH probe, all in an attempt to assess any narrowing of the esophagus. The procedure can be done laparoscopically or as an open procedure, which allows for more range of motion. In both procedures, general anesthesia is used, with the end result being the upper stomach is wrapped around the lower esophagus, creating a new sphincter. Unfortunately, like any surgery, results can’t be guaranteed, and symptom relief does not always last. Some patients can need another surgery after two to three years.

Making a Change

While heartburn is incredibly common, there is not an easily met standard for addressing the problem.  Some suffers might be willing to make every lifestyle modification available to avoid symptoms while others might be willing to keep a steady supply of TUMS® in the car, on the dresser, and at work. For those that find medication is the approach that works best, IPM always recommends plan sponsors keep generic PPIs on their approved formulary. If you are one of the 60 million sufferers, the question becomes, what are you going to do about it?