Cooling off heartburn

At some point, everyone experiences heartburn — that deep, painful burning sensation in the chest that can be so intense it's mistaken for a heart attack. Heartburn (also known as acid reflux) occurs when stomach acid flows backward into the esophagus, the tube connecting the mouth and stomach. It often happens when you eat too quickly or too much, or after you eat rich, spicy, or acidic foods.

Heartburn usually goes away on its own, but sometimes you need an over-the-counter remedy to get relief. For more severe and ongoing heartburn, you might need stronger medication. Which should you use, and when? Here's a breakdown.

Occasional heartburn

For now-and-then heartburn, use antacids. They quickly neutralize digestive acids in the stomach and esophagus. "They work well for people with mild, occasional heartburn and provide immediate relief," says Dr. Andrew T. Chan, a gastroenterologist at Harvard-affiliated Massachusetts General Hospital.

Liquid antacids provide faster relief, but many people find tablets more convenient. There are three categories of over-the-counter antacids: magnesium-based (Maalox, Mylanta), aluminum-based (Amphojel), and calcium-based (Tums, Rolaids). "There aren't data to support whether one works better than the others," says Dr. Chan.

Other products, like Gaviscon, contain both aluminum and magnesium. The combination of ingredients creates a foam layer when ingested, which floats to the top of the stomach to help block acid reflux. Another option is a seltzer (Alka-Seltzer), which has sodium bicarbonate (baking soda) as the active ingredient. "These are the least powerful antacids," says Dr. Chan. They contain high levels of sodium, so do not take them if you are on a salt-restricted diet or have heart failure, high blood pressure, or kidney problems.

Recurring heartburn

If heartburn strikes many times a week, symptoms become more severe, or antacids don't work, you can try an over-the-counter H2 blocker. These work by blocking histamine, a chemical that signals the stomach to produce acid. ComBrands include famotidine (Pepcid) and cimetidine (Tagamet).

H2 blockers are taken twice a day for one to two weeks. People whose heartburn is troublesome only at night often need only a single dose taken in the evening or at bedtime. "H2 blockers are fine to take in the short term, but check with your doctor if you need to continue taking one after a few weeks," says Dr. Chan. "They can prescribe a stronger H2 blocker if needed." Also consult your doctor before taking an H2 blocker if you take a blood thinner, antidepressant, or blood pressure medication.

Persistent heartburn

If symptoms become intense or linger longer than two to three weeks despite taking an H2 blocker, you should consult your doctor. "Persistent heartburn is caused by gastroesophageal reflux disease, or GERD," says Dr. Chan. If you are diagnosed with GERD, your doctor will probably recommend a proton-pump inhibitor (PPI), the strongest stomach acid inhibitor medication.

PPIs — such as omeprazole (Prilosec), lansoprazole (Prevacid), and esomeprazole (Nexium) — inhibit certain cells from "pumping" acid into the stomach, which lowers acid levels and reduces heartburn pain. PPIs are available over the counter or by prescription and are usually taken once daily.

"While both nonprescription and prescription PPIs work basically the same, your doctor will advise you on which one you need," says Dr. Chan. Long-term treatment with a PPI is often necessary, as heartburn usually returns when treatment ends. However, once your heartburn is under control, you may continue with a lower-dose PPI or switch to an H2 blocker.

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