Treatment of Heartburn
The treatment of heartburn focuses on relieving symptoms, preventing recurrence, and protecting the oesophagus from long-term damage caused by acid reflux. Most people respond well to a combination of lifestyle changes and medication, while others may require further investigation or even surgical intervention. Since the treatment of heartburn varies based on severity, frequency, and underlying cause, a personalised approach is essential to ensure lasting relief and prevent complications like gastro-oesophageal reflux disease (GORD) or oesophagitis.
The first line of defence involves lifestyle modification, which can significantly reduce both the frequency and intensity of symptoms. Patients are encouraged to:
Eat smaller meals: Large meals increase stomach pressure and promote reflux. Consuming modest portions spaced throughout the day reduces this risk.
Avoid known trigger foods: These include spicy dishes, acidic items (like tomatoes and citrus), fatty or fried foods, chocolate, peppermint, caffeine, and alcohol. Identifying personal triggers through food diaries can help tailor dietary choices.
Refrain from eating close to bedtime: Lying down shortly after eating makes it easier for stomach contents to flow back into the oesophagus. A minimum two- to three-hour gap between dinner and lying down is advised.
Elevate the head of the bed: Raising the head of the bed by 15–20 cm with blocks or wedges (not extra pillows) uses gravity to prevent night-time reflux.
Lose Excess Weight:
Lose excess weight: Obesity, particularly central adiposity, places pressure on the abdomen and weakens the lower oesophageal sphincter (LES). Even modest weight loss can result in marked symptom improvement.
Stop smoking: Nicotine reduces LES tone and impairs oesophageal function, increasing acid exposure.
Wear loose-fitting clothing: Tight garments around the waist or abdomen can increase intra-abdominal pressure and trigger reflux.
In addition to lifestyle adjustments, medication plays a key role in the treatment of heartburn. Over-the-counter and prescription drugs are available to neutralise acid, reduce its production, or protect the oesophageal lining.
Antacids (e.g., Gaviscon, Rennie, Maalox): These work quickly by neutralising stomach acid and are ideal for mild or occasional symptoms. Some antacids also form a protective barrier over the stomach contents to reduce reflux.
H2-receptor antagonists (e.g., ranitidine*, famotidine): These reduce acid production in the stomach. They are effective for more persistent symptoms and provide longer-lasting relief than antacids. (*Note: Ranitidine has been withdrawn in many countries due to safety concerns.)
Proton Pump Inhibitors (PPIs)
Proton Pump Inhibitors (PPIs) — such as omeprazole, esomeprazole, and lansoprazole — are the strongest medicines for reducing stomach acid. Doctors often prescribe them for people with frequent or severe heartburn. PPIs help heal the oesophagus when it becomes inflamed and are usually taken once a day before breakfast. While PPIs are generally safe, it’s important to use them under medical supervision. Long-term use can lead to side effects, including lower calcium and vitamin B12 levels, as well as a higher risk of certain infections. Therefore, regular check-ups are helpful for anyone taking PPIs over a long period.
Prokinetic agents—such as domperidone and metoclopramide—help the stomach empty faster and improve how the oesophagus moves food. Doctors use them in certain cases, especially when someone has delayed stomach emptying. However, these medicines are not prescribed as often because they can cause side effects. Even so, they may still be helpful for some people when used carefully.
Patients whose symptoms improve with medication but return after stopping may need to continue maintenance therapy or use an “on-demand” approach—taking medication only when symptoms flare up. However, those who do not respond adequately to treatment, or who relapse frequently, may require further evaluation to rule out complications or alternative diagnoses.
Surgical options are available for patients with severe or refractory heartburn who prefer not to rely on long-term medication or who experience side effects. The most common procedure is laparoscopic fundoplication, in which the upper part of the stomach is wrapped around the LES to strengthen it and prevent reflux. This minimally invasive surgery has a good success rate, although side effects like bloating, difficulty belching, or gas discomfort may occur in some individuals.
Treatment of Heartburn
Newer, less invasive interventions include magnetic sphincter augmentation (LINX device), which uses a ring of magnetic beads to reinforce the LES, and endoscopic procedures that aim to tighten the junction between the stomach and oesophagus. These options are generally reserved for selected patients who meet specific criteria and are managed by specialist gastroenterologists or surgeons.
The first step is usually making changes to daily habits. This includes adjusting the diet, eating smaller meals, avoiding trigger foods, and staying upright after eating. Sleeping with the head raised can also help reduce symptoms. If these changes aren’t enough, doctors may recommend antacids that don’t have aluminum or large amounts of sodium, as these are generally safe during pregnancy. In more severe cases, H2 blockers or PPIs may be used—but only with a doctor’s guidance. As a result, most pregnant individuals can find relief safely with the right approach.
Doctors usually take a gentle approach when treating reflux in babies and young children. For older kids, changing the diet and teaching good habits—like staying upright after eating—can also help. If symptoms become severe or start to affect growth, doctors may add medication to the treatment plan.
It is important to emphasise that self-medication without a clear diagnosis can sometimes delay appropriate treatment or mask more serious conditions, such as peptic ulcers or even gastrointestinal cancer. Persistent heartburn—especially when accompanied by red flag symptoms like unintentional weight loss, difficulty swallowing, vomiting blood, or black stools—warrants further evaluation, typically starting with an upper endoscopy.
Treatment of Heartburn
In conclusion, the treatment of heartburn is multifaceted, ranging from lifestyle changes and pharmacological therapy to surgical intervention in select cases. With proper management and individualised care, most people can achieve significant symptom relief and improve their quality of life. The key lies in identifying triggers, responding promptly to symptom changes, and seeking medical advice when symptoms persist or worsen.
