5 Steps to Take If Heartburn Won't Quit

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 When acid reflux persists

By Karen Pallarito
Proton pump inhibitors, or PPIs, curb stomach acid production, keeping gastric juice from backing up into the esophagus and causing heartburn.

But they don’t always work—sometimes because heartburn has been misdiagnosed. Even when PPIs do work, up to 40% of people can still have breakthrough symptoms from time to time.

Fortunately, there are things you can do to prevent and minimize breakthrough symptoms.

Make sure you're taking medication correctly

If you don’t know how and when to take your meds, call your doctor for specific instructions.

“Typically, the proton pump inhibitors are given 30 to 60 minutes before breakfast,” says David A. Johnson, MD, a professor of medicine and the chief of gastroenterology at Eastern Virginia Medical School, in Norfolk, Va., and past president of the American College of Gastroenterology.
However, some people do better taking two doses a day to stave off nighttime symptoms, he adds.

Don’t hit the sack on a full belly

Lying down within three to four hours of consuming a large meal, particularly a late-evening feast, could spell trouble.

"My big push is to keep the patients away from late eating, large meals, and recumbency," says Dr. Johnson. Such a triple threat may pose too large of an insult on the body, one that even PPIs—the gold standard in GERD treatment—can’t handle.
For nighttime symptoms, Dr. Johnson suggests elevating the head of the bed with blocks or using a bed wedge to elevate the upper torso.

Shed a few pounds

A 2006 study in the New England Journal of Medicine found that overweight and obese women were two to three times as likely as thinner women to have frequent reflux symptoms.

Moderate weight gain, even in normal-weight people, may exacerbate reflux symptoms, according to the survey of more than 10,500 people.

"A reduction of even 2.5 pounds may be enough for some patients to decrease or eliminate their reflux symptoms," Dr. Johnson points out.

Try an over-the-counter drug

Drugs like Tagamet HB, Pepcid AC, Axid AR, and Zantac 75 are very effective in knocking out acid, says Joel Richter, MD, the chair of the department of medicine at Temple University, in Philadelphia.

The paradox is they’re not very effective when taken daily, because people develop a tolerance to the drug, he adds.

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

Know your triggers

If jalapeños or onions always get you, consider skipping them. If you’re going to eat spicy food, taking an H2 blocker an hour or so before may help stop symptoms.

But if you make changes and still have heartburn, get help.

“If people are having residual symptoms several times per week, and certainly if they’re having residual symptoms to the point that it’s interfering with their ability to sleep…or function on a day-to-day basis, they should definitely talk to their physician about it,” says William D. Chey, MD, director of the gastrointestinal physiology laboratory at the University of Michigan Health System, in Ann Arbor.