Heartburn Medication Update

Overview

Heartburn is a burning feeling that rises from your stomach up behind your breastbone. It happens when stomach acid splashes back up into your food pipe (the oesophagus, the tube that carries food from your mouth to your stomach). This 'medication update' page explains the latest thinking about the medicines used to treat heartburn. In recent years, some heartburn medicines have been reviewed, recalled or withdrawn from sale because of safety concerns, and advice about using acid-reducing medicines long term has been updated. This page explains what has changed, what it may mean for you, and what to do next.

Yes. Heartburn is one of the most common stomach-related complaints worldwide. Around 1 in 5 adults in many countries get it at least once a week, and many more have it now and then. It is one of the reasons people most often ask a pharmacist for help.

Anyone can get heartburn, including children and babies with reflux. It is more common in adults over 40, in people who are overweight, in pregnant women, and in people who smoke or eat large meals late at night. It affects men and women about equally.

Symptoms

Common symptoms

• A burning feeling behind the breastbone, often after eating or lying down
• A sour or bitter taste in the back of the mouth
• A hot, acid feeling rising from the stomach into the throat
• Burping and bloating after meals
• A feeling of a lump in the throat or food sticking
• A dry cough or hoarse voice, especially at night
• Symptoms getting worse when you bend over or lie flat

Symptoms in children

• Frequent spitting up or vomiting after feeds in babies (some reflux is normal in babies under 1 year)
• Fussiness or crying during and after feeds
• Poor weight gain or refusing feeds
• A persistent cough or wheeze
• In older children: a burning feeling in the chest, a sour taste, or tummy pain after meals
• Children may find it hard to describe the burning, so watch for patterns after eating or at bedtime

Symptoms in older adults

• Symptoms may be less typical or milder, such as a cough, hoarse voice, sore throat or feeling full quickly
• Chest pain or discomfort that is easy to mistake for a heart problem — always get new chest pain checked
• Symptoms may be put down to 'just age', so it is worth mentioning them to your doctor
• More chance of medicines interacting, so a pharmacist review is helpful

Causes

Main causes

• The valve at the top of the stomach (the sphincter, a ring of muscle) relaxing when it should stay closed, letting acid escape upwards
• Large meals, especially fatty or spicy food, stretching the stomach
• Lying down or bending soon after eating
• Pressure on the stomach from extra weight or from pregnancy
• A hiatus hernia (when part of the stomach pushes up through the diaphragm, the muscle sheet that separates chest from tummy)
• Some medicines, such as certain painkillers and blood pressure tablets — ask your pharmacist if you are unsure
• Smoking, alcohol, coffee and fizzy drinks in some people
• Stress and poor sleep can make symptoms feel worse

Risk factors

• Being overweight or having a lot of fat around the middle
• Pregnancy
• Smoking or vaping
• Eating late at night or eating very large meals
• Wearing tight belts or clothing around the waist
• Taking certain medicines long term
• A family history of reflux or a hiatus hernia
• Hiatus hernia

When to see a doctor

See a doctor urgently if:

• You have chest pain — call your local emergency number if it is severe, comes with sweating or breathlessness, or spreads to your arm or jaw
• You are vomiting blood or passing black stools
• You find it hard to swallow or food feels stuck
• You are losing weight without trying
• Your heartburn is new and you are over 55
• Symptoms are getting worse quickly or you feel very unwell

Book a routine appointment if:

• You have heartburn more than twice a week
• You need heartburn medicine most days
• You have been taking acid-reducing medicine for more than a few weeks and have not had a review
• Pharmacy treatment has not helped after 2 weeks
• You are pregnant or breastfeeding and need advice on what is safe
• You want to check whether a medicine you have at home has been affected by a recent recall or safety review

Diagnosis

Most of the time, a doctor or pharmacist can recognise heartburn from your description of the symptoms and from a short trial of treatment. You do not usually need tests. If symptoms keep coming back, do not improve with treatment, or you have warning signs such as trouble swallowing or weight loss, your doctor may arrange further checks.

Tests that may be done

• A review of your symptoms, medicines and lifestyle — no test needed in many cases
• A short trial of acid-reducing treatment to see whether symptoms improve
• A test for Helicobacter pylori (a common stomach bacterium that can cause ulcers), using a breath or stool sample
• Blood tests to check for anaemia or other causes
• An endoscopy (a thin flexible camera passed through the mouth) if warning signs are present or symptoms do not settle
• A 24-hour acid monitor, where a small tube measures acid in the food pipe, in unclear cases
• A barium swallow X-ray in some situations

What to expect at your appointment

An appointment usually starts with questions about when symptoms happen, what makes them better or worse, and which medicines you take. If you need an endoscopy, you will usually be offered a sedative or throat spray to keep you comfortable, and it takes only a few minutes. Results are often available quickly, and your doctor will explain what they mean and what happens next.

Treatment

Treatment usually starts with simple lifestyle changes and medicines you can buy from a pharmacy. If those are not enough, your doctor can prescribe stronger acid-reducing medicines. Recent updates in this area have focused on three things: making sure any medicine that has been withdrawn is no longer in your cupboard, using the lowest dose that controls your symptoms, and reviewing long-term use regularly so you are not taking more medicine than you need.

Self-care at home

• Eat smaller meals more often rather than one big meal
• Leave 3 hours between your last meal and lying down
• Raise the head of your bed by about 10–15 cm, or sleep propped up on your left side
• Keep a simple diary of foods and drinks that trigger your symptoms, and cut back on those
• Reduce or avoid alcohol, coffee and fizzy drinks if they make it worse
• Stop smoking — this is one of the most effective changes you can make
• Lose some weight if you are above a healthy weight; even a small amount can help
• Wear looser clothing around your waist
• Chew sugar-free gum after meals — it can help clear acid from the food pipe

Medical treatments

Heartburn medicines fall into a few broad groups, and your pharmacist or doctor can explain which suits you. Some work by neutralising acid in the stomach and are used for quick, short-term relief. Others reduce how much acid the stomach makes; these are used for a few weeks at a time, or longer if your doctor advises it. There are also medicines that form a protective floating layer on top of the stomach contents to keep acid down. If you are taking an acid-reducing medicine long term, current advice is to review it with your doctor at least once a year, to see whether you still need it, whether a lower dose would work, and whether it can be stopped slowly. Never stop a prescribed medicine suddenly without checking first — your doctor can help you step down safely. Always tell your pharmacist about all medicines you take, including ones you bought yourself, because some medicines interact. If you have a box at home and are unsure whether it has been affected by a recall, take it to a pharmacy for a free check rather than using it.

When is surgery considered?

Surgery is only considered for a small number of people — for example, when symptoms are severe and stay uncontrolled despite the right treatment, when medicines cause troublesome side effects, or when there is a large hiatus hernia. The operation is called fundoplication; it strengthens the valve at the top of the stomach. It is not a first-line treatment and your specialist team will discuss the benefits and risks with you carefully.

Living with this condition

Living with heartburn is mostly about pattern-spotting. Once you notice which meals, drinks or habits set it off, small changes can make a big difference. Many people find that an earlier, lighter evening meal and a slightly raised pillow solve most of the problem. Keep any medicines in one place and bring them to your pharmacy review so someone can check them all together.

Lifestyle tips

• Plan your evening meal earlier and keep it lighter
• Avoid lying down or doing housework that bends you forward for 3 hours after eating
• Try a food and symptom diary for 2 weeks to spot your triggers
• Cut back on smoking and alcohol
• Manage stress with breathing exercises, walking or whatever helps you unwind
• Keep a repeat prescription list and have it reviewed yearly
• Ask your pharmacist before buying any over-the-counter heartburn remedy, especially if you take other medicines

Diet and exercise

There is no single 'heartburn diet' that suits everyone, but many people do better with smaller portions, less fried and very fatty food, and fewer fizzy drinks. You do not need to cut out whole food groups unless a diary clearly shows a trigger — and if you are thinking of cutting out major food groups, talk to your doctor or a dietitian first so you still get the nutrients you need. Gentle regular activity, like walking, helps with weight and digestion. Avoid vigorous exercise straight after a big meal, and try not to exercise on a very full stomach.

Mental health and emotional wellbeing

Heartburn can wear you down. Broken sleep, a cough at night and the worry of planning meals around symptoms can all affect your mood, and stress in turn can make symptoms feel worse. This is very common and worth mentioning. If low mood, anxiety or worry about your health is affecting your daily life, please talk to your doctor — support is available, and you do not have to cope alone. If you ever feel you cannot cope or have thoughts of harming yourself, contact your local crisis line or emergency services right away.

Prevention

You cannot always prevent heartburn, but you can greatly reduce how often it happens. The biggest wins are eating earlier and lighter in the evening, keeping to a healthy weight, not smoking, and raising the head of your bed if symptoms are worse at night. If a medicine you take is making reflux worse, your doctor may be able to suggest an alternative.

Screening programmes

There is no routine screening test for heartburn. The important thing is to see your doctor if symptoms are new after age 55, keep coming back, or come with warning signs such as trouble swallowing, weight loss, vomiting blood or black stools. People with very long-standing reflux may be offered a check of the food pipe, and your doctor will explain if that applies to you.

Complications

If left untreated

• Oesophagitis — soreness and inflammation of the food pipe, which can sometimes bleed
• Narrowing of the food pipe, which can make swallowing difficult
• Barrett's oesophagus — a change in the lining of the food pipe that a small number of people with long-term reflux develop; it is checked regularly and rarely turns into cancer
• A long-running cough, hoarse voice or disturbed sleep
• Worry and low mood from ongoing symptoms
• Problems caused by taking medicines you no longer need, or by using a medicine that has been withdrawn

Long-term outlook

The outlook is good. Most people manage heartburn well with simple changes and short courses of treatment, and serious problems are uncommon. The recent medication updates are a positive thing — they mean medicines are being checked more closely than ever, and your pharmacist or doctor can help you make sure what you are taking is right for you. If symptoms change or treatment stops working, that is a reason to check in, not to panic.

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