The best ways to manage heartburn

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Q. I have about three episodes of heartburn per month and it often lasts all day. What do you suggest?

A. Heartburn is caused by stomach acid moving up and out of the stomach and into the lower part of the esophagus. Reducing the overall acidity in the stomach protects the esophagus from irritation when the stomach contents back up (reflux).

The fastest treatment is to neutralize the acid already in the stomach and lower esophagus by taking an over-the-counter antacid. While antacids work within minutes, they often don't last, so you may have to take repeated doses until symptoms subside.

For longer-lasting relief, you can try an H2 blocker, which stops stomach cells from making acid. There are several over-the-counter brands of H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). Generic versions also are available. H2 blockers come as a pill, liquid, or chewable or effervescent tablet. Most people react well to all of them.

H2 blockers begin to act within an hour and last for another 10 to 12 hours. (If you still need the occasional antacid, wait 30 to 60 minutes after taking one before adding an H2 blocker.) Proton-pump inhibitors are even stronger acid blockers. Over-the-counter brands include lansoprazole (Prevacid 24HR), omeprazole (Losec, Omesec, Prilosec OTC), and omeprazole with sodium bicarbonate (Zegerid). If your heartburn doesn't respond to these drugs or lasts for more than 10 days, see your doctor.

— by Howard LeWine, M.D.
Editor in Chief, Harvard Men's Health Watch