There are several options to treat heartburn. Dreamstime/TNS

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Q: I get heartburn about once or twice a week. What’s the best approach to get fast relief?

A: Heartburn is caused by stomach acid moving up out of the stomach into the lower part of the esophagus. Reducing the overall acidity protects the esophagus from burning or irritation when the stomach contents back up or “reflux.”

The fastest treatment is to neutralize the acid already in the stomach and lower esophagus by taking an antacid. You can usually feel relief within minutes.

There are many varieties of antacids with different active ingredients, such as calcium carbonate, magnesium hydroxide and aluminum carbonate.

Magnesium containing products may cause loose stools, while aluminum may be constipating. That’s why many antacids contain a combination of magnesium and aluminum.

Antacids work quickly, but symptom relief often doesn’t last. If that happens, you could repeat the antacid.

But I would suggest following the antacid with an H2 blocker. H2 blockers work by inhibiting stomach cells from making acid.

There are several different H2 blockers, such as cimetidine (Tagamet), famotidine (Pepcid) and nizatidine (Axid AR). There are generic versions available at quite reasonable prices.

Some H2 blockers are marketed as faster acting. Rather than a swallowed pill, the product containing the H2 blocker might be in liquid form. Or it could be a chewable or effervescent tablet.

For most people, the onset of symptom relief is similar for all of them. But you may find a particular preparation that works best for you.

Ideally you should not take an H2 blocker at the same time you take an antacid. Wait for 30 to 60 minutes. The H2 blocker starts to act within an hour.

Generally, the medicine keeps working for another 10 to 12 hours. So, you might need to take another dose later on.

The strongest stomach acid inhibitors are called proton pump inhibitors (PPIs). They start acting the day you take the first pill. But it may be many hours before you get relief. And the maximal benefit might take two to three days.

So PPIs are better suited for people with more frequent heartburn than you have.

Help without drugs

To help prevent acid reflux, five pill-free approaches may significantly reduce both the number and severity of heartburn episodes.

According to research results published last year in JAMA Internal Medicine, they include maintaining a healthy body weight; not smoking; getting 30 minutes daily of moderate-to-vigorous physical activity; limiting coffee, tea and soda to no more than two cups per day; and eating a healthy diet.

Each one of these factors may prevent the inappropriate relaxation of the sphincter muscle between the stomach and the esophagus, helping to keep acid from refluxing up and causing heartburn.

Howard LeWine, M.D. is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, visit health.harvard.edu.

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